‘Hippocrates’ – support system for medical decision-making for primary care for early detection of socially significant diseases

2021 ◽  
pp. 11-14
Author(s):  
A. L. Vertkin ◽  
Yu. V. Sediakina ◽  
A. V. Pogonin ◽  
I. I. Romanenko
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Emergency Medicine ◽  
Clinical Pharmacology ◽  
Early Detection ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Medical Decisions ◽  
State Information ◽  
Testing Mode

Within the framework of the Federal Project ‘Creation of a unified digital contour in health care based on the unified state information system of health care’ of the National Project ‘Healthcare’, employees of the Moscow State Medical and Dental University n.a. A. I. Evdokimov (Department of Therapy, Clinical Pharmacology and Emergency Medicine) with the assistance of RPO ‘Outpatient Doctor’ in 2020, a system for supporting medical decisions was created. The program ‘Hippocrates’ works in the testing mode, but now it is fulfilling the tasks assigned to it to increase the early detection of chronic diseases, and it also plays an important role in teaching doctors to take action based on clinical guidelines.

Emotions and Medical Decision-Making

2020 ◽  
Vol 83 (2) ◽  
pp. 174-194
Author(s):  
Amanda M. Gengler
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Decision Making Process ◽  
Medical Decisions ◽  
Interactive Process ◽  
The Social ◽  
Life Threatening ◽  
Ethnographic Data

Sociologists have written surprisingly little about the role emotions play in medical decision-making, largely ceding this terrain to psychologists who conceptualize emotional influences on decision-making in primarily cognitive and individualistic terms. In this article, I use ethnographic data gathered from parents and physicians caring for children with life-threatening conditions to illustrate how emotions enter the medical decision-making process in fundamentally interactional ways. Because families and physicians alike often defined emotions as useful information to guide the decision-making process, both parties could leverage them in health care interactions by eliciting or demonstrating emotional investment, strategically deploying emotionally charged symbols, and using emotions as tiebreakers to help themselves and one another make choices in the midst of uncertainty. Constructing emotions as valuable in the decision-making process and effectively marshalling them in these ways offered a number of advantages. It could make decisions easier to arrive at, help people feel more confident in the decisions they made, and reduce interpersonal conflict. By connecting the dynamic role emotions can play in the interactive process through which medical decisions are made to the social advantages they can produce, I point to an underappreciated avenue through which inequalities in health care are perpetuated.

Medical Decision-Making for Adults Who Lack Decision-Making Capacity and a Surrogate: State of the Science

2018 ◽  
Vol 35 (9) ◽  
pp. 1227-1234 ◽  
Author(s):  
Hyejin Kim ◽  
Mi-Kyung Song
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Medical Decisions ◽  
Decision Making Capacity ◽  
Final Sample ◽  
State Of The Science ◽  
Professional Guidelines

Background: Adults who lack decision-making capacity and a surrogate (“unbefriended” adults) are a vulnerable, voiceless population in health care. But little is known about this population, including how medical decisions are made for these individuals. Objective: This integrative review was to examine what is known about unbefriended adults and identify gaps in the literature. Methods: Six electronic databases were searched using 4 keywords: “unbefriended,” “unrepresented patients,” “adult orphans,” and “incapacitated patients without surrogates.” After screening, the final sample included 10 data-based articles for synthesis. Results: Main findings include the following: (1) various terms were used to refer to adults who lack decision-making capacity and a surrogate; (2) the number of unbefriended adults was sizable and likely to grow; (3) approaches to medical decision-making for this population in health-care settings varied; and (4) professional guidelines and laws to address the issues related to this population were inconsistent. There have been no studies regarding the quality of medical decision-making and its outcomes for this population or societal impact. Conclusion: Extremely limited empirical data exist on unbefriended adults to develop strategies to improve how medical decisions are made for this population. There is an urgent need for research to examine the quality of medical decision-making and its outcomes for this vulnerable population.

Patient Autonomy, Capacity, and Consent

2020 ◽  
Author(s):  
Jessica Berg ◽  
Emma Cave
Keyword(s):  
Patient Autonomy ◽  
Medical Decision Making ◽  
The United States ◽  
Best Interests ◽  
Medical Decision ◽  
Human Rights Law ◽  
Federal Law ◽  
Medical Decisions ◽  
General Overview ◽  
Best Interests Standard

This chapter discusses patient autonomy, capacity, and consent involving children. It first provides a general overview of children’s rights with respect to making medical decisions in both the United States and Europe. The chapter then discusses the best interests standard (which is usually applied in cases of minors) and how to consider capacity in the context of children. In the discussions of European approaches, the chapter covers relevant international and regional human rights law. The jurisdiction of England and Wales are used as examples. The chapter also provides a general overview of US state approaches and federal law. The chapter concludes by noting some new areas of medical decision-making which challenge the traditional models.

