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Li ZH, Lou L, Chen YX, Shi W, Zhang X, Yang J. Severe hypoxemia after radiofrequency ablation for atrial fibrillation in palliatively repaired tetralogy of Fallot: A case report. World J Cardiol 2024; 16:161-167. [PMID: 38576523 PMCID: PMC10989222 DOI: 10.4330/wjc.v16.i3.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/21/2023] [Accepted: 01/12/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Patients with tetralogy of Fallot (TOF) often have arrhythmias, commonly being atrial fibrillation (AF). Radiofrequency ablation is an effective treatment for AF and does not usually cause severe postoperative hypoxemia, but the risk of complications may increase in patients with conditions such as TOF. CASE SUMMARY We report a young male patient with a history of TOF repair who developed severe hypoxemia after radiofrequency ablation for AF and was ultimately confirmed to have a new right-to-left shunt. The patient subsequently underwent atrial septal occlusion and eventually recovered. CONCLUSION Radiofrequency ablation may cause iatrogenic atrial septal injury; thus possible complications should be predicted in order to ensure successful treatment and patient safety.
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Affiliation(s)
- Zhi-Hang Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Lian Lou
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Yu-Xiao Chen
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Wen Shi
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Xuan Zhang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Jian Yang
- Department of Cardiology, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China.
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Lyu Y, Xu Q, Liu J. Exploring the medical decision-making patterns and influencing factors among the general Chinese public: a binary logistic regression analysis. BMC Public Health 2024; 24:887. [PMID: 38523310 PMCID: PMC10962172 DOI: 10.1186/s12889-024-18338-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/12/2024] [Indexed: 03/26/2024] Open
Abstract
OBJECTIVE With the ongoing evolution of the healthcare system and shifts in cultural paradigms, there is a pressing need to delve into the medical decision-making behaviors of general Chinese public and understand their underlying motivations. This research seeks to elucidate the prevailing tendencies in these decision-making processes and to empirically validate the pivotal factors that shape their choices, offering valuable insights for healthcare policymakers and institutions. METHOD A comprehensive survey was administered to 2,696 Chinese residents to examine their medical decision-making patterns. These patterns were classified into two primary categories: Unilateral Decision-making (Doctor-dominant, Family-centric, and Patient-driven subtypes) and Collaborative Decision-making (Doctor-led, Doctor-Patient, Patient-Family, and Doctor-Patient-Family subtypes). Binary logistic regression analysis was employed to empirically pinpoint the significant factors influencing these decision-making frameworks. RESULTS The study's analysis reveals distinct preferences in medical decision-making among Chinese residents. In the Collaborative Decision-making category, chosen by 70.81% of participants, the subtypes are as follows: Doctor-led (29.90%), Doctor-Patient (13.54%), Patient-Family (2.93%), and Doctor-Patient-Family (24.44%). The Unilateral Decision-making, preferred by 29.19%, includes Doctor-dominant (23.22%), Family-centric (1.74%), and Patient-driven (4.23%) models. The preference for Collaborative Decision-making is associated with higher educational levels, specific marital statuses (particularly married but childless), and choices of rural residents' basic medical insurance or occupational basic medical insurance. In contrast, Unilateral Decision-making correlates with males, individuals with religious beliefs, certain occupational roles (like civil servants), and holders of commercial or publicly funded medical insurance. CONCLUSION This study elucidates the complex interplay of socio-cultural and individual determinants shaping medical decision-making in China. The findings reveal a marked inclination towards collaborative models, closely linked to educational level, marital status, and specific insurance types, reflecting an evolving trend towards participatory healthcare. Simultaneously, the persistence of unilateral models, influenced by gender, religious beliefs, and occupational roles, highlights the heterogeneity within Chinese healthcare preferences. These insights are crucial for policymakers and healthcare practitioners, underscoring the need for adaptable, culturally attuned healthcare frameworks that cater to this diversity, thereby enhancing patient engagement and healthcare efficacy.
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Affiliation(s)
- Yuwen Lyu
- Institute of Humanities and Social Sciences, Guangzhou Medical University, Guangzhou, 511436, China
| | - Qian Xu
- School of Health Management, Guangzhou Medical University, Guangzhou, 511436, China
| | - Junrong Liu
- Institute of Humanities and Social Sciences, Guangzhou Medical University, Guangzhou, 511436, China.
