Group items tagged

"WHAT TO DO WHEN A PATIENT LACKS CAPACITY - The degree and urgency with which to act on findings of impaired capacity depends on multiple factors, including the expected duration of impairment, the severity of the impairment, and the seriousness of the decision. Unless the urgency of a patient's medical condition requires that a substituted decision be made immediately, efforts should be made to identify and correct any reversible causes of the impairment [26]. This is particularly relevant in hospitalized patients with impaired capacity due to delirium. Treatment of the underlying causes of delirium may restore decision-making capacity. Patients with mild to moderate cognitive impairment that is not expected to fluctuate may benefit from more intensive efforts at education to improve understanding of the relevant facts, followed by reassessment of decision-making abilities. A randomized trial found that a memory and organizational aid given to patients with mild stage Alzheimer disease dementia (n = 80) improved performance on understanding, which in turn increased the likelihood of being judged capable of providing informed consent to enroll in a clinical trial [34]. This enhancement was also effective in a randomized trial with middle-aged and older adults with schizophrenia [35]. For patients whose impairments are severe enough that they are judged to lack the capacity to make a decision, there is a clear ethical obligation to seek out a substitute decision maker. Substitute or surrogate decision makers should ideally have been chosen by the patient in advance. In the absence of a designated surrogate, laws may vary in terms of which people can serve in this proxy role and their hierarchy; in general, the order is the spouse, adult children, parents, siblings, and other relatives. (See "Legal aspects in palliative and end of life care", section on 'Surrogate decision makers'.) When making a substituted decision, the proxy should take into consideration

"These patient decision aids (PDAs) have been developed to help support difficult decisions in which patients need to consider benefits versus risks. Decision aids prepare patients for decision-making by increasing their knowledge about expected outcomes and personal values. The PDAs are based on the best available evidence but are not a substitute for a discussion with a suitably skilled healthcare professional. We hope that their use in such discussions will result in better informed, patient-focused decision-making. "

"Thirty are catalogued in this article, together with descriptions of their properties as well as the impact they have on clinical decision making in the ED. Strategies are delineated in each case, to minimize their occurrence. Detection and recognition of these cognitive phenomena are a first step in achieving cognitive de-biasing to improve clinical decision making in the ED."

"The two major products of clinical decision making are diagnoses and treatment plans. If the first is correct, the second has a greater chance of being correct too. Surprisingly, we don't make correct diagnoses as often as we think: the diagnostic failure rate is estimated to be 10 to 15%. "

" We stress the importance of ambient and contextual influences on the quality of individual decision making and the need to address factors known to impair calibration of the decision maker. We also emphasise the importance of introducing these concepts and corollary development of training in critical thinking in the undergraduate level in medical education. "

Isabel is an award-winning, clinical decision support system designed to enhance the quality of diagnosis decision making. Its unique feature is a diagnosis reminder system.For a given set of clinical features Isabel instantly provides a checklist of likely diagnoses including bio-terrorism conditions, related diagnoses and causative drugs.

"Compared to conscious processing, unconscious processing significantly increased the number of correct classifications. The results show the potential merits of unconscious processing in diagnostic decision making. "

"We are a non-profit organization advancing research, policy, and clinical models that assure patients are fully informed and involved in decisions that affect their health and well-being."

"Peer assessment of teaching can improve the quality of instruction and contribute to summative evaluation of teaching effectiveness integral to high-stakes decision making. There is, however, a paucity of validated, criterion-based peer assessment instruments. The authors describe development and pilot testing of one such instrument and share lessons learned"

"Although a physicians is not traditionally thought of as a Knowledge Worker, I think we should explore how the Internet changes the way we connect, learn, and make decisions."

"Nine organizations involved in postgraduate medical education and experts from across Canada have joined together to produce a groundbreaking report outlining pan-Canadian principles, key findings, recommendations and metrics to inform decision-making about resident duty hours across the country. Supported by Health Canada, the final report, Fatigue, Risk and Excellence: Towards a Pan-Canadian Consensus on Resident Duty Hours, includes five principles and detailed recommendations that are intended to outline a path forward that optimizes patient care and training for the 21st century."

"Assessment can be defined as "the process of collecting, synthesizing and interpreting information to aid decision making."1 Key to this process is: Mapping the assessment to the learning objective; and Mapping the assessment instrument to the sophistication of learning being tested."

"Problem-based learning (PBL) serves as an educational method to foster self-directed learning, integration across disciplines, small-group learning and decision-making strategies. The approach is student centred."

"It's not just patients who can learn from tools that help them make evidence-based decisions. Assessing patients' understanding of the information provided and the reasons for their health care choices has been an educational experience for Dale Collins Vidal, MD, director of the Center for Informed Choice at Dartmouth Medical School in Hanover, New Hampshire."

"Teaching clinical reasoning is important and feasible. Teachers who explicitly teach problem solving and decision making may help learners to improve their diagnostic accuracy and treatment choices."

"In this blog, we discussed diagnostic tests and their relationship with likelihood ratios as well as heuristics and cognitive errors."

"Our experience with the calculators shows that it helps surgeons improve the quality of care they provide their patients because it improves shared decision making and patient-centered informed consent."

"A large number of medical residents are unable to correctly interpret crucial statistical concepts that are commonly found in the medical literature. They are also especially prone to the gambler's fallacy bias, which may undermine clinical judgment and medical decision making. Formalized systematic teaching of biostatistics during residency will be required to de-bias residents and ensure that they are proficient in understanding and communicating statistical information."