scholarly journals Medical Decision Making for Youth in the Foster Care System

2016 ◽  
Author(s):  
Zachary Strassburger
Keyword(s):  
Foster Care ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Medical Decisions ◽  
Foster Care System ◽  
Birth Parents ◽  
Birth Parent ◽  
Laws And Policies ◽  
Do So ◽  
Care System

Youth in the foster care system often have no one person who isclearly authorized to make medical decisions for them. From acaseworker insisting upon a vaccine to a birth parent refusingpermission for psychotropic medication, this paper argues that thequestion of who makes these decisions matters for children’s rights.This paper reports the results of a survey of 132 stakeholdersrepresenting all U.S. states, 17 qualitative interviews, and a reviewof relevant laws and policies. The stakeholders and legal researchrevealed that in sixteen states, common practice disagreed with thewritten laws and policies about who should be making medical decisionsfor youth in the foster care system. Most often, foster parents aremaking medical decisions despite note having legal authority to do so,and birth parents are rarely making decisions even when they arelegally allowed to do so. This paper proposes that following federallaw about promoting family reunification, birth parents should be incharge of medical decision making for the first 12-24 months. Afterthat time, the foster parent, if one is available and has showncommitment to the child, should become the medical decision maker.Such a policy would promote birth parent involvement and familyreunification while acknowledging the need of young people in care fordecision makers who can make long-term commitments to their care.

Support for management medical decisions and the nature of uncertainty in them

2021 ◽  
Author(s):  
S.Yu. Zhuleva ◽  
A.V. Kroshilin ◽  
S.V. Kroshilina
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Medical Information ◽  
General Scheme ◽  
The Body ◽  
Medical Decision ◽  
Problem Situation ◽  
Medical Decisions ◽  
Inaccurate Information ◽  
Individual Decisions

The process of making a medical decision is characterized by a lack of knowledge and inconsistency of the available information, the lack of the possibility of attracting competent medical experts, limited time resources, incomplete or inaccurate information about the patient's condition. These aspects may be the causes of medical errors, which lead to further aggravation of the problem situation. Purpose – it is necessary to define and justify managerial medical decisions and types of medical information in conditions of uncertainty, when each variant of the sets of outcomes of the situation (recommendations) has its own unique set of values. The fundamental difference between this process for medical use is the concept of the "best medical solution", in which the key role is given to the patient's state of health in obtaining and evaluating alternatives, as well as the need to take into account the time, adverse reactions of the body and the costs of implementing this solution. In the medical field, support for medical decision-making can be classified as organizational-managerial and therapeutic-diagnostic, but both are determined by the position of the person making the medical decision and are aimed at effective management of the medical institution as a whole. The article describes the causes and factors of the nature of uncertainty in the tasks of supporting medical decision-making in medical-diagnostic and organizational-managerial areas. The analysis of the features of supporting medical decision-making in conditions of uncertainty is carried out. Approaches and directions in this area, as well as the concept of “solution”, are considered. The essence of the management medical decision is reflected. The classification of management medical decisions is given, the requirements that are imposed on them are highlighted. The features of the development of management medical solutions in the conditions of incompleteness and uncertainty, the problems that arise when they are implemented in information systems are presented. The general scheme of the process of creating a management medical solution is shown. The features of making group and individual decisions are reflected. The algorithm of actions of the person making the medical decision in the conditions of uncertainty, incompleteness and risk in medical subject areas is presented.

scholarly journals The Gray Zone: Adolescent and Young Adult Decision Support Needs for Ulcerative Colitis

2020 ◽  
Vol 5 (2) ◽  
pp. 238146832094070
Author(s):  
Andrea Meisman ◽  
Nancy M. Daraiseh ◽  
Phil Minar ◽  
Marlee Saxe ◽  
Ellen A. Lipstein
Keyword(s):  
Ulcerative Colitis ◽  
Decision Making ◽  
Decision Support ◽  
Focus Groups ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Support Needs ◽  
Final Decision ◽  
Care Providers ◽  
Medical Decisions