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Cottin A, Zulian M, Pécuchet N, Guilloux A, Katsahian S. MS-CPFI: A model-agnostic Counterfactual Perturbation Feature Importance algorithm for interpreting black-box Multi-State models. Artif Intell Med 2024; 147:102741. [PMID: 38184354 DOI: 10.1016/j.artmed.2023.102741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 11/17/2023] [Accepted: 11/28/2023] [Indexed: 01/08/2024]
Abstract
Multi-state processes (Webster, 2019) are commonly used to model the complex clinical evolution of diseases where patients progress through different states. In recent years, machine learning and deep learning algorithms have been proposed to improve the accuracy of these models' predictions (Wang et al., 2019). However, acceptability by patients and clinicians, as well as for regulatory compliance, require interpretability of these algorithms's predictions. Existing methods, such as the Permutation Feature Importance algorithm, have been adapted for interpreting predictions in black-box models for 2-state processes (corresponding to survival analysis). For generalizing these methods to multi-state models, we introduce a novel model-agnostic interpretability algorithm called Multi-State Counterfactual Perturbation Feature Importance (MS-CPFI) that computes feature importance scores for each transition of a general multi-state model, including survival, competing-risks, and illness-death models. MS-CPFI uses a new counterfactual perturbation method that allows interpreting feature effects while capturing the non-linear effects and potentially capturing time-dependent effects. Experimental results on simulations show that MS-CPFI increases model interpretability in the case of non-linear effects. Additionally, results on a real-world dataset for patients with breast cancer confirm that MS-CPFI can detect clinically important features and provide information on the disease progression by displaying features that are protective factors versus features that are risk factors for each stage of the disease. Overall, MS-CPFI is a promising model-agnostic interpretability algorithm for multi-state models, which can improve the interpretability of machine learning and deep learning algorithms in healthcare.
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Affiliation(s)
- Aziliz Cottin
- Healthcare and Life Sciences Research, Dassault Systemes, France; Université Paris Cité, France; HeKa team, INRIA, Paris, France.
| | - Marine Zulian
- Healthcare and Life Sciences Research, Dassault Systemes, France
| | - Nicolas Pécuchet
- Healthcare and Life Sciences Research, Dassault Systemes, France
| | | | - Sandrine Katsahian
- Université Paris Cité, France; HeKa team, INRIA, Paris, France; Medical Informatics, Biostatistics and Public Health Department, Georges Pompidou, Assistance Publique-Hôpitaux de Paris, France; Inserm, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris, France
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4
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Tsiampalis T, Panagiotakos D. Methodological issues of the electronic health records' use in the context of epidemiological investigations, in light of missing data: a review of the recent literature. BMC Med Res Methodol 2023; 23:180. [PMID: 37559072 PMCID: PMC10410989 DOI: 10.1186/s12874-023-02004-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 07/27/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Electronic health records (EHRs) are widely accepted to enhance the health care quality, patient monitoring, and early prevention of various diseases, even when there is incomplete or missing information in them. AIM The present review sought to investigate the impact of EHR implementation on healthcare quality and medical decision in the context of epidemiological investigations, considering missing or incomplete data. METHODS Google scholar, Medline (via PubMed) and Scopus databases were searched for studies investigating the impact of EHR implementation on healthcare quality and medical decision, as well as for studies investigating the way of dealing with missing data, and their impact on medical decision and the development process of prediction models. Electronic searches were carried out up to 2022. RESULTS EHRs were shown that they constitute an increasingly important tool for both physicians, decision makers and patients, which can improve national healthcare systems both for the convenience of patients and doctors, while they improve the quality of health care as well as they can also be used in order to save money. As far as the missing data handling techniques is concerned, several investigators have already tried to propose the best possible methodology, yet there is no wide consensus and acceptance in the scientific community, while there are also crucial gaps which should be addressed. CONCLUSIONS Through the present thorough investigation, the importance of the EHRs' implementation in clinical practice was established, while at the same time the gap of knowledge regarding the missing data handling techniques was also pointed out.
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Affiliation(s)
- Thomas Tsiampalis
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece.
- Faculty of Health, University of Canberra, Canberra, Australia.
