scholarly journals The patient with Acute Thrombocytopenia

2017 ◽  
Vol 16 (2) ◽  
pp. 84-91
Author(s):  
Ernest Suresh
Keyword(s):  
Decision Making ◽  
Therapeutic Intervention ◽  
Practical Approach ◽  
Case Vignette ◽  
Initial Management ◽  
Acute Setting ◽  
Initial Decision ◽  
Precise Diagnosis

A wide variety of conditions can present with acute thrombocytopenia, ranging from those that are relatively benign and self-limiting to those that require urgent therapeutic intervention. Initial decision-making relies on a good history and the results of some simple investigations. Although a precise diagnosis of the underlying cause might often not be possible in the acute setting, supportive treatments should be provided to all patients. This article describes a practical approach to the diagnosis and initial management of patients presenting with acute thrombocytopenia, with the aid of a case vignette.

scholarly journals Problem Based Review: The Patient with Acute Monoarthritis

2013 ◽  
Vol 12 (2) ◽  
pp. 111-116
Author(s):  
Ernest Suresh ◽  
Keyword(s):  
Differential Diagnosis ◽  
Physical Examination ◽  
Septic Arthritis ◽  
Medical Emergency ◽  
Case Vignette ◽  
Significant Morbidity ◽  
Initial Management ◽  
Precise Diagnosis ◽  
Underlying Causes ◽  
Crystal Induced Arthritis

Acute monoarthritis is a common medical emergency with wide differential diagnosis. Common underlying causes include trauma, septic arthritis, crystal induced arthritis (gout and pseudogout), and reactive arthritis. Of these, septic arthritis is the diagnosis not to miss because of its association with significant morbidity and mortality. Precise diagnosis of the underlying cause of monoarthritis relies on a good history, physical examination findings, and results of focussed investigations. In this article, a practical approach to diagnosis and initial management of patients presenting with acute monoarthritis is described with the aid of a case vignette.

scholarly journals Factors that influence treatment decision-making in elderly DLBCL patients: a case vignette study

2015 ◽  
Vol 94 (8) ◽  
pp. 1373-1379 ◽  
Author(s):  
M. W. M. van der Poel ◽  
W. J. Mulder ◽  
G. J. Ossenkoppele ◽  
E. Maartense ◽  
M. Hoogendoorn ◽  
...  
Keyword(s):  
Decision Making ◽  
Treatment Decision ◽  
Case Vignette ◽  
Treatment Decision Making ◽  
Vignette Study

End-of-life decision making in critical illness: Perspectives of Asian parents

2021 ◽  
pp. 1-10
Author(s):  
Kristy Xinghan Fu ◽  
Yee Keow Chiong ◽  
Nicola Ngiam
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Tertiary Care ◽  
Asian Population ◽  
Emergency Department Visits ◽  
Case Vignette ◽  
Healthcare Team ◽  
Care Hospital ◽  
Case Vignettes ◽  
End Of Life Decision

Abstract Objective To explore parents’ perspectives regarding end-of-life (EOL) decisions, factors and possible barriers that influence the EOL decision making process, and to understand parental preferences for communication about EOL care in an Asian population. Method A prospective questionnaire cohort study conducted in a university-based tertiary care hospital. 30 parents of children who had been admitted to general pediatric wards for acute ailments and/or were being followed up in general pediatric outpatient clinics after inpatient admissions or emergency department visits completed 30 interviewer-administered questionnaires. With the first 10 completed questionnaires, we sought feedback on the design of the four case vignettes and related questions. Responses to specific questions related to each case vignette were rated on a Likert scale. Results The majority of parents were able to comprehend and identify with the issues in the case vignettes, which allowed them to respond appropriately. Parents tended to avoid active withdrawal or withholding of life-sustaining treatment. The top three priorities for parents making EOL decisions for their children were: the chance of improvement, the presence of pain or discomfort, and information provided by healthcare staff. Parents reported that they would prefer to know immediately if their child is at risk of dying; they also preferred to get as much information as possible from the healthcare team and thought that meeting with the healthcare team before making EOL decisions was pivotal. Significance of results Parents place highest priorities on their child's likelihood of improvement, perception of their child's pain, and information provided by healthcare professionals in making EOL decisions.

