scholarly journals Clinical Decision Making Regarding Benzodiazepine Use in PTSD Treatment

2020 ◽  
Author(s):  
nancy bernardy ◽  
Erin Barnett ◽  
Brian Lund ◽  
Bruce Alexander ◽  
Louise Parker ◽  
...  
Keyword(s):  
Decision Making ◽  
Older Patients ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Structured Interviews ◽  
Treatment Practices ◽  
Medical Centers ◽  
Increased Risk ◽  
Benzodiazepine Use ◽  
Consistent Treatment

i. Rationale, Aims and Objectives: Despite guideline recommendations against their use, clinicians prescribe benzodiazepines for various symptoms to patients with posttraumatic stress disorder (PTSD). Clinicians’ reasons in making these decisions are not fully understood. This qualitative study sought to characterize factors identified by prescribing clinicians in clinical decision making in PTSD regarding the use of benzodiazepines. ii. Methods: The descriptive study involved semi-structured interviews with 26 prescribing clinicians across thirteen VA medical centers. Our overall aim in the study was to explore clinicians’ benzodiazepine practices in veterans with a PTSD diagnosis. We audio-recorded, transcribed, and analyzed the interviews using grounded theory methodology. iii. Results: Facilitators and barriers that contribute to benzodiazepine prescribing to veterans with PTSD included organizational, provider, and patient aspects. Most providers interviewed indicated that they inherited patients already on these medications initiated by other clinicians. These providers, as well as others interviewed, voiced concerns that tapering benzodiazepines may cause more harm than the risks of maintenance, particularly in older patients. Clinicians who noted consistent treatment practices among their hospital colleagues found it easier to decrease both new and maintenance benzodiazepine prescribing. iv. Conclusions: Patients with PTSD at increased risk of harms, such as older patients, are still receiving benzodiazepines suggesting that innovative solutions are now needed to decrease use. Specific protocols for inherited patient caseloads, increased dissemination of effective psychotherapies for symptoms such as insomnia and anxiety and the use of direct to consumer educational materials should help to foster needed culture change and increased evidence-based PTSD practice.

scholarly journals Shared clinical decision-making experiences in nursing: A qualitative study

2021 ◽  
Author(s):  
Fen-Fang Chung ◽  
Shu-Chuan Lin ◽  
Yu-Hsia Lee ◽  
Pao-Yu Wang ◽  
Hon-Yen Wu ◽  
...  
Keyword(s):  
Decision Making ◽  
Nursing Education ◽  
Nursing Staff ◽  
Cultural Sensitivity ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Information Communication ◽  
Structured Interviews ◽  
Clinical Nursing ◽  
Basic Ability

Abstract Background Shared decision making (SDM) is a patient-centred nursing concept that emphasises the autonomy of the patient. It is a co-operative process of exchanging information, communication and response, and treatment decisions made between medical staff and patients. In this study, we explored the experience of clinical nursing staff participating in SDM. Methods We adopted a qualitative research method. Semi-structured interviews were conducted with 21 nurses at a medical centre in northern Taiwan. The data obtained from interview recordings were transferred to verbatim manuscripts. Content analysis was used to analyse and summarise the data. Results Clinical nursing staff should have basic professional skills, communication and response skills, respect and cultural sensitivity, the ability to form a co-operative team, the ability to search for and integrate empirical data, and the basic ability to edit media to participate in SDM. Conclusions The results of this study describe the experiences of clinical nursing staff participating in SDM, which can be used as a reference for nursing education and nursing administrative supervisors to plan and enhance professional nursing SDM in nursing education.

Using the Outcome Prioritization Tool (OPT) to assess the preferences of older patients in clinical decision-making: A review

Maturitas ◽  
2019 ◽  
Vol 128 ◽  
pp. 49-52 ◽  
Author(s):  
Mariken E. Stegmann ◽  
Suzanne Festen ◽  
Daan Brandenbarg ◽  
Jan Schuling ◽  
Barbara van Leeuwen ◽  
...  
Keyword(s):  
Decision Making ◽  
Older Patients ◽  
Clinical Decision Making ◽  
Clinical Decision

scholarly journals 35. Acceptability of Proposed Stewardship Interventions to Reduce Preoperative Screening and Treatment of Asymptomatic Bacteriuria

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S140-S140
Author(s):  
Kimberly Dukes ◽  
Julia Walhof ◽  
Madisen Brown ◽  
Kalpana Gupta ◽  
Judith Strymish ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Asymptomatic Bacteriuria ◽  
Clinical Decision ◽  
Audit And Feedback ◽  
Structured Interviews ◽  
Research Support ◽  
Independent Contractor ◽  
Urine Screening ◽  
Urine Testing