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Chen Y, Xu J, Xing C. Framing Effects in Older Adults' Medical Decision-Making: Social Distance Matters. J Gerontol B Psychol Sci Soc Sci 2023; 78:82-86. [PMID: 36156135 DOI: 10.1093/geronb/gbac152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES The present study sought to explore how decision making is influenced by aging, framing, and social distance in the medical domain. Based on Socioemotional Selectivity Theory, we predicted that social distance would moderate age differences of framing effects as a result of older adults' emphasis on close partners. METHODS Younger and middle-aged (N = 206) and older (N = 208) adults from Shanghai, China completed 2 medical decision tasks in which they were presented with different descriptions of social distance, namely deciding for close relatives or for strangers. Participants' risk preferences were measured. RESULTS The results showed that framing effects were a function of social distance in older adults. Older adults showed smaller framing effects when making decisions for strangers as their preference for the riskier option was reduced in the loss-framed condition. For younger and middle-aged adults, framing effects existed consistently regardless of social distance. DISCUSSION These findings suggest that social distance moderates age differences in framing effects in medical decision-making. It also highlights a potential way to improve older adults' medical decision-making quality: having older adults imagine as if they are making medical decisions for a stranger.
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Affiliation(s)
- Yunjiao Chen
- Department of Psychology, Renmin University of China, Beijing, China
| | - Jie Xu
- Department of Psychology, Renmin University of China, Beijing, China
| | - Cai Xing
- Department of Psychology, Renmin University of China, Beijing, China
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de Vries E, Leal Arenas FA, van der Heide A, Gempeler Rueda FE, Murillo R, Morales O, Diaz-Amado E, Rodríguez N, Gonzalez BJ, Castilblanco Delgado DS, Calvache JA. Medical decisions concerning the end of life for cancer patients in three Colombian hospitals - a survey study. BMC Palliat Care 2021; 20:161. [PMID: 34657613 PMCID: PMC8520825 DOI: 10.1186/s12904-021-00853-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 09/20/2021] [Indexed: 12/02/2022] Open
Abstract
Background Cancer patients’ end-of-life care may involve complex decision-making processes. Colombia has legislation regarding provision of and access to palliative care and is the only Latin American country with regulation regarding euthanasia. We describe medical end-of-life decision-making practices among cancer patients in three Colombian hospitals. Methods Cancer patients who were at the end-of-life and attended in participating hospitals were identified. When these patients deceased, their attending physician was invited to participate. Attending physicians of 261 cancer patients (out of 348 identified) accepted the invitation and answered a questionnaire regarding end-of-life decisions: a.) decisions regarding the withdrawal or withholding of potentially life-prolonging medical treatments, b.) intensifying measures to alleviate pain or other symptoms with hastening of death as a potential side effect, and c.) the administration, supply or prescription of drugs with an explicit intention to hasten death. For each question addressing the first two decision types, we asked if the decision was fully or partially made with the intention or consideration that it may hasten the patient’s death. Results Decisions to withdraw potentially life-prolonging treatment were made for 112 (43%) patients, 16 of them (14%) with an intention to hasten death. For 198 patients (76%) there had been some decision to not initiate potentially life-prolonging treatment. Twenty-three percent of patients received palliative sedation, 97% of all patients received opioids. Six patients (2%) explicitly requested to actively hasten their death, for two of them their wish was fulfilled. In another six patients, medications were used with the explicit intention to hasten death without their explicit request. In 44% (n = 114) of all cases, physicians did not know if their patient had any advance care directives, 26% (n = 38) of physicians had spoken to the patient regarding the possibility of certain treatment decisions to hasten death where this applied. Conclusions Decisions concerning the end of life were common for patients with cancer in three Colombian hospitals, including euthanasia and palliative sedation. Physicians and patients often fail to communicate about advance care directives and potentially life-shortening effects of treatment decisions. Specific end-of-life procedures, patients’ wishes, and availability of palliative care should be further investigated. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00853-9.
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Affiliation(s)
- Esther de Vries
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Cra. 7 No 40-62 Edificio Hospital San Ignacio, Piso 2, Bogota, Colombia.
