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E/M Medical Decision Making

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81. American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients with Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty

on low- or moderate-quality evidence. Conclusion. This guideline should help decision-making by clinicians and patients regarding perioperative antirheu- matic medication management at the time of elective THA or TKA. These conditional recommendations re?ect the paucity of high-quality direct randomized controlled trial data. INTRODUCTION Although the wide utilization of disease-modifying antirheu- matic drugs (DMARDs) and biologic agents has improved the quality of life for patients with rheumatoid (...) , WebMD, and UBM LLC (less than $10,000 each), research grants from Takeda andSavientandwasprincipalinvestigatorforaninvestigator- initiated study funded by Horizon through a grant to Dinora (morethan$10,000). Address correspondence to Susan M. Goodman, MD, Hospital for Special Surgery/Weill Cornell, 535 East 70th Street, New York, NY 10021. E-mail: goodmans@hss.edu. Submitted for publication September 26, 2016; accepted in revised form April 28, 2017. 1112 Goodman et al?are when the medications

2017 American College of Rheumatology

82. Folic Acid for the Prevention of Neural Tube Defects: Preventive Medication

. The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms. Rationale Importance Neural tube defects are major birth defects of the brain and spine that occur early in pregnancy due to improper closure (...) University, Durham, North Carolina); Alex H. Krist, MD, MPH (Fairfax Family Practice Residency, Fairfax, Virginia, and Virginia Commonwealth University, Richmond); Ann E. Kurth, PhD, RN, MSN, MPH (Yale University, New Haven, Connecticut); C. Seth Landefeld, MD (University of Alabama at Birmingham); Carol M. Mangione, MD, MSPH (University of California, Los Angeles); William R. Phillips, MD, MPH (University of Washington, Seattle); Maureen G. Phipps, MD, MPH (Brown University, Providence, Rhode Island

2017 U.S. Preventive Services Task Force

83. Jennifer McCaughan and Aisling E Courtney: Is balancing risk the most important skill in clinical medicine?

and stressful cases in the past can distort our decision making in the present. This has the potential to result in suboptimal patient management. The ability to objectively balance the many aspects (surgical, anaesthetic, medical, immunological, psychological) of the risk associated with a treatment against that of avoiding the treatment is an essential skill for physicians. The capacity to do this effectively for each individual patient is the cornerstone of personalised medicine and an attribute (...) Jennifer McCaughan and Aisling E Courtney: Is balancing risk the most important skill in clinical medicine? Jennifer McCaughan and Aisling E Courtney: Is balancing risk the most important skill in clinical medicine? - The BMJ ---> Every decision, both in life and in medicine, involves a balance of risk: the decision to go on holiday balances the risk of travelling to and staying in a foreign country against the benefit of a fortnight’s sunshine and relaxation; the decision to treat bacterial

2017 The BMJ Blog

84. Dr. Kelly Brogan’s e-book “Vaccines and Brain Health”: A cornucopia of antivaccine misinformation and pseudoscience

: As a passionate believer in the power of informed consent, I feel that we have a right to know the full breadth of available data so that we’re empowered to make our own decisions about our bodies and our children . As a practicing psychiatrist, my major concern is how vaccines affect brain health, behavior, and cognition. As a mother and a woman, I bring special entitlements to the conversation about bodily integrity, health choice freedom, and autonomy. To make your own judgment, it’s important (...) vaccines to specific physiologies. As each person contains a unique signature of interrelated characteristics, people can react in wildly different ways to the same vaccines. This is the sort of spinning of science that makes individual points that are true and weaves them into a misleading argument that, because biology is complicated and there is variability in response to a medical intervention, we might as well throw up our hands and do nothing until we find out how to quantify exactly how each

2017 Respectful Insolence

85. A Decision Aid: Goals of Care for Patients with Dementia #SDM

a patient is admitted to a long term care facility. This video has been added to the part of the Less is More Medicine site, where you will find lots of other shared decision-making tools. Hanson LC, Zimmerman S, Song M-K, Lin F-C, Rosemond C, Carey TS, et al. Effect of the Goals of Care Intervention for Advanced Dementia. JAMA Internal Medicine. 2017; 177(1):24-31 Source: In , Tags , , , , , , , , , , , articles and Original Commentary on the topic of "Less is More in Medicine" and The "Right Care (...) , at the University of North Carolina at Chapel Hill, and her colleagues were, in short, exploring the following: Question Can a decision aid intervention about goals of care improve communication, decision-making, and palliative care for patients with advanced dementia? Findings In this randomized trial of 302 nursing home residents with advanced dementia, family decision makers reported better end-of-life communication with clinicians. Clinicians were more likely to address palliative care in treatment plans

