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E/M Medical Decision Making

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101. 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

102. Vitamin E infused Polyethylene Liners, Regular Polyethylene Liners, Cross-Linked Polyethylene Liners for Knee Articular Surfacing in Adults : A Review of Clinical Effectiveness and Cost Effectiveness

of polymer. It is believed the process of crosslinking may reduce fracture strength or toughness and fatigue resistance. 4,5 It has been suggested these factors could make individuals uneasy when selecting highly cross- linked polyethylene in TKA. 4 However, some sources suggest cross-linking increases wear resistance of polyethylene knee bearing by as much as 100 fold. 5 The addition of vitamin E to the polyethylene “cushion” component of knee resurfacing could be a promising approach to increase (...) to observe typical proportions of failures observed over a long-term period in the real world; as a result, the findings of the studies may have limited external validity. In addition, because none of the included studies were conducted in Canada, it is unclear if the surgical techniques used in the studies are generalizable to Canadian setting. CONCLUSIONS AND IMPLICATIONS FOR DECISION OR POLICY MAKING There was no evidence to suggest a difference in revision surgery/failure between highly cross- linked

2012 Canadian Agency for Drugs and Technologies in Health - Rapid Review

103. Hillary Clinton is “medically unfit to serve” as President and Donald Trump has narcissistic personality disorder: Stop this uninformed medical speculation about the candidates!

and Donald Trump has narcissistic personality disorder: Stop this uninformed medical speculation about the candidates! By on August 18, 2016. I’ve been debating whether to write about this for a while now, given that the first article that I noticed about it was first published a week and a half ago. Part of the reason for my reluctance is that it would be too easy for politics to be dragged into this more than I generally like. Of course, I don’t make a secret of my political leanings, but I usually (...) don’t go out of my way to be an explicitly political blogger. I do, however, frequently write about areas where science and medicine intersect, and when I do I always come down on the side of science and rationality. This brings us to a trope that has popped up in the media that Hillary Clinton is somehow “medically unfit” to be President. I first learned of this smear on August 10, when I found the latest e-mail release from the American Association of Physicians and Surgeons (AAPS), written by its

2016 Respectful Insolence

104. People with severe mental illness have more adverse outcomes from medical or surgical treatment

strong evidence that adverse outcomes occur for people with SMI when being treated surgically or medically in hospital. Understanding the range of factors that could contribute to poorer quality care could have greater implications for clinical practice. Conflicts of interest None. We need to understand the full range of factors that contribute to poorer quality physical health care for people with severe mental illness. Links Primary paper Reeves E, Henshall C, Hutchinson M, Jackson D. (2018) . Int (...) that service-users and clinicians views of their physical health is not concordant (Renwick et al., 2018); while this evidence is relevant it is just one piece of a complicated puzzle of factors driving inequitable healthcare delivery, acceptance and receipt. Much more research is needed to illuminate service-users and clinicians beliefs and attitudes towards treatment to understand clinical and shared decision-making. In summary, the delivery of care is often delayed and inconsistently delivered

2018 The Mental Elf

105. 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

106. Comparing data accuracy between structured abstracts and full-text journal articles: implications in their use for informing clinical decisions

of search behaviour in a medical teaching hospital . Marcelo A , Gavino A , Isip-Tan IT , et al . A comparison of the accuracy of clinical decisions based on full-text articles and on journal abstracts alone: a study among residents in a tertiary care hospital . Winker MA . The need for concrete improvement in abstract quality . Read MEDLINE abstracts with a pinch of salt . Barry HC , Ebell MH , Shaughnessy AF , et al . Family physicians’ use of medical abstracts to guide decision making: style (...) Association Journal and the Journal of the American Medical Association: a 10-year follow-up study . Sackett DL , Rosenberg WM , Gray JA , et al . Evidence based medicine: what it is and what it isn't . McGowan J , Hogg W , Campbell C , et al . Just-in-time information improved decision-making in primary care: a randomized controlled trial . Crowley SD , Owens TA , Schardt CM , et al . A Web-based compendium of clinical questions and medical evidence to educate internal medicine residents . Westbrook JI

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2013 Evidence-Based Medicine (Requires free registration)

107. 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

108. 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

109. 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: http://www.ncbi.nlm.nih.gov/books/NBK2682/ (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

110. 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

111. 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

112. Nabilone for Non-chemotherapy-Associated Nausea and Weight Loss Due to Medical Conditions

of weight loss due to medical conditions or for the treatment of non-chemotherapy associated nausea and vomiting. CONCLUSIONS AND IMPLICATIONS FOR DECISION OR POLICY MAKING One low quality RCT and one low quality cohort study assessed the clinical effectiveness of nabilone in the treatment of non-chemotherapy associated nausea and vomiting or weight loss related to medical conditions, respectively. While both studies supported the use of nabilone for these indications, they had multiple limitations (...) www.cadth.ca Nabilone for Nausea or Weight Loss 8 REFERENCES 1. Ben Amar M. Cannabinoids in medicine: a review of their therapeutic potential. J Ethnopharmacol. 2006 Apr 21;105(1-2):1-25. 2. e-CPS [Internet]. Ottawa: Canadian Pharmacists Association; 2009 -. Cesamet®; 2009 [cited 2014 Aug 29]. Available from: https://www.e-therapeutics.ca Subscription required. 3. Keeley PW. Nausea and vomiting in people with cancer and other chronic diseases. Clin Evid (Online) [Internet]. 2009 [cited 2014 Sep 9