| | - Fabián Alexander Leal Arenas
- Instituto Nacional de Cancerología, Cl. 1 No 9-85, Bogota, Colombia.,Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Carrera 7ª No. 40-62 Edificio Santacoloma (No 30), Bogota, Colombia
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Fritz E Gempeler Rueda
- Anesthesiology Department, Pontificia Universidad Javeriana, Cra. 7 No 40-62 Edificio Hospital San Ignacio, Bogota, Colombia.,Clinical Ethics Service, Hospital Universitario San Ignacio, Cra. 7 No 40-62, Bogota, Colombia
| | - Raul Murillo
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Carrera 7ª No. 40-62 Edificio Santacoloma (No 30), Bogota, Colombia.,Department of Internal Medicine, Pontificia Universidad Javeriana, Cra. 7 No 40-62 Edificio Hospital San Ignacio, Bogotá, Colombia
| | - Olga Morales
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Carrera 7ª No. 40-62 Edificio Santacoloma (No 30), Bogota, Colombia
| | - Eduardo Diaz-Amado
- Instituto de Bioética, Pontificia Universidad Javeriana, Tv. 4 #42, Bogota, Colombia
| | - Nelcy Rodríguez
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Cra. 7 No 40-62 Edificio Hospital San Ignacio, Piso 2, Bogota, Colombia
| | - Beatriz Juliana Gonzalez
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Carrera 7ª No. 40-62 Edificio Santacoloma (No 30), Bogota, Colombia
| | - Danny Steven Castilblanco Delgado
- Instituto Nacional de Cancerología, Cl. 1 No 9-85, Bogota, Colombia.,Universidad Militar Nueva Granada, Carrera 11 n.° 101-80, Bogota, Colombia
| | - Jose A Calvache
- Department of Anesthesiology, Universidad del Cauca, Cl 5 #4-70, Popayán, Cauca, Colombia.,Department of Anesthesiology, Erasmus MC University Medical Center Rotterdam, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
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Haaser T, Constantinides Y, Huguet F, De Crevoisier R, Dejean C, Escande A, Ghannam Y, Lahmi L, Le Tallec P, Lecouillard I, Lorchel F, Thureau S, Lagrange JL. [Ethical stakes in palliative care in radiation oncology]. Cancer Radiother 2021; 25:699-706. [PMID: 34400087 DOI: 10.1016/j.canrad.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/24/2021] [Indexed: 11/29/2022]
Abstract
In 2021, the Ethics Commission of the SFRO has chosen the issue of the practice of palliative care in radiotherapy oncology. Radiation oncology plays a central role in the care of patients with cancer in palliative phase. But behind the broad name of palliative radiotherapy, we actually find a large variety of situations involving diverse ethical issues. Radiation oncologists have the delicate task to take into account multiple factors throughout a complex decision-making process. While the question of the therapeutic indication and the technical choice allowing it to be implemented remains central, reflection cannot be limited to these decision-making and technical aspects alone. It is also a question of being able to create the conditions for a singularity focused care and to build an authentic care relationship, beyond technicity. It is through this daily ethical work, in close collaboration with patients, and under essential conditions of multidisciplinarity and multiprofessionalism, that our fundamental role as caregiver can be deployed.
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Affiliation(s)
- T Haaser
- Service d'Oncologie Radiothérapie, Hôpital Haut Lévêque, Centre Hospitalier Universitaire de Bordeaux, avenue Magellan, 33600 Pessac, France.
| | - Y Constantinides
- Espace Éthique Ile de France, Paris Université Sorbonne Nouvelle, Paris, France
| | - F Huguet
- Service d'Oncologie Radiothérapie, Hôpital Tenon, Centre de Recherche Saint-Antoine UMR_S 938, Institut Universitaire de Cancérologie, AP-HP, Sorbonne Université, Paris, France
| | - R De Crevoisier
- Service d'Oncologie Radiothérapie, Centre Eugène Marquis, Rennes, France
| | - C Dejean
- Service d'Oncologie Radiothérapie, Unité de Physique Médicale, Centre Antoine Lacassagne, Nice, France
| | - A Escande
- Service universitaire d'Oncologie Radiothérapie, Centre Oscar Lambret, Faculté de médecine Henri Warembourg, Laboratoire CRIStAL, UMR9189, Université de Lille, Lille, France
| | - Y Ghannam
- Service d'Oncologie Radiothérapie, Hôpital Tenon, Centre de Recherche Saint-Antoine UMR_S 938, Institut Universitaire de Cancérologie, AP-HP, Sorbonne Université, Paris, France
| | - L Lahmi
- Service d'Oncologie Radiothérapie, Hôpital Tenon, Centre de Recherche Saint-Antoine UMR_S 938, Institut Universitaire de Cancérologie, AP-HP, Sorbonne Université, Paris, France
| | - P Le Tallec
- Service d'Oncologie Radiothérapie, Quantis Litis EA 4108, Centre Henri Becquerel, Rouen, France
| | - I Lecouillard
- Service d'Oncologie Radiothérapie, Centre Eugène Marquis, Rennes, France
| | - F Lorchel