2017 Less is More in Medicine Blog

86. Use of Biomarkers to Guide Decisions on Systemic Therapy for Women With Metastatic Breast Cancer

- published online before print July 20, 2015 PMID: Use of Biomarkers to Guide Decisions on Systemic Therapy for Women With Metastatic Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline x Catherine Van Poznak , x Mark R. Somerfield , x Robert C. Bast , x Massimo Cristofanilli , x Matthew P. Goetz , x Ana M. Gonzalez-Angulo , x David G. Hicks , x Elizabeth G. Hill , x Minetta C. Liu , x Wanda Lucas , x Ingrid A. Mayer , x Robert G. Mennel , x William F. Symmans , x Daniel F (...) : informal consensus. Evidence quality: insufficient. Strength of recommendation: moderate.) ASCO believes that cancer clinical trials are vital to inform medical decisions and improve cancer care and that all patients should have the opportunity to participate. Many reviews and commentaries have discussed the nature of evidence required to support conclusions that using biomarker assay results to guide or influence treatment decisions improves health outcomes for patients with a malignancy. – Although

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2015 American Society of Clinical Oncology Guidelines

87. Choices about first trimester ultrasound scans: A decision aid for pregnant women

Choices about first trimester ultrasound scans: A decision aid for pregnant women Choices about first trimester ultrasound scans: A decision aid for pregnant womenThis decision aid has been written to support pregnant women to know what to expect and to have a say in making decisions about first trimester ultrasound scans. An ultrasound scan is when a small handheld device is used to create a picture of a woman’s uterus (womb) and baby during pregnancy. A first trimester ultrasound scan (...) ultrasound scan. » What happens if I choose to have a first trimester ultrasound scan. » Will I always be able to choose? » How might I choose between not having and having a first trimester ultrasound scan? » What are the differences between not having and having a first trimester ultrasound scan? » How can I make the decision that’s best for me? » How can I ask questions to get more information? Women may also be offered an ultrasound scan at other times in pregnancy. This decision aid provides

2015 EUnetHTA

88. Choices about clamping your baby?s umbilical cord: A decision aid for women having a vaginal birth

aid is not meant to give you medical advice or recommend a course of treatment and you should not rely on it to provide you with a recommended course of treatment. It is not intended and should not be used to replace the advice or care provided by your midwife, your doctor and/or your obstetrician. You should consult and discuss your treatment options with your midwife, your doctor and/ or your obstetrician before making any treatment decisions. The University of Queensland, its employees (...) Choices about clamping your baby?s umbilical cord: A decision aid for women having a vaginal birth Choices about clamping your baby’s umbilical cord: A decision aid for women having a vaginal birthThis decision aid has been written to support women having an actively managed third stage of labour to know what to expect and to have a say in making decisions about clamping their baby’s umbilical cord. An actively managed third stage of labour is when a woman is given Syntocinon® to help her birth

2015 EUnetHTA

89. Using a bath or pool during first stage labour: A decision aid for women having a vaginal birth

for Mothers & Babies. The Centre is an independent research centre based at The University of Queensland and funded by Queensland Health. The Centre does not stand to gain or lose anything by the choices you make after reading this decision aid. This decision aid has been developed to be consistent with International Patient Decision Aid Standards criteria for quality decision aids whereever possible. This decision aid is not meant to give you medical advice or recommend a course of treatment and you (...) Using a bath or pool during first stage labour: A decision aid for women having a vaginal birth Using a bath or pool during first stage labour: A decision aid for women having a vaginal birthThis decision aid has been written to support women who are wanting to have a vaginal birth to know what to expect and to have a say in making decisions about using a bath or pool during labour. This decision aid provides information about two options: 1. Not using a bath or pool during labour 2 Using

2015 EUnetHTA

90. Choices about epidural: A decision aid for women having a vaginal birth

Centre for Mothers & Babies. The Centre is an independent research centre based at The University of Queensland and funded by Queensland Health. The Centre does not stand to gain or lose anything by the choices you make after reading this decision aid. This decision aid has been developed to be consistent with International Patient Decision Aid Standards criteria for quality decision aids wherever possible. This decision aid is not meant to give you medical advice or recommend a course of treatment (...) Intensive Care Unit (a unit in the hospital for babies who need a high level of special medical care) [9] The chance of the baby having a low APGAR score (a score to assess a baby’s well-being after birth, a score lower than 7 means that a baby might need help breathing) five minutes after birth [9] The chance of feeling poor control in labour [9] What are the differences between not having an epidural and having an epidural? Continued... 12How can I make the decision that’s best for me

