scholarly journals Impacto de la infección por SARS-CoV-2 (COVID-19) en el tratamiento de una lesión duodenal por arma de fuego

2020 ◽  
Vol 112 (4) ◽  
pp. 445-449
Author(s):  
Mora Achával ◽  
◽  
Sofía I. Rapp ◽  
Facundo Nogueira ◽  
Juan C. López Meyer ◽  
...  
Keyword(s):  
Decision Making ◽  
Surgical Management ◽  
Percutaneous Drainage ◽  
Treatment Options ◽  
Severe Pneumonia ◽  
Duodenal Injury ◽  
Initial Surgery ◽  
Pyloric Exclusion ◽  
Severity Of The Disease ◽  
Determining Factor

We report the case of a patient with an abdominal gunshot trauma with liver and duodenal injury who underwent pyloric exclusion and liver repair in another institution. The patient was transferred to our institution 12 hours after surgery. During hospitalization, severe pneumonia due to COVID-19 and complications of the initial surgery developed. Non-surgical management was decided due to the severity of the disease. Percutaneous drainage allowed for the management of the collections avoiding a major initial surgery. Once he recovered from the pneumonia, the definite surgery was performed. Severe COVID-19 pneumonia in a patient with serious duodenal shotgun injury is a determining factor for decision-making of treatment options.

scholarly journals A case of traumatic isolated duodenal perforation due to blunt abdominal trauma

2021 ◽  
Vol 8 (3) ◽  
pp. 1048
Author(s):  
Waqar A. Ansari ◽  
Deepak B. Gadekar ◽  
Asif Ansari ◽  
Ahana Ghosh ◽  
Sumit Malgaonkar ◽  
...  
Keyword(s):  
Decision Making ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Posterior Wall ◽  
The Other ◽  
Duodenal Perforation ◽  
Rare Clinical Entity ◽  
Duodenal Injury ◽  
Present Patient ◽  
Pyloric Exclusion

Isolated duodenal injury following blunt abdominal trauma is a rare clinical entity and is often unnoticed leading to delay in management thereby increasing morbidity and mortality. We report a case of isolated duodenal perforation following blunt abdominal trauma and highlight the challenges and decision-making dilemmas associated with its management. The present patient had two perforations, one on the anterior and the other on the posterior wall of the duodenum. Complete duodenal mobilization during laparotomy and a decision of performing pyloric exclusion aided momentously in the management.

The impact of a physician’s recommendation and gender on informed decision making: A randomized controlled study in a simulated decision situation

2020 ◽  
Author(s):  
Marie Eggeling ◽  
Anna Meinhardt ◽  
Ulrike Cress ◽  
Joachim Kimmerle ◽  
Martina Bientzle
Keyword(s):  
Decision Making ◽  
Cruciate Ligament ◽  
Treatment Options ◽  
General Information ◽  
Treatment Preference ◽  
Controlled Study ◽  
Treatment Preferences ◽  
Hypothetical Scenario ◽  
And Gender ◽  
The Impact

Objective: This study examined the influence of physicians’ recommendations and gender on the decision-making process in a preference-sensitive situation. Methods: N = 201 participants were put in a hypothetical scenario in which they suffered from a rupture of the anterior cruciate ligament (ACL). They received general information on two equally successful treatment options for this injury (surgery vs. physiotherapy) and answered questions regarding their treatment preference, certainty and satisfaction regarding their decision, and attitude toward the treatment options. Then participants watched a video that differed regarding physician’s recommendation (surgery vs. physiotherapy) and physician’s gender (female vs. male voice and picture). Afterward, they indicated again their treatment preference, certainty, satisfaction, and attitude, as well as the physician’s professional and social competence.Results: Participants changed their treatment preferences in the direction of the physician’s recommendation (P<.001). Decision certainty (P<.001) and satisfaction (P<.001) increased more strongly if the physician’s recommendation was congruent with the participant’s prior attitude than if the recommendation was contrary to the participant’s prior attitude. Finally, participants’ attitudes toward the recommended treatment became more positive (surgery recommendation: P<.001; physiotherapy recommendation: P<.001). We found no influence of the physician’s gender on participants’ decisions, attitudes, or competence assessments.Conclusion: This research indicates that physicians should be careful with recommendations when aiming for shared decisions, as they might influence patients even if the patients have been made aware that they should take their personal preferences into account. This could be particularly problematic if the recommendation is not in line with the patient’s preferences.

