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Patient Care Under Uncertainty by Charles F. Manski Pdf
For the past few years, the author, a renowned economist, has been applying the statistical tools of economics to decision making under uncertainty in the context of patient health status and response to treatment. He shows how statistical imprecision and identification problems affect empirical research in the patient-care sphere.
Patient Care under Uncertainty by Charles F. Manski Pdf
How cutting-edge economics can improve decision-making methods for doctors Although uncertainty is a common element of patient care, it has largely been overlooked in research on evidence-based medicine. Patient Care under Uncertainty strives to correct this glaring omission. Applying the tools of economics to medical decision making, Charles Manski shows how uncertainty influences every stage, from risk analysis to treatment, and how this can be reasonably confronted. In the language of econometrics, uncertainty refers to the inadequacy of available evidence and knowledge to yield accurate information on outcomes. In the context of health care, a common example is a choice between periodic surveillance or aggressive treatment of patients at risk for a potential disease, such as women prone to breast cancer. While these choices make use of data analysis, Manski demonstrates how statistical imprecision and identification problems often undermine clinical research and practice. Reviewing prevailing practices in contemporary medicine, he discusses the controversy regarding whether clinicians should adhere to evidence-based guidelines or exercise their own judgment. He also critiques the wishful extrapolation of research findings from randomized trials to clinical practice. Exploring ways to make more sensible judgments with available data, to credibly use evidence, and to better train clinicians, Manski helps practitioners and patients face uncertainties honestly. He concludes by examining patient care from a public health perspective and the management of uncertainty in drug approvals. Rigorously interrogating current practices in medicine, Patient Care under Uncertainty explains why predictability in the field has been limited and furnishes criteria for more cogent steps forward.
Health Care in Contexts of Risk, Uncertainty, and Hybridity by Daniel Messelken,David Winkler Pdf
This book sheds light on various ethical challenges military and humanitarian health care personnel (HCP) face while working in adverse conditions. Contexts of armed conflict, hybrid wars or other forms of violence short of war, as well as natural disasters, all have in common that ordinary circumstances can no longer be taken for granted. Hence, the provision of health care has to adapt, for example, to a different level of risk, to scarce resources, or uncommon approaches due to external incentives or requirements. This affects the practice of health care as well as its ethics. This book offers a panoramic overview on various challenges healthcare faces in extraordinary situations and provides new insights from practitioners’ as well as from academic scholars’ perspectives.
Clinical Uncertainty in Primary Care by Lucia Siegel Sommers,John Launer Pdf
The Power of Colleagues What happens when primary care clinicians meet together on set aside time in their practice settings to talk about their own patients? .....Complimenting quality metrics or performance measures through discussing the actual stories of individual patients and their clinician-patient relationships In these settings, how can clinicians pool their collective experience and apply that to ‘the evidence’ for an individual patient? .....Especially for patients who do not fit the standard protocols and have vague and worrisome symptoms, poor response to treatment, unpredictable disease courses, and/or compromised abilities for shared decision making What follows when discussion about individual patients reveals system-wide service gaps and coordination limitations? .....Particularly for patients with complex clinical problems that fall outside performance monitors and quality screens How can collaborative engagement of case-based uncertainties with one’s colleagues help combat the loneliness and helplessness that PCPs can experience, no matter what model or setting in which they practice? .....And where they are expected to practice coordinated, evidence-based, EMR-directed care These questions inspired Lucia Sommers and John Launer and their international contributors to explore the power of colleagues in “Clinical Uncertainty in Primary Care: The Challenge of Collaborative Engagement” and offer antidotes to sub-optimal care that can result when clinicians go it alone. From the Foreword: “Lucia Sommers and John Launer, with the accompanying input of their contributing authors, have done a deeply insightful and close-to-exhaustive job of defining clinical uncertainty. They identify its origins, components and subtypes; demonstrate the ways in which and the extent to which it is intrinsic to medicine...and they present a cogent case for its special relationship to primary care practice...‘Clinical Uncertainty in Primary Care’ not only presents a model of collegial collaboration and support, it also implicitly legitimates it.’’ Renee Fox, Annenberg Professor Emerita of the Social Sciences, University of Pennsylvania.
Clinical Reasoning: Knowledge, Uncertainty, and Values in Health Care by Daniele Chiffi Pdf
This book offers a philosophically-based, yet clinically-oriented perspective on current medical reasoning aiming at 1) identifying important forms of uncertainty permeating current clinical reasoning and practice 2) promoting the application of an abductive methodology in the health context in order to deal with those clinical uncertainties 3) bridging the gap between biomedical knowledge, clinical practice, and research and values in both clinical and philosophical literature. With a clear philosophical emphasis, the book investigates themes lying at the border between several disciplines, such as medicine, nursing, logic, epistemology, and philosophy of science; but also ethics, epidemiology, and statistics. At the same time, it critically discusses and compares several professional approaches to clinical practice such as the one of medical doctors, nurses and other clinical practitioners, showing the need for developing a unified framework of reasoning, which merges methods and resources from many different clinical but also non-clinical disciplines. In particular, this book shows how to leverage nursing knowledge and practice, which has been considerably neglected so far, to further shape the interdisciplinary nature of clinical reasoning. Furthermore, a thorough philosophical investigation on the values involved in health care is provided, based on both the clinical and philosophical literature. The book concludes by proposing an integrative approach to health and disease going beyond the so-called "classical biomedical model of care".