- Service d'Oncologie Radiothérapie, Centre Hospitalier Universitaire Lyon-Sud, Lyon, France; Centre d'Oncologie Radiothérapie et Oncologie de Mâcon - ORLAM, Mâcon, France
| | - S Thureau
- Service d'Oncologie Radiothérapie, Quantis Litis EA 4108, Centre Henri Becquerel, Rouen, France
| | - J L Lagrange
- Université Paris-Est Créteil Val de Marne, Paris, France
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Sulieman L, Robinson JR, Jackson GP. Automating the Classification of Complexity of Medical Decision-Making in Patient-Provider Messaging in a Patient Portal. J Surg Res 2020; 255:224-232. [PMID: 32570124 PMCID: PMC7303623 DOI: 10.1016/j.jss.2020.05.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/09/2020] [Accepted: 05/05/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Patient portals are consumer health applications that allow patients to view their health information. Portals facilitate the interactions between patients and their caregivers by offering secure messaging. Patients communicate different needs through portal messages. Medical needs contain requests for delivery of care (e.g. reporting new symptoms). Automating the classification of medical decision complexity in portal messages has not been investigated. MATERIALS AND METHODS We trained two multiclass classifiers, multinomial Naïve Bayes and random forest on 500 message threads, to quantify and label the complexity of decision-making into four classes: no decision, straightforward, low, and moderate. We compared the performance of the models to using only the number of medical terms without training a machine learning model. RESULTS Our analysis demonstrated that machine learning models have better performance than the model that did not use machine learning. Moreover, machine learning models could quantify the complexity of decision-making that the messages contained with 0.59, 0.45, and 0.58 for macro, micro, and weighted precision and 0.63,0.41, and 0.63 for macro, micro, and weighted recall. CONCLUSIONS This study is one of the first to attempt to classify patient portal messages by whether they involve medical decision-making and the complexity of that decision-making. Machine learning classifiers trained on message content resulted in better message thread classification than classifiers that employed medical terms in the messages alone.
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Affiliation(s)
- Lina Sulieman
- Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Jamie R Robinson
- Vanderbilt University Medical Center, Nashville, Tennessee; IBM Watson Health, IBM, Cambridge, Massachusetts
| | - Gretchen P Jackson
- Vanderbilt University Medical Center, Nashville, Tennessee; IBM Watson Health, IBM, Cambridge, Massachusetts
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Yang SJ, He GN, Han X, Wang N, Chen Y, Zhu XR, Ma BQ, Li MM, Zhao P, Chen YN, Zhao T, Ma H. A scale for prediction of response to AEDs in patients with MRI-negative epilepsy. Epilepsy Behav 2019; 94:41-46. [PMID: 30884406 DOI: 10.1016/j.yebeh.2019.02.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/14/2019] [Accepted: 02/21/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Antiepileptic drugs (AEDs) are the first choice in magnetic resonance imaging (MRI)-negative patients with epilepsy, although the responses to AEDs are diverse. Preoperative evaluation and postoperative prognosis in MRI-negative epilepsy have been reported. However, there are few tools for predicting the response to AEDs. Herein, we developed an AED response scale based on clinical factors and video-electroencephalography (VEEG) in MRI-negative patients with epilepsy. METHODS A total of 132 consecutive patients with MRI-negative epilepsy at the Epilepsy Center of Henan Provincial People's Hospital between August 2016 and August 2018 were included. Patients were further divided into drug-responsive epilepsy ([DSE-MRI (-)]; n = 101) and drug-resistant epilepsy ([DRE-MRI (-)]; n = 31) groups. The clinical and VEEG factors were evaluated in univariate analyses and multivariate logistic regression analyses. A scale was derived and the scores categorized into 3 risk levels of DRE-MRI (-). RESULTS A scale was established based on 4 independent risk factors for DRE-MRI (-). The scale had a sensitivity of 83.87%, specificity of 80.20%, positive likelihood ratio of 4.24, negative likelihood ratio of 0.20, and showed good discrimination with the area under the curve (AUC) of 0.886 (0.826-0.946). The categorization of the risk score based on this scale was: low risk (0-3 points), medium risk (3-5 points), and high risk (>5 points). CONCLUSION We established a DRE-MRI (-) scale with a good sensitivity and specificity, which may be useful for clinicians when making medical decisions in patients with MRI-negative epilepsy.