The Oxford Handbook of Impulse Control Disorders

2012 ◽  
Keyword(s):  
Decision Making ◽  
Impulse Control ◽  
Treatment Options ◽  
Impulse Control Disorders ◽  
Clear Understanding ◽  
Intermittent Explosive Disorder ◽  
Normal Behavior ◽  
Assessment And Treatment ◽  
Decision Making Processes ◽  
Psychopathological Disorders

Impulsivity, to varying degrees, is what underlies human behavior and decision-making processes. As such, a thorough examination of impulsivity allows us to better understand modes of normal behavior and action as well as a range of related psychopathological disorders, including kleptomania, pyromania, trichotillomania, intermittent explosive disorder, and pathological gambling—disorders grouped under the term "impulse control disorders" (ISDs). Recent efforts in the areas of cognitive psychology, neurobiology, and genetics have provided a greater understanding of these behaviors and given way to improved treatment options. The Oxford Handbook of Impulse Control Disorders provides a clear understanding of the developmental, biological, and phenomenological features of a range of ICDs, as well as detailed approaches to their assessment and treatment. Bringing together founding ICD researchers and leading experts from psychology and psychiatry, this volume reviews the biological underpinnings of impulsivity and the conceptual challenges facing clinicians as they treat individuals with ICDs.

scholarly journals Personalized treatment options for chronic diseases using precision cohort analytics

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kenney Ng ◽  
Uri Kartoun ◽  
Harry Stavropoulos ◽  
John A. Zambrano ◽  
Paul C. Tang
Keyword(s):  
Decision Making ◽  
Chronic Diseases ◽  
Primary Care Physicians ◽  
Treatment Guidelines ◽  
Point Of Care ◽  
Data Extraction ◽  
Treatment Options ◽  
Personalized Treatment ◽  
Medical Decision ◽  
Similarity Model

AbstractTo support point-of-care decision making by presenting outcomes of past treatment choices for cohorts of similar patients based on observational data from electronic health records (EHRs), a machine-learning precision cohort treatment option (PCTO) workflow consisting of (1) data extraction, (2) similarity model training, (3) precision cohort identification, and (4) treatment options analysis was developed. The similarity model is used to dynamically create a cohort of similar patients, to inform clinical decisions about an individual patient. The workflow was implemented using EHR data from a large health care provider for three different highly prevalent chronic diseases: hypertension (HTN), type 2 diabetes mellitus (T2DM), and hyperlipidemia (HL). A retrospective analysis demonstrated that treatment options with better outcomes were available for a majority of cases (75%, 74%, 85% for HTN, T2DM, HL, respectively). The models for HTN and T2DM were deployed in a pilot study with primary care physicians using it during clinic visits. A novel data-analytic workflow was developed to create patient-similarity models that dynamically generate personalized treatment insights at the point-of-care. By leveraging both knowledge-driven treatment guidelines and data-driven EHR data, physicians can incorporate real-world evidence in their medical decision-making process when considering treatment options for individual patients.

scholarly journals Decision Making from the Experience of Orthognathic Surgery Patients: A Grounded Theory Approach

2021 ◽  
pp. 238008442110144
Author(s):  
N.R. Paul ◽  
S.R. Baker ◽  
B.J. Gibson
Keyword(s):  
Decision Making ◽  
Grounded Theory ◽  
Treatment Options ◽  
Study Data ◽  
Primary Objective ◽  
Major Surgery ◽  
Future Research ◽  
Decision Making Process ◽  
Theory Approach

