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E/M Medical Decision Making


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101. Routine psychosocial care in infertility and medically assisted reproduction ? A guide for fertility staff

infertility. Hum Reprod 2012;27: 488-495. Boivin J, Appleton TC, Baetens P, Baron J, Bitzer J, Corrigan E, Daniels KR, Darwish J, Guerra-Diaz D, Hammar M, McWhinnie A, Strauss B, Thorn P, Wischmann T, Kentenich H, European Society of Human Reproduction and Embryology. Guidelines for counselling in infertility: outline version. Hum Reprod 2001;16: 1301-1304. Boivin J, Domar AD, Shapiro DB, Wischmann TH, Fauser BC, Verhaak C. Tackling burden in ART: an integrated approach for medical staff. Hum Reprod (...) to the emotional impact of infertility.(A) • that both partners are involved in the treatment process.(A) • being involved in decision-making.(A) • receiving psychosocial care from sensitive and trustworthy staff members.(A) • receiving attention to their distinct needs related to their medical history.(B) Clinic characteristics Fertility staff should be aware that patients value • minimal waiting times, not being hurried in medical consultations, and continuity of care.(A) • the professional competence

2015 European Society of Human Reproduction and Embryology

102. Medication Reconciliation at Discharge

and analyzes information about how a health intervention fits within current practice and existing treatment alternatives. Details about the diffusion of the intervention into current health care practices in Ontario add an important dimension to the review. Information concerning the health benefits, economic and human resources, and ethical, regulatory, social, and legal issues relating to the intervention may be included to assist in making timely and relevant decisions to optimize patient outcomes (...) Oct 5;141(7):533-6. (6) Hughes RG. Tools and strategies for quality improvement and patient safety. In: Hughes RG, ed. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008. Available from: (7) Pronovost P, Weast B, Schwarz M, Wyskiel RM, Prow D, Milanovich SN, et al. Medication reconciliation: a practical tool to reduce the risk of medication errors. J Crit Care. 2003 Dec

2015 Health Quality Ontario

103. What is the effectiveness of motivational interviewing in changing risk behaviours (e.g. sex, drug use, medication adherence) for people living with HIV?

Interventions that make use of motivational interviewing can be effective in changing risk behaviours for people living with HIV (1-18); the longer the motivational interviewing intervention, the more it may help intervention participants to maintain healthier practices over time (19). For people living with HIV, motivational interviewing can have a positive effect on medication adherence (1;6-9;15;17;18), sexual risk behaviours (3-5;10;11), drug use (2;12;14), and numerous outcomes at the same time (13;16 (...) ambivalence they may feel and to encourage them to make healthy decisions for themselves that are aligned with their own values, beliefs and concerns. As a result, decisions are made by the individual for the individual rather than by an outside party. What We Found We found many studies reporting the efficacy of motivational interviewing interventions in changing behaviours among people living with HIV. Desired outcomes included better adherence (1;6-9;15;17;18), a decrease in sexual risk behaviours (3

2014 Ontario HIV Treatment Network

104. Reprocessing of Single-Use Medical Devices

nation’s legislation regulates this practice differently throughout Europe. For example, in Germany, the existing regulatory framework addresses only quality standards and validated procedures for reprocessing and makes no legal distinction between single- and multiple-use medical devices. 22 Both in-house and third-party reprocessing are allowed but must conform to German regulations on reprocessing, which stipulate that institutions reprocessing SUMDs must adopt and implement a quality management (...) of International Conference on Nosocomial Infections. Chicago: American Hospital Association; 1970. p. 254-74. 3. Hailey D, Jacobs PD, Ries NM, Polisena J. Reuse of single use medical devices in Canada: clinical and economic outcomes, legal and ethical issues, and current hospital practice. Int J Technol Assess Health Care. 2008;24(4):430-6. 4. Canadian Agency for Drugs and Technologies in Health. Supporting informed decisions reprocessing of single-use medical devices: national survey of Canadian acute-care