National Academies of Sciences, Engineering, and Medicine,Institute of Medicine,Board on Health Care Services,Committee on Diagnostic Error in Health Care
Author : National Academies of Sciences, Engineering, and Medicine,Institute of Medicine,Board on Health Care Services,Committee on Diagnostic Error in Health Care Publisher : National Academies Press Page : 473 pages File Size : 48,6 Mb Release : 2015-12-29 Category : Medical ISBN : 9780309377720
Improving Diagnosis in Health Care by National Academies of Sciences, Engineering, and Medicine,Institute of Medicine,Board on Health Care Services,Committee on Diagnostic Error in Health Care Pdf
Getting the right diagnosis is a key aspect of health care - it provides an explanation of a patient's health problem and informs subsequent health care decisions. The diagnostic process is a complex, collaborative activity that involves clinical reasoning and information gathering to determine a patient's health problem. According to Improving Diagnosis in Health Care, diagnostic errors-inaccurate or delayed diagnoses-persist throughout all settings of care and continue to harm an unacceptable number of patients. It is likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences. Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions. The committee concluded that improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative. Improving Diagnosis in Health Care, a continuation of the landmark Institute of Medicine reports To Err Is Human (2000) and Crossing the Quality Chasm (2001), finds that diagnosis-and, in particular, the occurrence of diagnostic errorsâ€"has been largely unappreciated in efforts to improve the quality and safety of health care. Without a dedicated focus on improving diagnosis, diagnostic errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity. Just as the diagnostic process is a collaborative activity, improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families, researchers, and policy makers. The recommendations of Improving Diagnosis in Health Care contribute to the growing momentum for change in this crucial area of health care quality and safety.
Uncertainty in Medical Innovation by Jessica Mesman Pdf
The Neonatal Intensive Care Unit is a site where hi-tech medicine and vulnerable human beings come into close contact. Focusing on a number of medical and ethical challenges encountered by staff and parents, this book provides a new perspective on the complexity of these treatments and the inventiveness of those involved.
Author : Avril Danczak,Alison Lea,Geraldine Murphy Publisher : Royal College of General Practitioners Page : 342 pages File Size : 53,9 Mb Release : 2016-02-28 Category : Medical ISBN : 9780850844184
Mapping Uncertainty in Medicne by Avril Danczak,Alison Lea,Geraldine Murphy Pdf
Uncertainty is the norm in medical practice, yet often gives rise to distress in clinicians, who fear they will make shameful or guilt inducing errors. This book offers a succinct method to clinicians for classifying uncertainty and finding the right skills to manage different types of uncertainty successfully. Every clinician experiences moments when 'they don't know what to do'. Modern medicine is increasingly complex and training has also become more complicated. The days of 'see one, do one, teach one' are over. Yet, both younger clinicians and senior practitioners describe uncertainty as one of the most challenging and stressful aspects of clinical work. If uncertainty is uncomfortable or threatening to individual practitioners, it also provides complex educational challenges. How can we learn to cope with uncertainty effectively ourselves? How can we teach others to understand and manage uncertainty? In this ground breaking book, the authors propose ways to cut through uncertainty, which is explored as an inevitable (and even desirable) component of clinical practice. A Map of Uncertainty in Medicine (MUM) is used to classify uncertainty and to define the skills that will help find a way though practical difficulties. It is always good to have your MUM with you in a tricky situation!
M. G. Myriam Hunink,Milton C. Weinstein,Eve Wittenberg,Joseph S. Pliskin,Michael F. Drummond,Paul P. Glasziou,John B. Wong
Author : M. G. Myriam Hunink,Milton C. Weinstein,Eve Wittenberg,Joseph S. Pliskin,Michael F. Drummond,Paul P. Glasziou,John B. Wong Publisher : Cambridge University Press Page : 447 pages File Size : 52,9 Mb Release : 2014-10-16 Category : Health & Fitness ISBN : 9781107690479
Decision Making in Health and Medicine by M. G. Myriam Hunink,Milton C. Weinstein,Eve Wittenberg,Joseph S. Pliskin,Michael F. Drummond,Paul P. Glasziou,John B. Wong Pdf
A guide for everyone involved in medical decision making to plot a clear course through complex and conflicting benefits and risks.