Introduction: Patients’ decisions to undergo major surgery such as orthognathic treatment are not just about how the decision is made but what influences the decision. Objectives: The primary objective of the study was to identify the key processes involved in patients’ experience of decision making for orthognathic treatment. Methods: This study reports some of the findings of a larger grounded theory study. Data were collected through face-to-face interviews of patients who were seen for orthognathic treatment at a teaching hospital in the United Kingdom. Twenty-two participants were recruited (age range 18–66 y), of whom 12 (male = 2, female = 10) were 6 to 8 wk postsurgery, 6 (male = 2, female = 4) were in the decision-making stage, and 4 (male = 0, female = 4) were 1 to 2 y postsurgery. Additional data were also collected from online blogs and forums on jaw surgery. The data analysis stages of grounded theory methodology were undertaken, including open and selective coding. Results: The study identified the central role of dental care professionals (DCPs) in several underlying processes associated with decision making, including legitimating, mediating, scheduling, projecting, and supporting patients’ decisions. Six categories were related to key aspects of decision making. These were awareness about their underlying dentofacial problems and treatment options available, the information available about the treatment, the temporality of when surgery would be undertaken, the motivations and expectation of patients, social support, and fear of the surgery, hospitalization, and potentially disliking their new face. Conclusion: The decision-making process for orthognathic treatment is complex, multifactorial, and heavily influenced by the role of DCPs in patient care. Understanding the magnitude of this role will enable DCPs to more clearly participate in improving patients’ decision-making process. The findings of this study can inform future quantitative studies. Knowledge Transfer Statement: The results of this study can be used both for informing clinical practice around enabling decision making for orthognathic treatment and also for designing future research. The findings can better inform clinicians about the importance of their role in the patients’ decision-making process for orthognathic treatment and the means to improve the patient experience. It is suggested that further research could be conducted to measure some of the key constructs identified within our grounded theory and assess how these change during the treatment process.

scholarly journals Patient decision aid based on multi-criteria decision analysis for disease-modifying drugs for multiple sclerosis: prototype development

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
I. E. H. Kremer ◽  
P. J. Jongen ◽  
S. M. A. A. Evers ◽  
E. L. J. Hoogervorst ◽  
W. I. M. Verhagen ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Decision Aid ◽  
Healthcare Professionals ◽  
Treatment Options ◽  
Shared Decision ◽  
Patient Decision Aid ◽  
Disease Modifying Drugs ◽  
Patient Decision ◽  
Further Development

Abstract Background Since decision making about treatment with disease-modifying drugs (DMDs) for multiple sclerosis (MS) is preference sensitive, shared decision making between patient and healthcare professional should take place. Patient decision aids could support this shared decision making process by providing information about the disease and the treatment options, to elicit the patient’s preference and to support patients and healthcare professionals in discussing these preferences and matching them with a treatment. Therefore, a prototype of a patient decision aid for MS patients in the Netherlands—based on the principles of multi-criteria decision analysis (MCDA) —was developed, following the recommendations of the International Patient Decision Aid Standards. MCDA was chosen as it might reduce cognitive burden of considering treatment options and matching patient preferences with the treatment options. Results After determining the scope to include DMDs labelled for relapsing-remitting MS and clinically isolated syndrome, users’ informational needs were assessed using focus groups (N = 19 patients) and best-worst scaling surveys with patients (N = 185), neurologists and nurses (N = 60) to determine which information about DMDs should be included in the patient decision aid. Next, an online format and computer-based delivery of the patient decision aid was chosen to enable embedding of MCDA. A literature review was conducting to collect evidence on the effectiveness and burden of use of the DMDs. A prototype was developed next, and alpha testing to evaluate its comprehensibility and usability with in total thirteen patients and four healthcare professionals identified several issues regarding content and framing, methods for weighting importance of criteria in the MCDA structure, and the presentation of the conclusions of the patient decision aid ranking the treatment options according to the patient’s preferences. Adaptations were made accordingly, but verification of the rankings provided, validation of the patient decision aid, evaluation of the feasibility of implementation and assessing its value for supporting shared decision making should be addressed in further development of the patient decision aid. Conclusion This paper aimed to provide more transparency regarding the developmental process of an MCDA-based patient decision aid for treatment decisions for MS and the challenges faced during this process. Issues identified in the prototype were resolved as much as possible, though some issues remain. Further development is needed to overcome these issues before beta pilot testing with patients and healthcare professionals at the point of clinical decision-making can take place to ultimately enable making conclusions about the value of the MCDA-based patient decision aid for MS patients, healthcare professionals and the quality of care.