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Affiliation(s)
- Shi-Jun Yang
- Department of Neurology, Zhengzhou University People's Hospital, Henan Province, Zhengzhou 450003, China
| | - Gui-Nv He
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Xiong Han
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou 450003, China.
| | - Na Wang
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Yi Chen
- Clinical research service center, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Xue-Rui Zhu
- Department of Neurology, Zhengzhou University People's Hospital, Henan Province, Zhengzhou 450003, China
| | - Bing-Qian Ma
- Department of Neurology, Zhengzhou University People's Hospital, Henan Province, Zhengzhou 450003, China
| | - Ming-Min Li
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Pan Zhao
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Ya-Nan Chen
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Ting Zhao
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Huan Ma
- Department of Neurology, Zhengzhou University People's Hospital, Henan Province, Zhengzhou 450003, China
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Janssens JFAM, de Kort SJ, Achterberg WP, Kurrle S, Kerse N, Cameron ID, Touwen DP. Medical and moral considerations regarding complex medical decisions in older patients with multimorbidity: a compact deliberation framework. BMC Geriatr 2018; 18:25. [PMID: 29370767 PMCID: PMC5785799 DOI: 10.1186/s12877-018-0707-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 01/03/2018] [Indexed: 11/29/2022] Open
Abstract
In health care for older adults, patients with multimorbidity usually receive the same interventions as those patients without multimorbidity. However, standard curative or life-sustaining treatment options have to be considered carefully in view of the maximally attainable result in older and frail patients. To guide such complex medical decisions, we present a compact deliberation framework that could assist physician(s) in charge of the medical treatment of a specific elderly patient to systematize his own thinking about treatment and decisional responsibilities, in case of an intercurrent disease. The framework includes four questions to be addressed when deciding on a single urgent standard curative or life-sustaining intervention in acute medical problems of an elderly patient with multimorbidity: 1) What is known about the patient’s aims and preferences? 2) Will the intervention be effective? 3) Will the intervention support the aims and preferences of the patient? 4) In view of the aims and preferences, will the risks and benefits be in balance? If all four considerations are answered favorably, the intervention will fit patient-centered and appropriate care for frail older patients with multimorbidity. Application to a patient case illustrates how our framework can improve the quality of the shared decision-making process in care for older people and helps clarify medical and moral considerations regarding how to appropriately treat the individual patient.
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Affiliation(s)
- Jeroen F A M Janssens
- Department of public health and primary care, Leiden University Medical Center, Postal adres: V06-P, Postbus 9600, 2300 RC, Leiden, The Netherlands. .,Novicare, Laan van Vredenoord 33, 2289 DA, Rijswijk, The Netherlands.
| | - Susanne J de Kort
- Topaz-Zuydtwijck, Aaltje Noordewierlaan 50, 2324 KS, Leiden, The Netherlands
| | - Wilco P Achterberg
- Department of public health and primary care, Leiden University Medical Center, The Netherlands, Postal adres: V06-P, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Susan Kurrle
- Curran Ageing Research Unit, University of Sydney, Hornsby Ku-ring-gai Health Service, Hornsby, NSW, 2077, Australia
| | - Ngaire Kerse
- School of Population Health, University of Auckland, Tamaki Campus, Private Bag 92019, Auckland, 1001, New Zealand
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, Kolling Institute, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Dorothea P Touwen
- Department of Medical Ethics and Health Law, Leiden University Medical Centre, The Netherlands, Postal adres: J1-P, Postbus 9600, 2300 RC, Leiden, The Netherlands
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11
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van Grootel RJ, Buchner R, Wismeijer D, van der Glas HW. Towards an optimal therapy strategy for myogenous TMD, physiotherapy compared with occlusal splint therapy in an RCT with therapy-and-patient-specific treatment durations. BMC Musculoskelet Disord 2017; 18:76. [PMID: 28183288 PMCID: PMC5301345 DOI: 10.1186/s12891-017-1404-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 01/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Temporomandibular Disorders (TMD) may be characterized by pain and restricted jaw movements. In the absence of somatic factors in the temporomandibular joint, mainly myogenous, psychobiological, and psychosocial factors may be involved in the aetiology of myogenous TMD. An occlusal appliance (splint) is commonly used as a basic therapy of the dental practice. Alternatively, a type of physiotherapy which includes, apart from massage of sore muscles, aspects of cognitive-behavioural therapy might be a basic therapy for myogenous TMD. Treatment outcome of physiotherapy (Ph-Tx) was evaluated in comparison to that of splint therapy (Sp-Tx), using the index Treatment Duration Control (TDC) that enabled a randomized controlled trial with, comparable to clinical care, therapy-and-patient-specific treatment