2015 Canadian Agency for Drugs and Technologies in Health - Rapid Review

105. E/M Emergency Services

E/M Emergency Services E/M Emergency Services Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 E/M Emergency Services E/M Emergency (...) Services Aka: E/M Emergency Services , E/M Emergency , CPT 99281 , CPT 99282 , CPT 99283 , CPT 99284 , CPT 99285 II. Indication Emergency Department Services III. Approach Know your intended level of service from the start and document to meet that level of service HPI Code 99281 - 99283: Requires 1 of 8 component Code 99284 - 99285: Requires 4 of 8 components ROS Code 99281: Requires 0 component Code 99282 - 99283: Requires 1 component Code 99284: Requires 2 components Code 99285: Requires 10

2015 FP Notebook

106. Who Decides When a Patient Can’t? Statutes on Alternate Decision Makers (PubMed)

(D.M.D., D.B.K.), and the Richard A. and Susan F. Smith Center for Outcomes Research, Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center (D.B.K.) - all in Boston. Dudzinski David M DM From the Division of Pulmonary and Critical Care Medicine (E.S.D.), the Biomedical Ethics Research Program (E.S.D., B.P.S., P.S.M.), and the Division of General Internal Medicine (P.S.M.), Mayo Clinic, Rochester, MN; the MacLean Center for Clinical Medical Ethics, University of Chicago (...) in Chicago; the Departments of Medicine and Philosophy, Georgetown University, Washington, DC (D.P.S.); and the Division of Cardiology, Massachusetts General Hospital (D.M.D.), Harvard Medical School (D.M.D., D.B.K.), and the Richard A. and Susan F. Smith Center for Outcomes Research, Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center (D.B.K.) - all in Boston. Gregory Sarah E SE From the Division of Pulmonary and Critical Care Medicine (E.S.D.), the Biomedical Ethics

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2017 The New England journal of medicine

107. The false promises of shared decision making in rehabilitation

The false promises of shared decision making in rehabilitation The false promises of shared decision making in rehabilitation Research into the role of the brain and mind in chronic pain The false promises of shared decision making in rehabilitation October 25, 2016 by In the recent years, Shared Decision Making (SDM) has been increasingly advocated as an ideal model of treatment decision-making during the medical encounter, as it has been shown to increase benefits for both clinicians (...) pain in vulnerable populations (ie: elderly, critical care). References [1] Oshima Lee E, Emanuel EJ. Shared decision making to improve care and reduce costs. The New England journal of medicine [Internet]. 2013;368(1):6–8. Available from:\n\n [2] Legare F, Witteman HO. Shared decision making: examining key elements and barriers to adoption into routine

2016 Body in Mind blog

108. Towards a guided and phased introduction of high-risk medical devices in Belgium

-risk medical devices 1 ¦ FOREWORD If we genuinely want to nail our colours to the patient rights' mast - as we are all supposed to do - then it is high time that we pull up our socks when it comes to obtaining patients' informed consent and supporting patients' preferences. All too often, a patient's so-called informed choice makes for nothing other than a woeful caricature. A polite request to sign, here, at the bottom of this incomprehensible form, and that's the end of it. To be fair (...) (SANTE) to the Directorate-General for the Internal Market, Industry, Entrepreneurship and SMEs (GROW). International protest caused the decision regarding medicinal products to be reversed because Juncker agreed that these goods are not like any others. What we fail to understand however is why medical devices should be treated any differently. It all points to the fact that economic forces, backed by certain powerful Member States, are at work behind the scenes. With the result that the initially

2015 Belgian Health Care Knowledge Centre

109. American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for Comprehensive Medical Care of Patients with Obesity

; Elise M. Brett, MD, FACE, CNSC, ECNU 3 ; Alan J. Garber, MD, PhD, FACE 4 ; Daniel L. Hurley, MD, FACE 5 ; Ania M. Jastreboff, MD, PhD 6 ; Karl Nadolsky, DO 7 ; Rachel Pessah-Pollack, MD 8 ; Raymond Plodkowski, MD 9 ; and Reviewers of the AACE/ACE Obesity Clinical Practice Guidelines* American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice are systematically devel- oped statements to assist health care professionals in medical decision-making for specific clinical (...) recommendations allow for nuanced clinical decision-making that addresses real-world medical care of patients with obesity, includ- ing screening, diagnosis, evaluation, selection of therapy, treatment goals, and individualization of care. The goal is to facilitate high-quality care of patients with obesity and provide a rational, scientific approach to management that optimizes health outcomes and safety. (Endocr Pract. 2016;22:Supp3;1-205) Abbreviations: A1C = hemoglobin A1c; AACE = American Association