Internal review systems and administrative justice

2021 ◽  
Author(s):  
Tom Mullen
Keyword(s):  
Decision Making ◽  
Public Administration ◽  
Judicial Review ◽  
Cost Effective ◽  
Administrative Organization ◽  
Initial Decision ◽  
Internal Review ◽  
Administrative Justice

Internal review is a process whereby an administrative organization reconsiders its own decisions. The rationales typically offered for internal review are that it provides a means of challenging administrative decisions which is more accessible, quicker, and more cost-effective than external remedies such as appeals to tribunal and judicial review, and encourages improvement in the quality of initial decision-making in public administration. This chapter reviews the use made of internal review and evaluates the performance of several existing systems of internal review, concluding that they have failed to deliver the benefits claimed for them. Possible reasons for this failure are discussed and suggestions made as to what is required for internal review systems to achieve the aims to providing effective remedies for bad decisions and to contributing to improving initial decision-making.

Ethical Decision-Making in Marriage and Family Therapy: An Introduction of a New Model

2020 ◽  
Vol 39 (4) ◽  
pp. 40-55
Author(s):  
Heather Katafiasz ◽  
Rikki Patton ◽  
David Tefteller ◽  
Momoko Takeda
Keyword(s):  
Decision Making ◽  
Family Therapy ◽  
Marriage And Family Therapy ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Case Vignette ◽  
Clinical Services ◽  
Marriage And Family ◽  
New Model ◽  
Systemic Nature

Ethical decision-making within marriage and family therapy is complex and often convoluted due to the relational-systemic nature of the clinical services provided. The aim of this article is to provide an overview for a new model for ethical decision-making in marriage and family therapy. This new model, entitled the Butterfly Model, will then be applied to a case vignette for illustration. It is hoped that the Butterfly Model can provide marriage and family therapists with a guide for ethical decision-making that is tailored more for the relational-systemic work they engage in.

Critical Illness and the Emergency Room

2011 ◽  
pp. 63-74
Author(s):  
R. K. Goyal ◽  
M. O’Neill ◽  
N. Agostinelli ◽  
P. Wyer
Keyword(s):  
Decision Making ◽  
Critical Illness ◽  
Emergency Room ◽  
Medical Futility ◽  
Critically Ill Patient ◽  
Industrial Complex ◽  
Acute Setting ◽  
Construction Of Knowledge ◽  
Military Industrial Complex ◽  
The Military

The care of the critically-ill patient in the acute setting, an ‘everyday’ occurrence in most urban emergency departments, often proceeds through the dictates of Parsonian paternalism: the Physician knows best. But through a discussion of three such ‘everyday’ encounters, we hope to complicate this notion and find a place for healthcare users in the decision making process while developing a language and analytic basis for thinking seriously about the clinical dyad and the construction of knowledge in relationship economies. Finally, we discuss the escalation and de-escalation (terms derived from the military industrial complex) of care as it relates to medical futility.

18. Administrative Justice: Tribunals and Ombuds

Public Law ◽  
2019 ◽  
pp. 558-611
Author(s):  
Andrew Le Sueur ◽  
Maurice Sunkin ◽  
Jo Eric Khushal Murkens
Keyword(s):  
Decision Making ◽  
Justice System ◽  
Court System ◽  
Initial Decision ◽  
Administrative Justice ◽  
Public Bodies

This chapter considers the main ways in which disputes between individuals and public bodies are resolved outside the court system in what is widely referred to as the landscape of ‘administrative justice’. The discussions cover initial decision-making; accessing the administrative justice ‘system’; and the two pillars of administrative justice—tribunals and ombuds.