durations. METHODS Seventy-two patients were randomly assigned to either Ph-Tx or Sp-Tx, with an intended treatment duration between 10 and 21 or 12 and 30 weeks respectively. Using TDC, the clinician controlled treatment duration and the number of visits needed. A blinded assessor recorded anamnestic and clinical data to determine TDC-values following treatment and a 1-year follow-up, yielding success rate (SR) and effectiveness (mean TDC) as treatment outcomes. Cohen's d, was determined for pain intensity. Overall SR for stepped-care was assessed in a theoretical model, i.e. a second of the two studied therapies was applied if the first treatment was unsuccessful, and the effect of therapy sequence and difference in success rates was examined. RESULTS SR and effectiveness were similar for Ph-Tx and Sp-Tx (long-term SR: 51-60%; TDC: -0.512- -0.575). Cohen's d was 0.86 (Ph-Tx) and 1.39 (Sp-Tx). Treatment duration was shorter for Ph-Tx (on average 10.4 weeks less; p < 0.001). Sp-Tx needed 7.1 less visits (p < 0.001). CONCLUSIONS Physiotherapy may be preferred as initial therapy over occlusal splint therapy in stepped-care of myogenous TMD. With a similar SR and effectiveness, physiotherapy has a shorter duration. Thus patients whose initial physiotherapy is unsuccessful can continue earlier with subsequent treatment. The stepped-care model reinforces the conclusion on therapy preference as the overall SR hardly depends on therapy sequence. TRIAL REGISTRATION isrctn.com/ISRCTN17469828 . Retrospectively registered: 11/11/2016.
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Affiliation(s)
| | | | - Daniël Wismeijer
- Department of Oral Implantology and Prosthetic Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), VU University and University of Amsterdam, Amsterdam, The Netherlands
| | - Hilbert W van der Glas
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands. .,The Dental School, University of Dundee, Park Place, Dundee, DD1 4HR, Scotland, UK.
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12
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Gaille M. On prenatal diagnosis and the decision to continue or terminate a pregnancy in France: a clinical ethics study of unknown moral territories. Med Health Care Philos 2016; 19:381-391. [PMID: 26864662 DOI: 10.1007/s11019-016-9689-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This article presents a part of the results of an empirical study conducted at a Parisian hospital between 2011 and 2014. It aimed at understanding the women and couples' motivations to terminate or not a pregnancy once a prenatal diagnosis has revealed a genetically related disease in the embryo or fetus. The article first presents the social and legal context of the study, the methodology used and the pathologies that were encountered. Then, it examines the results of the interviews conducted with 5 women alone and 23 couples explaining their reasons for deciding to terminate or not the pregnancy. Finally, it explores the patients' views about the doctor's involvement in the decision-making process. The findings reveal the reasons they formulate when they ponder whether to terminate or not the pregnancy. It highlights the process of their deliberation, their hierarchisation of arguments and concerns. They also show how patients, though often consumed in sorrow, claim to be the legitimate decision-makers, especially women, in a social and legal context in which the rejection of eugenics is viewed as an undisputable principle.
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Affiliation(s)
- Marie Gaille
- Laboratoire SPHERE, UMR 7219, CNRS-USPC, Université Paris Diderot, Bâtiment Condorcet, Case 7093, 5 rue Thomas Mann, 75205, Paris Cedex 13, France.
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13
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Yger M, Crozier S, Dubourdieu S, Vivien B, Dolveck F, Samson Y. Triage practices in stroke units: Physicians' perceptions and ethical issues. Rev Neurol (Paris) 2016; 172:146-51. [PMID: 26563667 DOI: 10.1016/j.neurol.2015.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 08/06/2015] [Accepted: 09/01/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We aimed to explore acute stroke admission decisions and to discuss ethical issues in triage practices in stroke units (SUs) in France. METHODS In this study, 337 questionnaires were sent to physicians involved in acute admission to SUs in Île-de-France (neurologists and physicians from emergency medical services). The questionnaires comprised questions about physicians' perceptions of the reasonable allocation of SU beds and admission criteria for patients in SU in clinical vignettes illustrating complex situations. RESULTS In total, 162 questionnaires were fully completed. There were some discrepancies in perceptions and reporting practices between emergency physicians and neurologists concerning patient admission criteria. Triage choices were more frequently declared by emergency physicians than by neurologists and were related to the difficulty of obtaining a positive response for the admission of certain complex patients (particularly those with comorbidities). CONCLUSIONS Despite recommendations stating that all patients with stroke should be admitted to SUs, this study has shown that triage practices exist in stroke admission decisions. The triage depends on the role and perceptions of each physician in acute stroke management. These decisions suggest reflections on the applicability of distributive justice theories and on ethical issues in triage practices in medicine.