2016 American Association of Clinical Endocrinologists

110. 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

111. 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

112. 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

113. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 15: Legal Aspects of Medical Eligibility and Disqualification Recommendations

that the exclusion or disqualification of an individual was individualized, reasonably made, and based upon competent medical evidence. . . . [W]e wish to make clear that we are not saying Northwestern’s decision is necessarily the right decision. We say only that it is not an illegal one under the Rehabilitation Act.” The court recognized that one of the factors a physician may rely on is then-current consensus medical guidelines: “Although the Bethesda Conferences were not convened by public health officials (...) to exclude Knapp from its basketball team was legally justified: “We do not believe that, in cases where medical experts disagree in their assessment of the extent of a real risk of serious harm or death, Congress intended that the courts—neutral arbiters but generally less skilled in medicine than the experts involved—should make the final medical decision. Instead, in the midst of conflicting expert testimony regarding the degree of serious risk of harm or death, the court’s place is to ensure

2015 American Heart Association

114. Improving Adherence to Therapy and Clinical Outcomes While Containing Costs: Opportunities From the Greater Use of Generic Medications: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians

in the management of chronic disease, yet physicians and other providers frequently treat patients with more expensive brand-name products even when equally effective, well-proven, and less expensive generic therapies are available ( ). The purpose of this article is to help guide internists and other clinicians in making high-value, cost-conscious decisions about the use of generic drugs. This review sought to address 5 questions: 1) How commonly are brand-name medications used when a generic version (...) in the prescription of generics and medications in the lowest cost-sharing tier of the plans' incentive formularies. Further, an interrupted time-series analysis of a decision-support tool introduced by a large academic medical center into an e-prescribing system specifically to promote generic substitution found an absolute increase in generic drug use of more than 20% that was sustained for more than 2 years after the intervention went into effect ( ). Interactive forms of continuing medical education

2015 American College of Physicians

115. Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications

ASA (aspirin), the platelet effects of these drugs are directly related to systemic plasma drug concentrations and influenced by the pharmacokinetic clearance of these medications. Once steady-state concentrations have been achieved, terminal half-life is a predictive time parameter to guide decision making. For NSAIDs, terminal half-lives and half-lives are interchangeable and equivalent. Because NSAIDs are well absorbed and absorption is not the limiting factor, half-life is more dependent (...) syndrome. Because of the lack of effect on platelet function with COX-2 selective inhibitors and perioperative bleeding risks, these medications do not need to be stopped. | Summary recommendation for aspirin A patient- and procedural-specific strategy is recommended when deciding whether to continue or discontinue aspirin in the perioperative period for interventional pain procedures. Decision making should include an understanding of the reason for aspirin utilization, vascular anatomy surrounding

2015 American Society of Regional Anesthesia and Pain Medicine

116. A Practice Guideline from the American College of Medical Genetics and Genomics and the National Society of Genetic Counselors: Referral Indications for Cancer Predisposition Assessment

of Genetic Counselors (NSGC) are developed by members of the ACMG and NSGC to assist medical geneticists, genetic counselors, and other health-care providers in making decisions about appropriate management of genetic concerns, including access to and/or delivery of services. Each practice guideline focuses on a clinical or practice-based issue and is the result of a review and analysis of current professional literature believed to be reliable. As such, information and recom- mendations within the ACMG (...) by qualified clinicians has been associated with negative patient and societal outcomes such as misinterpretation of genetic test results, inappropriate medical management, lack of informed decision making, viola- tion of established ethical standards, adverse psychosocial out- comes, and costly, unnecessary genetic testing. 1–3 Cancer genetic consultation is an important aspect of the care of individuals at increased risk of a hereditary cancer syn- drome. 4–8 Yet, several patient, clinician, and system