2015 EUnetHTA

91. Choosing how to birth your placenta: A decision aid for women having a vaginal birth

by Queensland Health. The Centre does not stand to gain or lose anything by the choices you make after reading this decision aid. This decision aid has been developed to be consistent with International Patient Decision Aid Standards criteria for quality decision aids whereever possible. This decision aid is not meant to give you medical advice or recommend a course of treatment and you should not rely on it to provide you with a recommended course of treatment. It is not intended and should not be used (...) Choosing how to birth your placenta: A decision aid for women having a vaginal birth Birthing your placenta Choosing how to birth your placenta: A decision aid for women having a vaginal birth. This decision aid has been written to support women who have a vaginal birth to know what to expect and to have a say in making decisions about the third stage of labour. The third stage of labour (or just the third stage) is the time from when a woman births her baby to when she births her placenta

2015 EUnetHTA

92. Choosing your positions during labour and birth: A decision aid for women having a vaginal birth

Centre for Mothers & Babies. The Centre is an independent research centre based at The University of Queensland and funded by Queensland Health. The Centre does not stand to gain or lose anything by the choices you make after reading this decision aid. This decision aid has been developed to be consistent with International Patient Decision Aid Standards criteria for quality decision aids whereever possible. This decision aid is not meant to give you medical advice or recommend a course of treatment (...) Choosing your positions during labour and birth: A decision aid for women having a vaginal birth Choosing your positions during labour and birth: A decision aid for women having a vaginal birthThis decision aid has been written to support women who are planning a vaginal birth to know what to expect and to have a say in making decisions about positions in labour and birth. This decision aid provides information about two options: 1. Being upright 2 Lying down This decision aid will also answer

2015 EUnetHTA

93. Choosing your model of care: A decision aid for pregnant women choosing their maternity care provider

to complete this work for the Queensland Centre for Mothers & Babies. The Centre is an independent research centre based at The University of Queensland and funded by the Queensland Government. The Centre does not stand to gain or lose anything by the choices you make after reading this decision aid. This decision aid has been developed to be consistent with International Patient Decision Aid Standards criteria for quality decision aids wherever possible. This decision aid is not meant to give you medical (...) Choosing your model of care: A decision aid for pregnant women choosing their maternity care provider Choosing your model of care A decision aid for pregnant women choosing their maternity care providerThis decision aid has been written to support women to know what to expect and to have a say in making decisions about their care during pregnancy, labour, birth and after birth. This decision aid provides information about four options: 1. Shared care 2. Public midwifery models of care 3

2015 EUnetHTA

94. Applying deep neural networks to unstructured text notes in electronic medical records for phenotyping youth depression

web-based system . 3. Kitterman DR , Cheng SK , Dilts DM , et al . The prevalence and economic impact of low-enrolling clinical studies at an academic medical center . 4. Schmickl CN , Li M , Li G , et al . The accuracy and efficiency of electronic screening for recruitment into a clinical trial on COPD . 5. Weng C , Batres C , Borda T , et al . A real-time screening alert improves patient recruitment efficiency . 6. Salem RM , Pandey B , Richard E , et al . The VA hypertension Primary Care (...) of publicly available Twitter data into several mental health diagnoses, including depression and bipolar disorder. A later publication identified patients with depression from free-text discharge summaries: a combination of NLP and ML algorithms was used, with the best performance coming from Medical Text Extraction, Reasoning and Mapping System's knowledge-based decision tree method, yielding an F-measure of 89.6%. To summarise the rationale for extracting diagnosis inclusion criteria from unstructured

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2017 Evidence-Based Mental Health

95. Shared Medical Appointments for Chronic Medical Conditions: A Systematic Review

John W Williams Jr., M.D., M.H.Sc., Director Shared Medical Appointments for Chronic Medical Conditions: A Systematic Review Investigators: Principal Investigator: David Edelman, M.D. Co-Investigators: Jennifer R. McDuffie, Ph.D. Eugene Oddone, M.D., M.H.Sc. Jennifer M. Gierisch, Ph.D., M.P .H. John W. Williams Jr., M.D., M.H.Sc. Research Associate: Avishek Nagi, M.S. Medical Editor: Liz Wing, M.A.i Shared Medical Appointments for Chronic Medical Conditions Evidence-based Synthesis Program PREFACE (...) . Comments on this evidence report are welcome and can be sent to Nicole Floyd, ESP Coordinating Center Program Manager, at nicole.floyd@va.gov. Recommended citation: Edelman D, McDuffie JR, Oddone E, Gierisch JM, Nagi A, Williams JW Jr. Shared Medical Appointments for Chronic Medical Conditions: A Systematic Review. VA- ESP Project #09-010; 2012. This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the Durham VA Medical Center, Durham, NC, funded

2012 Veterans Affairs Evidence-based Synthesis Program Reports

96. ROS1 Targeting With Crizotinib in Advanced E-cadherin Negative, ER Positive Lobular Breast Cancer or Diffuse Gastric Cancer Study