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14
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Hanslik T, Flahault A. [Overmedicalization: When too much medicine harms]. Rev Med Interne 2016; 37:201-5. [PMID: 26586148 DOI: 10.1016/j.revmed.2015.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 10/06/2015] [Accepted: 10/08/2015] [Indexed: 11/23/2022]
Abstract
Overmedicalization refers to non-validated medical practices, with no clear benefits, potentially harmful and therefore unnecessarily costly. Awareness is growing with respect to this serious public health problem. Permanent expansion of diagnostic or therapeutic interventions, disease mongering, inadequate management of diagnostic uncertainty, conflict of interest or lack of commitment by physicians and patients in shared decision making. Overmedicalization is made possible by a lack of training of health professionals and users on medical decision process. Only a multidisciplinary research program, involving medical and non-medical worlds, will allow the implementation of corrective actions.
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Wortley S, Flitcroft K, Howard K. WHAT IS THE ROLE OF COMMUNITY PREFERENCE INFORMATION IN HEALTH TECHNOLOGY ASSESSMENT DECISION MAKING? A CASE STUDY OF COLORECTAL CANCER SCREENING. Int J Technol Assess Health Care 2015; 31:241-8. [PMID: 26376934 DOI: 10.1017/S0266462315000367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The aim of this study was to determine the role of community preference information from discrete choice studies of colorectal cancer (CRC) screening in health technology assessment (HTA) reports and subsequent policy decisions. METHODS We undertook a systematic review of discrete choice studies of CRC screening. Included studies were reviewed to assess the policy context of the research. For those studies that cited a recent or pending review of CRC screening, further searches were undertaken to determine the extent to which community preference information was incorporated into the HTA decision-making process. RESULTS Eight discrete choice studies that evaluated preferences for CRC screening were identified. Four of these studies referred to a national or local review of CRC screening in three countries: Australia, Canada, and the Netherlands. Our review of subsequently released health policy documents showed that while consideration was given to community views on CRC, policy was not informed by discrete choice evidence. CONCLUSIONS Preferences and values of patients are increasingly being considered "evidence" to be incorporated into HTA reports. Discrete choice methodology is a rigorous quantitative method for eliciting preferences and while as a methodology it is growing in profile, it would appear that the results of such research are not being systematically translated or integrated into HTA reports. A formalized approach is needed to incorporate preference literature into the HTA decision-making process.
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Burnod A, Choquet C, Houissa H, Danis J, Pellenc Q, Duchateau FX. [ Medical decision in a very elderly patient: a case report of application of the Leonetti law in emergency medicine]. Ann Fr Anesth Reanim 2014; 33:361-363. [PMID: 24821341 DOI: 10.1016/j.annfar.2014.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 03/20/2014] [Indexed: 06/03/2023]
Abstract
Advanced care decision in emergency medicine is difficult for the elderly. How to be fair, avoiding an unreasonable obstinacy? Based on the case of very old person, we show how an optimal management can be decided in accordance with the spirit of the law.
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Affiliation(s)
- A Burnod
- Smur, hôpital Beaujon, hôpitaux universitaires Paris Nord Val-de-Seine, 100, boulevard du Général-Leclerc, 92110 Clichy, France; Unité de soins de supports et soins palliatifs, institut Curie, 75005 Paris, France.
| | - C Choquet
- Service d'accueil des urgences, hôpital Bichat, hôpitaux universitaires Paris Nord Val-de-Seine, 75018 Paris, France
| | - H Houissa
- Service d'anesthésie-réanimation chirurgicale, hôpital Bichat, hôpitaux universitaires Paris Nord Val-de-Seine, 75018 Paris, France
| | - J Danis
- Unité de soins de supports et soins palliatifs, institut Curie, 75005 Paris, France
| | - Q Pellenc
- Service de chirurgie vasculaire et thoracique, hôpital Bichat, hôpitaux universitaires Paris Nord Val-de-Seine, 75018 Paris, France
| | - F X Duchateau
- Smur, hôpital Beaujon, hôpitaux universitaires Paris Nord Val-de-Seine, 100, boulevard du Général-Leclerc, 92110 Clichy, France
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