Abstract Background In 2019, the IDSA Clinical Practice guidelines on asymptomatic bacteriuria (ASB) recommended that clinicians no longer screen or treat patients for ASB before non-urological surgeries. However, it remains to be seen whether these guideline recommendations alone will produce changes in practice. Understanding clinical decision-making about preoperative urine screening and treatment can help design effective interventions to facilitate guideline concordance and support antibiotic stewardship. Our project objective was to qualitatively assess barriers and facilitators to reducing preoperative urine testing and treatment. Methods We conducted semi-structured interviews with 24 participants (surgeons, advance practice providers, pharmacists, infectious disease physicians, epidemiologists) at 4 Veterans Administration hospitals. We solicited feedback on 4 proposed interventions (substitution, lab restrictions, audit and feedback, interactive workshop), and invited suggestions on other interventions. Three researchers separately coded 20% of interview notes to sort responses to each intervention into acceptable, possibly acceptable, and not acceptable. The team then compared coding, resolved differences by consensus, and refined the code dictionary to ensure intercoder agreement; then each member coded one third of remaining notes. Results Participants expressed concerns about de-implementing routine urine testing and treatment for specific procedures and specialties (e.g., cardiothoracic). Some actively sought to identify and treat ASB. Participants found audit and feedback and substitution of different infection-control practices most acceptable. Participants suggested changes to make interventions more acceptable or feasible (e.g., tailoring to procedure, educational tailoring). Participants also identified new potential interventions (e.g. order set changes, collaborative decision making, education on potential harms, identification of testing costs). Table 1. Acceptability of Proposed Interventions by Percentage of Participants. Percentages Do Not Add up to 100% Because Some Interviewees Did Not Answer Every Question. Conclusion Interventions to optimize urine screening and treatment for patients undergoing surgeries may require tailoring for surgical specialties, and should address clinical concerns about intervention feasibility. Disclosures Kalpana Gupta, MD, MPH, Abbott (Shareholder)DBC Pri-Med (Consultant)Glaxo Smith Kline (Consultant)Moderna (Shareholder)Nabriva Therapeutics (Consultant)Pfizer (Other Financial or Material Support, Grant to the institution)Qiagen (Consultant)Rebiotix (Consultant)Spero Therapeutics (Consultant)Utility Therapeutics (Consultant) Daniel Suh, MS MPH, General Electric (Shareholder)Merck (Shareholder)Moderna (Shareholder)Smile Direct Club (Shareholder) Bruce Alexander, PharmD, Bruce Alexander Consulting (Independent Contractor) Marin Schweizer, PhD, 3M (Grant/Research Support)PDI (Grant/Research Support)

Validation Of a Comprehensive Health Status Assessment Scale In Older Patients (≥ 65 years) With Hematological Malignances. Gah Study

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2979-2979
Author(s):  
Santiago Bonanad ◽  
Ernesto Perez Persona ◽  
Itziar Oiartzabal ◽  
Bernardo Gonzalez ◽  
Carlos Fernandez-Lago ◽  
...  
Keyword(s):  
Decision Making ◽  
Health Status ◽  
Geriatric Assessment ◽  
Older Patients ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Health Status Assessment ◽  
Comprehensive Health ◽  
Status Assessment ◽  
Test Retest Reliability

Abstract Background Older patients are increasingly prevalent in oncological practice. However, the evidence suggests that this group of patients is undertreated, mainly because of their advanced age, regardless of whether they are highly functional patients, do not present comorbidities, or could benefit from oncological therapies. The US National Comprehensive Cancer Network and the International Society of Geriatric Oncology have recommended that some form of geriatric assessment should be conducted to help Hematologists and Oncologists in order to identify current health problems and to guide interventions to reduce adverse outcomes and optimize the functional status Currently, the main tool for assessing older patients is a comprehensive geriatric assessment, although its complexity and duration may hinder its regular use in daily practice as a tool for clinical decision making. Several attempts have been made to assess comorbidities in the specific field of mielodysplasia, but mainly focused on organic damage rather than global assessment. Aim We are in the process of developing and validating a comprehensive health status assessment scale (Geriatric Assessment in Hematology, GAH Scale) with eight dimensions in patients ≥ 65 years with: Myelodysplastic syndromes (MDS), acute myeloblastic leukemia (AML) and multiple myeloma (MM). Methods After item-pool generation, stakeholder consultation and content validation, a brief scale of 8 dimensions with selected items has been created. Feasibility was confirmed in 83 patients. Afterwards, a multicenter, observational, prospective study has been carried out in 20 hospitals in Spain, enrolling 189 elderly naïve to treatment patients with newly diagnosed MDS, AML or MM. The scale validation process integrates the analysis of criterion and concept validity, internal consistency (Cronbach's alpha), test-retest reliability, as well as the evaluation of intraclass correlation coefficient (ICC) and factor analysis. After psychometric validation phase, further studies will be carried out in order to evaluate its clinical use for prognosis and clinical decision making. Results 189 patients fulfilling inclusion criteria have been enrolled in the study, 54% women. Median age at diagnosis was 73.3 ± 6.64 years. According to diagnosis, 103 patients (54.5%) had MDS or AML and 86 (45.5%) had MM. Regarding feasibility, mean time for filling in the questionnaire was 12.1 ± 4.5 min. 83.6% of patients answered 100% of questions of the scale. Mean percentage of unanswered questions per patient was 1%. Test-retest was completed by 112 patients. GAH Scale showed satisfactory test-retest reliability. ICC was statistically significant for each dimension, being greater than 0.65 for 6 of the 8 dimensions (p<0.05), indicating that GAH Scale is independent of the observer and is stable in clinically stable patients along the time. Floor and ceiling effects were no detected. Internal consistency, content validity and factor analysis are being carried out and results will be presented in the forthcoming congress. Conclusion This new GAH Scale is a valid, reliable and consistent tool, simple enough to assess health status in older patients with haematological malignancies. Further studies will have to stablish if it may be a tool to improve decision making in such patients. Disclosures: Bonanad: Celgene: Consultancy. Gonzalez:Celgene: Consultancy. Durán:Celgene: Employment. Marcos:Celgene: Employment. López:Celgene: Employment. Cruz-Jentoft:Celgene: Research Funding.