2015 American College of Medical Genetics and Genomics

117. Systematic review of needs for medical devices for ageing populations

Systematic review of needs for medical devices for ageing populations Systematic review of needs for medical devices for ageing populations Commissioned to the Australian Safety and Ef? cacy Register of New Interventional Procedures – Surgical (ASERNIP-S) by the World Health Organization (WHO) Department of Essential Medicines and Health Products World Health Organization 20 Avenue Appia CH-1211 Geneva 27 Switzerland Tel: +41 22 791 21 11 E-mail: (...) a foundation for future decisions, a detailed mapping of the need for medical devices for older people in the region is to be conducted. This will determine the technological needs for diagnosis and treatment of the diseases of this population. Further research and surveys will be conducted at a country-by-country level to ascertain the availability and affordability of these devices. For low-income countries and low- resource settings, needs of priority core devices will be defined, especially for devices


118. Medical eligibility criteria for contraceptive use

Medical eligibility criteria for contraceptive use Department of Reproductive Health and Research World Health Organization Avenue Appia 20, CH-1211 Geneva 27 Switzerland Fax: +41 22 791 4171 E-mail: For more information, please contact: COCs Barrier methods IUDs Fertility awareness-based methods Lactational Coitus interruptus Copper IUD for amenorrhoea Patch Female surgical sterilization Intrauterine devices CICs emergency contraception (...) characterstics; primarily, whether the contraceptive method worsens the medical condition or creates additional health risks, and secondarily, whether the medical circumstance makes the contraceptive method less effective. The safety of the method should be weighed along with the benefits of preventing unintended pregnancy. This fifth edition of the MEC is divided into two parts. Part I describes how the recommendations were developed and Part II contains the recommendations and describes how to use them

2015 World Health Organisation Guidelines

119. Optimal Arrangements for Neonatal Intensive Care Units in the UK including guidance on their medical staffing

provided in many local units in each region which is not the case in many other developed countries. Following the DH review of Neonatal Intensive Care in 2003 [6], there was a move to provide this service within regional networks. This decision was made because of the need to provide better services for babies 4 and families, improve outcomes and make the best use of available resources. Some evidence of the improved outcomes of larger units compared with smaller ones was considered in making (...) Optimal Arrangements for Neonatal Intensive Care Units in the UK including guidance on their medical staffing BRITISH ASSOCIATION OF PERINATAL MEDICINE Optimal Arrangements for Neonatal Intensive Care Units in the UK including guidance on their Medical Staffing A Framework for Practice June 2014 2 Members of the working group Chair: Dr Steve Jones, Consultant Neonatologist, Bath (appointed by BAPM’s Executive Committee) Members (self-nominated from BAPM membership and approved by Executive

2014 British Association of Perinatal Medicine

120. Beyond consent--the ethics of decision-making in emergency medicine. (PubMed)

Beyond consent--the ethics of decision-making in emergency medicine. 847978 1977 05 12 2018 11 13 0093-0415 126 2 1977 Feb The Western journal of medicine West. J. Med. Beyond consent--the ethics of decision-making in emergency medicine. 156-9 Tait K K Winslow G G eng Journal Article United States West J Med 0410504 0093-0415 E IM Decision Making Emergency Medicine Ethics, Medical Humans Informed Consent Paternalism Personal Autonomy Wounds and Injuries therapy 06292 KIE BoB Subject Heading (...) : PROLONGATION OF LIFE/EMERGENCY CARE Full author name: Tait, Karen M Full author name: Winslow, Gerald 1977 2 1 1977 2 1 0 1 1977 2 1 0 0 ppublish 847978 PMC1237490 JAMA. 1974 Jul 8;229(2):172-6 4406917 N Engl J Med. 1974 Apr 18;290(16):907-8 4816967 J Leg Med (N Y). 1975 Oct;3(9):15-9 1081111 Hastings Cent Rep. 1975 Jun;5(3):9-10, 47 1150424 J Pediatr. 1975 Aug;87(2):327-8 1151575 J Trauma. 1975 Feb;15(2):94-8 1113362 Neb Law Rev. 1975;54(1):66-92 11664487 New Engl Law Rev. 1974 Winter;9(2):293-310

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1977 Western Journal of Medicine

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