Social Metadata and Public-Contributed Contents in Memory Institutions: “Crowd Voice” Versus “Authenticated Heritage”?

2016 ◽  
Vol 45 (3) ◽  
pp. 122-133 ◽  
Author(s):  
Chern Li Liew
Keyword(s):  
Decision Making ◽  
Cultural Heritage ◽  
Knowledge Base ◽  
Participatory Culture ◽  
Collective Memories ◽  
Digital Cultural Heritage ◽  
The Social ◽  
Social Technologies ◽  
Determining Factor ◽  
Shed Light

AbstractSocial technologies have led to increasing participatory activities and institutions are interested in the potential of using these for outreach and engagement. Through offering new spaces and tools that allow users to consume and also to contribute content, institutions are expanding their traditional services which could redefine their role and relevance in the digital cultural heritage landscape. This study investigates the decision-making and practices underpinning current handling of social metadata and public-contributed contents (PCC). The focus is on examining the motivations for soliciting contributions, if and how these are moderated and managed, if they are integrated into the institutional data and knowledge base, and the extent to which public stakeholders moderate. The study also involves an investigation of whether, and how, memory institutions consider diversity and inclusiveness in soliciting participation and contributions, and the values placed on PCC, as compared to institutional resources. The aim of this study is to shed light on these by surveying libraries, archives, museums, and other institutions.How institutions deal with the social metadata and PCC they gather, and what they do with the contributions, could be a key determining factor of the success of their participatory practice as part of their larger effort to capture and preserve collective memories. This survey shows that the profession still has a way to go towards these goals. There is little evidence that demonstrates integration of a participatory culture and activities into the strategic directions and documentary practices of institutions.

scholarly journals Surgical Management of Pediatric Gastroesophageal Reflux Disease

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Hope T. Jackson ◽  
Timothy D. Kane
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Surgical Management ◽  
Reflux Disease ◽  
Clinical Presentation ◽  
Pediatric Population ◽  
Treatment Options ◽  
Failure To Thrive ◽  
Solid Diet ◽  
Esophageal Sphincter

Gastroesophageal reflux (GER) is common in the pediatric population. Most cases represent physiologic GER and as the lower esophageal sphincter (LES) matures and a solid diet is introduced, many of these patients (>65%) experience spontaneous resolution of symptoms by two years of age. Those who continue to have symptoms and develop complications such as failure to thrive, secondary respiratory disease, and others are classified as having gastroesophageal reflux disease (GERD). Goals of GERD treatment include the resolution of symptoms and prevention of complications. Treatment options to achieve these goals include dietary or behavioral modifications, pharmacologic intervention, and surgical therapy. This paper will review the clinical presentation of GERD and discuss options for surgical management and outcomes in these patients.

Primary Lung Hernia After Blunt Chest Trauma: Chest Wall Repair Strategies

2021 ◽  
pp. 000313482110234
Author(s):  
Leonid A. Belyayev ◽  
William J. Parker ◽  
Emad S. Madha ◽  
Elliot M. Jessie ◽  
Matthew J. Bradley
Keyword(s):  
Decision Making ◽  
Chest Wall ◽  
Surgical Management ◽  
Blunt Chest Trauma ◽  
Thoracic Trauma ◽  
Chest Trauma ◽  
Blunt Thoracic Trauma ◽  
Lung Herniation ◽  
Lung Hernia

Lung herniation is a rare pathology seen after trauma. A case of acquired lung hernia is presented after blunt thoracic trauma that was repaired primarily. Surgical management and decision-making for this process are discussed.

Sign in / Sign up

Export Citation Format

Share Document