2014 Canadian Agency for Drugs and Technologies in Health - Rapid Review

113. Electronic Medical Records (EMR) and Quality of Care

transitions to the new EMR. It’s a time of possibility and excitement as well as apprehension. However, we all have the opportunity to use this technology to improve our own practices and, ultimately influence more positive patient outcomes. Gill, J. M. (2009). EMRs for improving quality of care: promise and pitfalls. Family Medicine , 41 (7), 513–515. Hsiao, C. J., Marsteller, J. A., & Simon, A. E. (2014). Electronic Medical Record Features and Seven Quality of Care Measures in Physician Offices (...) . American Journal of Medical Quality , 29 (1), 44–52. doi:10.1177/1062860613483870 Lau, F., Lau, F., Price, M., Price, M., Boyd, J., Boyd, J., et al. (2012). Impact of electronic medical record on physician practice in office settings: a systematic review. Management Science , 36 (2), 123–139. doi:10.1186/1472-6947-12-10 Menachemi, N., & Collum. (2011). Benefits and drawbacks of electronic health record systems. Risk Management and Healthcare Policy , 47. doi:10.2147/RMHP.S12985 Menachemi, N., Ford, E

2018 Evidence-Based Nursing blog

114. 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

115. Making Cancer Less Painful for Kids

cancer-related pain in children using both pharmacologic (e.g., medications) and non-pharmacologic (e.g., distraction, relaxation) methods. It is understood that most cancer-related pain can be effectively managed with a variety of techniques[8], yet, children with cancer continue to report pain throughout the course of their disease.[9] The problem is that much of the research on effective pain management never makes it into the hands of parents, who are becoming increasingly responsible (...) Making Cancer Less Painful for Kids Making Cancer Less Painful for Kids • Body in Mind Research into the role of the brain and mind in chronic pain Making Cancer Less Painful for Kids July 12, 2016 by New advances in cancer therapies have drastically improved the prognosis for children diagnosed with cancer. Forty years ago, children were only given a 58% chance of living 5 years after a cancer diagnosis. Today, that number as soared to over 80% of children surviving 5 years.[1] Children

2016 Body in Mind blog

116. 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

117. Energy Balancing Modeling and Mobile Technology to Support e-Weight Loss

this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Layout table for eligibility information Ages Eligible for Study: 18 Years to 70 Years (Adult, Older Adult) Sexes Eligible for Study: All Accepts Healthy Volunteers: No Criteria Inclusion Criteria: Body mass index (BMI) between 27 and 45 kg/m^2 Exclusion Criteria: Self-report of health problems that make weight loss or unsupervised exercise unsafe or unreasonable A heart (...) Energy Balancing Modeling and Mobile Technology to Support e-Weight Loss Energy Balancing Modeling and Mobile Technology to Support e-Weight Loss - 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 reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Energy

2016 Clinical Trials

118. External validation of clinical prediction models using big datasets from e-health records or IPD meta-analysis: opportunities and challenges. (PubMed)

ST5 5BG, Staffordshire, UK r.riley@keele.ac.uk. Ensor Joie J Research Institute for Primary Care and Health Sciences, Keele University, Keele ST5 5BG, Staffordshire, UK. Snell Kym I E KI Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK. Debray Thomas P A TP Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands Cochrane Netherlands, University Medical Center Utrecht, Utrecht, Netherlands. Altman Doug G DG (...) Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK. Moons Karel G M KG Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands Cochrane Netherlands, University Medical Center Utrecht, Utrecht, Netherlands. Collins Gary S GS Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University

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2016 BMJ (Clinical research ed.)

119. National Mobile Asthma Management System-E Project

National Mobile Asthma Management System-E Project National Mobile Asthma Management System-E Project - 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 reached the maximum number of saved studies (100). Please remove one or more studies before adding more. National Mobile Asthma Management System-E Project (...) years, application softwares of mobile-phones for asthma have gradually increased, studies suggested that application of these application softwares can make treatment more standard, reduce asthma attacks, help patients to control their asthma, improve adherence and these application softwares also show many other advantages. This study is a prospective, multi center, randomized, controlled study, aims to evaluate the efficacy of application softwares in asthma patients, provide a new tool to asthma

2016 Clinical Trials

120. Real-Time Monitoring and Evaluation of a Visual-Based Cervical Cancer Screening Program Using a Decision Support Job Aid (PubMed)

aggregated statistics were broadcast on a public website. Screening organizations were able to assess the number of patients screened, alongside treatment rates, and the patients who tested positive and required treatment in real time, which allowed them to make adjustments as needed. The real-time M&E enabled by "smart" diagnostic medical devices holds promise for broader use in screening programs in low-resource settings. (...) Real-Time Monitoring and Evaluation of a Visual-Based Cervical Cancer Screening Program Using a Decision Support Job Aid In many developing nations, cervical cancer screening is done by visual inspection with acetic acid (VIA). Monitoring and evaluation (M&E) of such screening programs is challenging. An enhanced visual assessment (EVA) system was developed to augment VIA procedures in low-resource settings. The EVA System consists of a mobile colposcope built around a smartphone

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2016 Diagnostics

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