Purpose. To understand the medical decision support needs specific to adolescents and young adults (AYAs) with ulcerative colitis (UC) and inform development of a decision support tool addressing AYAs’ preferences. Methods. We conducted focus groups with AYAs with UC and mentors from a pediatric inflammatory bowel disease clinic’s peer mentoring program. Focus groups were led by a single trained facilitator using a semistructured guide aimed at eliciting AYAs’ roles in medical decision making and perceived decision support needs. All focus groups were audio recorded, transcribed, and coded by the research team. Data were analyzed using content analysis and the immersion crystallization method. Results. The facilitator led six focus groups: one group with peer mentors aged 18 to 24 years, three groups with patients aged 14 to 17 years, and two groups with patients aged 18 to 24 years. Decision timing and those involved in decision making were identified as interacting components of treatment decision making. Treatment decisions by AYAs were further based on timing, location (inpatient v. outpatient), and family preference for making decisions during or outside of clinic. AYAs involved parents and health care providers in medical decisions, with older participants describing themselves as “final decision makers.” Knowledge and experience were facilitators identified to participating in medical decision making. Conclusions. AYAs with UC experience changes to their roles in medical decisions over time. The support needs identified will inform the development of strategies, such as decision support tools, to help AYAs with chronic conditions develop and use skills needed for participating in medical decision making.

May We Support Your Decision?

1996 ◽  
Vol 1 (3) ◽  
pp. 175-178 ◽  
Author(s):  
Colin Gordon
Keyword(s):  
Artificial Intelligence ◽  
Health Care ◽  
Decision Making ◽  
Clinical Practice ◽  
Decision Support ◽  
Health Care Professionals ◽  
Medical Decision Making ◽  
Electronic Patient Record ◽  
Medical Decision ◽  
Technical Developments

Expert systems to support medical decision-making have so far achieved few successes. Current technical developments, however, may overcome some of the limitations. Although there are several theoretical currents in medical artificial intelligence, there are signs of them converging. Meanwhile, decision support systems, which set themselves more modest goals than replicating or improving on clinicians' expertise, have come into routine use in places where an adequate electronic patient record exists. They may also be finding a wider role, assisting in the implementation of clinical practice guidelines. There is, however, still much uncertainty about the kinds of decision support that doctors and other health care professionals are likely to want or accept.

scholarly journals Exploring Types of Information Sources Used When Choosing Doctors: Observational Study in an Online Health Care Community (Preprint)

2020 ◽  
Author(s):  
Shuang Zhang ◽  
Jying-Nan Wang ◽  
Ya-Ling Chiu ◽  
Yuan-Teng Hsu
Keyword(s):  
Health Care ◽  
Medical Decision Making ◽  
Information Sources ◽  
Information Source ◽  
Online Reviews ◽  
Medical Decision ◽  
Medical Specialties ◽  
Care Community ◽  
Types Of Information ◽  
Friend Recommendations

BACKGROUND Patients attempt to make appropriate decisions based on their own knowledge when choosing a doctor. In this process, the first question usually faced is that of how to obtain useful and relevant information. This study investigated the types of information sources that are used widely by patients in choosing a doctor and identified ways in which the preferred sources differ in various situations. OBJECTIVE This study aims to address the following questions: (1) What is the proportion in which each of the various information sources is used? (2) How does the information source preferred by patients in choosing a doctor change when there is a difference in the difficulty of medical decision making, in the level of the hospital, or in a rural versus urban situation? (3) How do information sources used by patients differ when they choose doctors with different specialties? METHODS This study overcomes a major limitation in the use of the survey technique by employing data from the Good Doctor website, which is now China's leading online health care community, data which are objective and can be obtained relatively easily and frequently. Multinomial logistic regression models were applied to examine whether the proportion of use of these information sources changes in different situations. We then used visual analysis to explore the question of which type of information source patients prefer to use when they seek medical assistance from doctors with different specialties. RESULTS The 3 main information sources were online reviews (OR), family and friend recommendations (FR), and doctor recommendations (DR), with proportions of use of 32.93% (559,345/1,698,666), 23.68% (402,322/1,698,666), and 17.48% (296,912/1,698,666), respectively. Difficulty in medical decision making, the hospital level, and rural-urban differences were significantly associated with patients’ preferred information sources for choosing doctors. Further, the sources of information that patients prefer to use were found to vary when they looked for doctors with different medical specialties. CONCLUSIONS Patients are less likely to use online reviews when medical decisions are more difficult or when the provider is not a tertiary hospital, the former situation leading to a greater use of online reviews and the latter to a greater use of family and friend recommendations. In addition, patients in large cities are more likely to use information from online reviews than family and friend recommendations. Among different medical specialties, for those in which personal privacy is a concern, online reviews are the most common source. For those related to children, patients are more likely to refer to family and friend recommendations, and for those related to surgery, they value doctor recommendations more highly. Our results can not only contribute to aiding government efforts to further promote the dissemination of health care information but may also help health care industry managers develop better marketing strategies.

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