How to incorporate geriatric assessment in clinical decision-making for older patients with cancer. An implementation study

2019 ◽  
Vol 10 (6) ◽  
pp. 951-959 ◽  
Author(s):  
Suzanne Festen ◽  
Maaike Kok ◽  
Jana S. Hopstaken ◽  
Hanneke van der Wal-Huisman ◽  
Annya van der Leest ◽  
...  
Keyword(s):  
Decision Making ◽  
Geriatric Assessment ◽  
Older Patients ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Implementation Study ◽  
Patients With Cancer

scholarly journals Perceptions and experiences of wrist surgeons on the management of triangular fibrocartilage complex tears: a qualitative study

2019 ◽  
Vol 44 (6) ◽  
pp. 572-581
Author(s):  
Vanessa I. Robba ◽  
Alexia Karantana ◽  
Andrew P. G. Fowler ◽  
Claire Diver
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Triangular Fibrocartilage Complex ◽  
Classification Systems ◽  
Structured Interviews ◽  
Level Of Evidence ◽  
Related Factors ◽  
Data Saturation ◽  
Triangular Fibrocartilage

There is lack of consensus on the management of triangular fibrocartilage injuries. The aim of this study was to investigate wrist surgeons’ experiences and perceptions regarding treatment of triangular fibrocartilage complex injuries and to explore the rationale behind clinical decision-making. A purposive sample of consultant wrist surgeons ( n = 10) was recruited through ‘snow-balling’ until data saturation was reached. Semi-structured interviews were conducted, digitally recorded and transcribed verbatim. Two researchers independently analysed data using an iterative/thematic approach. Findings suggest that surgeons rely more on their own training and experience, and patient-related factors such as individual expectations, to inform their decision-making, rather than on published material. Current classification systems are largely considered to be unhelpful. Level of evidence: V

scholarly journals Moral-uncertainty-distress related to Advance Directives: a qualitative study

2020 ◽  
Author(s):  
Uiara Raiana Vargas de Castro Oliveira Ribeiro ◽  
Liliane Mayumi Swiech ◽  
Waldir Souza ◽  
Úrsula Bueno do Prado Guirro ◽  
Carla Corradi-Perini
Keyword(s):  
Decision Making ◽  
Advance Directives ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Decision Making Process ◽  
Structured Interviews ◽  
Cross Sectional ◽  
Moral Uncertainty ◽  
Patient’S Autonomy ◽  
The Impact

Abstract Background: moral-uncertainty-distress (MUD) is defined as moral distress related to moral conflict about best course of action, impacting the clinical decision making process in morally complex situations. This study aims to correlate physician’s perception about advance directives (AD) with presence or absence of MUD, identifying the impact that AD promotes on clinical decision making.Methods: this is a qualitative, cross-sectional, exploratory study. Data was collected through semi-structured interviews with physicians of a hospital in southern Brazil. Interviews content was submitted to categorization analysis content technique by Laurence Bardin.Results: eight physicians were interviewed. The analysis contend identified two categories: (1) AD as a morally challenging element and (2) recognition of AD as instruments that exercises patient’s autonomy. In the first, paternalistic attitude; insecurities in uncertain prognoses; uncertainty about patient values and motivations to write the document; and little previous knowledge about AD, were elements of MUD for physicians. In second category, autonomy in AD was seen as prima facie principle and as shared autonomy.Conclusion: although AD were comprehended as instruments of exercise of patient’s autonomy by the participants, some elements were morally challenging for them, which can be a source of MUD to physician during decision making process.

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