Pomerantz, Joaquim Bellmunt, Channing Yu, Zijie Sun, Sandy Srinivas, Philip W. Kantoff, Christopher Sweeney. An investigator-initiated phase I study of crizotinib in combination with enzalutamide in metastatic castration-resistant prostate cancer (mCRPC) before or after progression on docetaxel. in ASCO Annual Meeting. 2016. Chicago: J Clin Oncol. E. L. Kwak, D.R.C., J. Clark, G. I. Shapiro, R. G. Maki, M. J. Ratain, B. Solomon, Y. Bang, S. Ou, R. Salgia. Clinical activity observed in a phase I dose (...) ROS1 Targeting With Crizotinib in Advanced E-cadherin Negative, ER Positive Lobular Breast Cancer or Diffuse Gastric Cancer Study ROS1 Targeting With Crizotinib in Advanced E-cadherin Negative, ER Positive Lobular Breast Cancer or Diffuse Gastric Cancer Study - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have

2018 Clinical Trials

97. Off-label prescribing of psychotropic medication to children and adolescents

choosing an off-label medication in preference to a licensed one, a non-pharmacological treatment or no treatment at all. The purpose of off-label use is to benefit the individual patient. Practitioners use their professional judg- ment to determine these uses. As such, the term off-label does not imply an improper, illegal, contraindicated or investigational use. ‘Therapeutic decision making must always rely on the best avail- able evidence and balance this against the risks and benefits (...) , Institute of Psychiatry, Psychology and Neurosciences, King’s College London, London, UK 10 University of Nottingham and Institute of Mental Health, Developmental Psychiatry, Queen’s Medical Centre, Nottingham, UK Corresponding author: Chris Hollis, University of Nottingham and Institute of Mental Health, Developmental Psychiatry, South Block, E Floor, Queen’s Medical Centre, Nottingham NG7 2UH, UK. Email: chris.hollis@nottingham.ac.uk 636107 JOP0010.1177/0269881116636107Journal

2017 British Association for Psychopharmacology

98. Medical Assistance in Dying (MAID) in the ED: Implications for EM Practice

. 1996;3(10):938-945. [ ] 25. Leeman C. Distinguishing among irrational suicide and other forms of hastened death: implications for clinical practice. Psychosomatics . 2009;50(3):185-191. [ ] 26. Heinrich R, Morgan M, Rottman S. Advance directives, preemptive suicide and emergency medicine decision making. Narrat Inq Bioeth . 2011;1(3):189-197. [ ] (Visited 2,227 times, 1 visits today) Francis Bakewell Dr. Francis Bakewell is an 4th year Emergency Medicine resident at the University of Ottawa (...) conceivable in the form of a loved one or substitute decision maker (SDM) bringing in an unconscious or minimally conscious patient and asking for them to be resuscitated, insisting that they changed their mind after ingesting a medication at home. The ED physician may be torn between wondering if it is in fact the SDM who is having second thoughts, while also not wanting to withhold treatment from a patient who may genuinely have changed their mind. Organizational policies on resolving end-of-life care

2016 CandiEM

99. AACE/ACE/AME Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules

Nodules are systemati- cally developed statements to assist health care professionals in medical decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. The first edition of the AACE/ACE/AME Guidelines for the Diagnosis and Management of Thyroid Nodules was published in 2006 after extensive review of the literature by representatives of endocrinologists, endocrine surgeons, and thyroid (...) tools and treatments, and addresses avoiding unneces - sary diagnostic procedures and risk of medical or surgical overtreatment. The importance of patient information and participation in clinical decision making and the role of a multidisciplinary approach to thyroid nodular disease are fully considered. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revision is inevitable. We

2016 American Association of Clinical Endocrinologists

100. Clearing the Smoke on Cannabis: Medical Use of Cannabis and Cannabinoids ? An Update

Clearing the Smoke on Cannabis: Medical Use of Cannabis and Cannabinoids ? An Update Key Points • Healthcare practitioners need access to the best available scientific evidence to help patients make informed decisions about the medical use of cannabis and cannabinoids. There is a great need for well-designed prospective clinical trials in Canada that assess the efficacy of cannabis and cannabinoids in treating various conditions. • Evidence suggests that cannabis and cannabinoids are effective (...) cannabis improved their pain relief significantly. However, most of those patients had previously used cannabis non-medically, and it was not clear whether the improvement on adding cannabis to the opioid treatment was really due to better pain relief or to improved emotional outlook (Degenhardt et al., 2015). Adverse Effects Very little research has been conducted on the risks associated with the medical use of cannabis, making it challenging for physicians to discuss this concern with their patients

2016 Canadian Centre on Substance Abuse

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