scholarly journals 233 Potential Deprivation of Patient Liberty: A Qualitative Study of Current Practice Amongst Geriatricians in a Tertiary Setting

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Michelle O'Brien ◽  
Deirdre O'Donnell ◽  
Barbara Clyne
Keyword(s):  
Decision Making ◽  
Perceived Risk ◽  
Current Practice ◽  
Structured Interview ◽  
Structured Interviews ◽  
Healthcare Ethics ◽  
Patient Decision Making ◽  
Acute Setting ◽  
Difficult Decision ◽  
Patient Decision

Abstract Background The Assisted Decision Making (ADM) Act 2015 was introduced to support decision making and maximise a person’s capacity to make decisions but has not yet commenced. Within this context, medical professionals such as geriatricians must adjust from a best interest’s outlook to that of patient autonomy in response to the changing legislation. The aim of this study is to explore current geriatrician’s practice. In scrutinizing current practice, it will be evident as to what, if any, adaptations are required in order to practice in accordance with the new legislation. Methods Ten semi-structured interviews with individual consultant geriatricians were conducted, each lasting approximately 20 minutes on average in one hospital. Each interview was recorded and transcribed verbatim. The interview involved the geriatrician reading a vignette and answering questions as to how they would manage this situation. Following the vignette, the semi-structured interview proceeded covering topics including; patient decision making in the acute setting, deprivation of patient liberty in the acute setting, thoughts on the ADM (Capacity) Act 2015, and elements learned from experiences in other countries. A thematic analysis was conducted. Results Preliminary themes identified from the interviews include; (a) identification, accessibility and availability of medical and legal colleagues in assisting with difficult decision making, (b) need for clear frameworks, guidance and education in relation to laws applying to medical practice, (c) influence of environment, family, perceived risk and delirium on capacity assessment, (d) paternalism versus autonomy. This work is being conducted as part of a master’s in healthcare ethics and law. Conclusion Preliminary results highlight the need for collaborative communication between medics and the legal profession in order to achieve a structured and supportive framework to inform practice considering the new legislation.

scholarly journals “What Bothers Me Most Is the Disparity between the Choices that People Have or Don’t Have”: A Qualitative Study on the Health Systems Responsiveness to Implementing the Assisted Decision-Making (Capacity) Act in Ireland

2020 ◽  
Vol 17 (9) ◽  
pp. 3294 ◽  
Author(s):  
Éidín Ní Shé ◽  
Deirdre O’Donnell ◽  
Sarah Donnelly ◽  
Carmel Davies ◽  
Francesco Fattori ◽  
...  
Keyword(s):  
Decision Making ◽  
Older People ◽  
Healthcare System ◽  
Health Systems ◽  
Critical Incident ◽  
Family Carers ◽  
Acute Setting ◽  
Face To Face ◽  
Health And Social Care ◽  
Diagnosis Of Dementia

Objective: The Assisted Decision-Making (ADM) (Capacity) Act was enacted in 2015 in Ireland and will be commenced in 2021. This paper is focused on this pre-implementation stage within the acute setting and uses a health systems responsiveness framework. Methods: We conducted face-to-face interviews using a critical incident technique. We interviewed older people including those with a diagnosis of dementia (n = 8), family carers (n = 5) and health and social care professionals (HSCPs) working in the acute setting (n = 26). Results: The interviewees reflected upon a healthcare system that is currently under significant pressures. HSCPs are doing their best, but they are often halted from delivering on the will and preference of their patients. Many older people and family carers feel that they must be very assertive to have their preferences considered. All expressed concern about the strain on the healthcare system. There are significant environmental barriers that are hindering ADM practice. Conclusions: The commencement of ADM provides an opportunity to redefine the provision, practices, and priorities of healthcare in Ireland to enable improved patient-centred care. To facilitate implementation of ADM, it is therefore critical to identify and provide adequate resources and work towards solutions to ensure a seamless commencement of the legislation.

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