scholarly journals Reflection on Clinical Decision Science: Substance abuse relapse is not about willpower but is the culmination of psychological and socioeconomic stress

2021 ◽  
Vol 7 (2) ◽  
Author(s):  
Paul A. Steffes
Keyword(s):  
Substance Abuse ◽  
Clinical Decision ◽  
Decision Science ◽  
Socioeconomic Stress

scholarly journals Reflection on Clinical Decision Science: COVID-19, colleagues, confusion, and conversations

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Nathanael R Sanchez ◽  
Katherine S Lee ◽  
Karen Weaver
Keyword(s):  
Decision Making ◽  
Community Hospital ◽  
Treatment Options ◽  
Clinical Decision ◽  
Decision Science

During the COVID-19 pandemic, doctors in a community hospital reflect on their decision-making regarding treatment options for COVID-19. Whether to use hydroxychloroquine is the treatment discussed in most detail.

scholarly journals Assessment and treatment of mood disorders in the context of substance abuse

2015 ◽  
Vol 17 (2) ◽  
pp. 181-190 ◽  
Keyword(s):  
Substance Abuse ◽  
Substance Use ◽  
Mood Disorders ◽  
Substance Use Disorders ◽  
Clinical Decision Making ◽  
Bipolar Disorders ◽  
Clinical Decision ◽  
Public Health Burden ◽  
Substance Dependent ◽  
Treatment Research

Recognition and management of mood symptoms in individuals using alcohol and/or other drugs represent a daily challenge for clinicians in both inpatient and outpatient treatment settings. Diagnosis of underlying mood disorders in the context of ongoing substance abuse requires careful collection of psychiatric history, and is often critical for optimal treatment planning and outcomes. Failure to recognize major depression or bipolar disorders in these patients can result in increased relapse rates, recurrence of mood episodes, and elevated risk of completed suicide. Over the past decade, epidemiologic research has clarified the prevalence of comorbid mood disorders in substance-dependent individuals, overturning previous assumptions that depression in these patients is simply an artifact of intoxication and/or withdrawal, therefore requiring no treatment. However, our understanding of the bidirectional relationships between mood and substance use disorders in terms of their course(s) of illness and prognoses remains limited. Like-wise, strikingly little treatment research exists to guide clinical decision making in co-occurring mood and substance use disorders, given their high prevalence and public health burden. Here we overview what is known and the salient gaps of knowledge where data might enhance diagnosis and treatment of these complicated patients.

scholarly journals Reflection on Clinical Decision Science: Clinical Decision Science suggests different research questions need to be asked related to informed consent

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
John K Geddes
Keyword(s):  
Acute Coronary Syndrome ◽  
Informed Consent ◽  
Clinical Decision ◽  
Research Literature ◽  
Decision Science ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
New Directions ◽  
Research Questions

The author examines the literature relating to informed consent for early cardiac catheterization to treat Non-ST-segment elevation acute coronary syndrome, and considers whether Clinical Decision Science might provide new directions for applying the clinical research literature.

scholarly journals Clinical Decision Science: Proof of concept

2020 ◽  
Vol 6 (2) ◽  
Author(s):  
James Peter Meza ◽  
Nicholus Yee ◽  
Bennett Riddering ◽  
Ali Nasrallah ◽  
Urtė Zableckas
Keyword(s):  
Decision Making ◽  
Family Medicine ◽  
Medical Practice ◽  
Patient Preference ◽  
Cultural Context ◽  
Clinical Decision ◽  
Prescribe Medication ◽  
Decision Science ◽  
Group A ◽  
Group B

Clinical decision science, a newly identified area of scholarship, describes how clinical research is used for a patient, within the context of their unique social conditions. We hypothesize that physicians use sociocultural context as an important input to their decision making. We performed a prospective, randomized, double-blind mixed methods study. Family medicine faculty and residents at a community hospital family medicine residency were included in the study. After academic journal club discussing a primary research paper, physicians were asked if they would prescribe medication for a patient who was similar to the subjects in a research paper. However, social and cultural context was given to the cases. The physicians were block randomized into two groups; Group A was given a case with a patient who had a social and cultural context more conducive to lifestyle modification, while group B had a case more conducive to prescribing medication. Primary outcome was whether or not physicians prescribed medication, allowing for a 2x2 table for analysis. We also asked a free response question regarding the reasoning for their decision and performed qualitative analysis. In group A (n=14), no subjects prescribed medication. In group B (n=18), six subjects prescribed medication. (chi-square statistic with Yates correction 9.95, p=0.001). Thematic analysis in group A showed 22 statements related to medical practice or disease characteristics, and 25 statements related to familial relationships and patient preferences. In group B, subjects who prescribed medication made 30 statements related to medical practice, and 13 statements related to patient preference. Subjects who did not prescribe medication made 10 statements related to medical practice, and 1 statement related to patient preference. This study demonstrates social context of individual patients, together with evidence, affects clinical decision and management. We propose further study into how this affects physician decision making, a scholarly field we call Clinical Decision Science.

The Management of Schizophrenia: Safety, Treatment, and Continuity of Care

CNS Spectrums ◽  
2007 ◽  
Vol 12 (S17) ◽  
pp. 4-4
Author(s):  
John M. Kane
Keyword(s):  
Substance Abuse ◽  
Continuity Of Care ◽  
Negative Symptoms ◽  
Clinical Decision Making ◽  
Symptom Control ◽  
Clinical Decision ◽  
High Rate ◽  
Positive Symptom ◽  
Research Findings ◽  
Treatment Continuity

Schizophrenia affects ~1% of the population and is associated with enormous personal suffering, family distress and burden, and tremendous healthcare and societal costs. Although considerable progress has been made in treating this illness enormous challenges remain.Early detection and treatment are at present a distant goal. There is undue delay between the onset of full-blown psychosis and appropriate diagnosis and treatment. Continuity of care is often spoken about rather than truly implemented. Adverse effects remain a critical challenge, and comorbid medical conditions as well as suicide result in a markedly diminished life expectancy. Substance abuse affects a substantial proportion of patients, creating an impediment to optimum outcome. Nonadherence remains a very common, but inadequately appreciated obstacle to adequate and sustained treatment response and contributes enormously to a high rate of preventable relapse and rehospitalization.The focus of this CNS Spectrums supplement is to address many of these topics in a clinically relevant manner by reviewing the latest research findings in pharmacologic and behavioral treatments, with an emphasis on evaluating appropriate treatment for each patient while considering the host of issues that should inform our clinical decision-making. Historically, a major focus of treatment has been positive symptom control. Though this is clearly important, negative symptoms, cognitive dysfunction, depression, demoralization, and comorbid substance abuse are also critical targets in enhancing functional outcome. Concepts such as remission and recovery are useful metrics to help establish targets and goals for treatment planning and for creating a framework for assessing outcome.

scholarly journals The biopsychosocial model and Clinical Decision Science in the age of Black Lives Matter: A clinical reflection

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Abdul-Rahman M Suleiman ◽  
Samer Ilayan
Keyword(s):  
Blood Pressure ◽  
African American ◽  
Biopsychosocial Model ◽  
African American Youth ◽  
Clinical Decision ◽  
Elevated Blood Pressure ◽  
Decision Science ◽  
Elevated Blood ◽  
Black Lives Matter

The author reflects on the biopsychosocial considerations of elevated blood pressure in teenage African American youth during the era of Black Lives Matter (BLM). Parallels are drawn between Dr. Engel’s biopsychosocial model and clinical decision science.

scholarly journals Does HIV status confer a higher risk of acquiring COVID-19? Using Clinical Decision Science to combat patients’ anxiety

2021 ◽  
Vol 7 (2) ◽  
Author(s):  
Camilo Guzman
Keyword(s):  
Internal Medicine ◽  
Antiretroviral Therapy ◽  
Clinical Decision ◽  
Hiv Positive ◽  
Decision Science ◽  
Hiv Status

A clinical decision report using: del Amo J, Polo R, Moreno S, et al. Incidence and Severity of COVID-19 in HIV-Positive Persons Receiving Antiretroviral Therapy. Annals of Internal Medicine. 2020;173(7):536-541. https://doi.org/10.7326/m20-3689 for a patient with HIV and concerns about COVID-19 for immunocompromised individuals.

Laboratory decision science applied to chemometrics: strategic testing of thyroid function.

1986 ◽  
Vol 32 (9) ◽  
pp. 1707-1713 ◽  
Author(s):  
J R Beck
Keyword(s):  
Decision Analysis ◽  
Thyroid Function ◽  
Clinical Decision ◽  
Economic Feasibility ◽  
Decision Science ◽  
Analysis Method ◽  
Clinical Context ◽  
Effectiveness Analysis ◽  
Clinical Chemical ◽  
Academic Laboratory

Abstract Clinical decision analysis and cost-effectiveness analysis have begun to penetrate academic laboratory medicine. Decision science offers tools by which clinical chemical tests may be evaluated for their medical efficacy and economic feasibility. In the "treat, test, observe" paradigm it provides a framework for placing new laboratory tests in an appropriate clinical context. A general overview of the decision analysis method and the laboratory-oriented model is presented, with an application to the development of strategies for hospital-based testing of thyroid function.

The marriage of clinical trials and clinical decision science

1990 ◽  
Vol 9 (11) ◽  
pp. 1243-1257 ◽  
Author(s):  
Jørgen Hilden ◽  
J. Dik F. Habbema
Keyword(s):  
Clinical Trials ◽  
Clinical Decision ◽  
Decision Science
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