Institute of Medicine,Board on Health Sciences Policy,Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care
Author : Institute of Medicine,Board on Health Sciences Policy,Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care Publisher : National Academies Press Page : 781 pages File Size : 41,8 Mb Release : 2009-02-06 Category : Medical ISBN : 9780309082655
Unequal Treatment by Institute of Medicine,Board on Health Sciences Policy,Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care Pdf
Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the quality of health care received. In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. Patients' and providers' attitudes, expectations, and behavior are analyzed. How to intervene? Unequal Treatment offers recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other arenas. The committee highlights the potential of cross-cultural education to improve provider-patient communication and offers a detailed look at how to integrate cross-cultural learning within the health professions. The book concludes with recommendations for data collection and research initiatives. Unequal Treatment will be vitally important to health care policymakers, administrators, providers, educators, and students as well as advocates for people of color.
Institute of Medicine,Board on Health Care Services,Committee on Standards for Developing Trustworthy Clinical Practice Guidelines
Author : Institute of Medicine,Board on Health Care Services,Committee on Standards for Developing Trustworthy Clinical Practice Guidelines Publisher : National Academies Press Page : 217 pages File Size : 55,5 Mb Release : 2011-06-16 Category : Medical ISBN : 9780309216463
Clinical Practice Guidelines We Can Trust by Institute of Medicine,Board on Health Care Services,Committee on Standards for Developing Trustworthy Clinical Practice Guidelines Pdf
Advances in medical, biomedical and health services research have reduced the level of uncertainty in clinical practice. Clinical practice guidelines (CPGs) complement this progress by establishing standards of care backed by strong scientific evidence. CPGs are statements that include recommendations intended to optimize patient care. These statements are informed by a systematic review of evidence and an assessment of the benefits and costs of alternative care options. Clinical Practice Guidelines We Can Trust examines the current state of clinical practice guidelines and how they can be improved to enhance healthcare quality and patient outcomes. Clinical practice guidelines now are ubiquitous in our healthcare system. The Guidelines International Network (GIN) database currently lists more than 3,700 guidelines from 39 countries. Developing guidelines presents a number of challenges including lack of transparent methodological practices, difficulty reconciling conflicting guidelines, and conflicts of interest. Clinical Practice Guidelines We Can Trust explores questions surrounding the quality of CPG development processes and the establishment of standards. It proposes eight standards for developing trustworthy clinical practice guidelines emphasizing transparency; management of conflict of interest ; systematic review-guideline development intersection; establishing evidence foundations for and rating strength of guideline recommendations; articulation of recommendations; external review; and updating. Clinical Practice Guidelines We Can Trust shows how clinical practice guidelines can enhance clinician and patient decision-making by translating complex scientific research findings into recommendations for clinical practice that are relevant to the individual patient encounter, instead of implementing a one size fits all approach to patient care. This book contains information directly related to the work of the Agency for Healthcare Research and Quality (AHRQ), as well as various Congressional staff and policymakers. It is a vital resource for medical specialty societies, disease advocacy groups, health professionals, private and international organizations that develop or use clinical practice guidelines, consumers, clinicians, and payers.
Disaster Nursing, Primary Health Care and Communication in Uncertainty by Sakiko Kanbara,Shoko Miyagawa,Hiroyuki Miyazaki Pdf
The primary aim of this textbook is to contribute towards the promotion of human security by educating nurses with a profound understanding of disaster nursing and to conduct innovative research and practices in cooperation. This textbook emphasizes on multi-professional connections; offers knowledge on how Japanese disaster nursing got evolved in changing social contexts and provides various case studies that reflect wonderful practices in the disaster nursing field which have contributed to the Sendai Framework for Disaster Risk Reduction, the UN Sustainable Development Goals, and sustainable human security. Frequent disasters have triggered the need for more trans-disciplinary work, high-level care throughout all phases of a disaster event, and the need for nursing leaders. Apart from hospitals, in local communities, nurses can take a role to mitigate health risks. Being a member of every part of the healthcare system, they can become critically needed leaders in emergency management and disaster preparedness. This work includes a DRR Framework and the application to disaster nursing, information on preparedness and community resilience and on the related disciplines and coordination with disaster nursing. It informs on the challenges in disaster nursing, offers instructional design, education development and research in disaster nursing. Students, professional nurses, clinicians, community health practitioners, health volunteers, disaster support organizations, researchers, and community partners who are involved in the care of disaster survivors can use this resource. Written by distinguished experts with diverse backgrounds of nursing, public health, health informatics, and geography, this book shows how practitioners, researchers, policymakers, and multiple community stakeholders who can collaborate effectively and efficiently to restore primary health care of survivors after a local disaster.
The Good Doctor by Kenneth Brigham,Michael M. E. Johns Pdf
What makes a good doctor? It's not what you think. A doctor willing to face their own uncertainty in the face of illness and treatment might just be the best medicine. Too often we choose the wrong doctor for the wrong reasons. It doesn't have to be that way. In The Good Doctor, Ken Brigham, MD, and Michael M.E. Johns, MD, argue that we need to change the way we think about health care if we want to be the healthiest we can be. Counterintuitive as it may seem, uncertainty is integral to medicine, and you want a doctor who knows that: someone who sees you as the unique case you are, someone who knows that data isn't everything, someone who is able to change her mind as the information changes. For too long we've clung to the myth of the infallible doctor--one who assuredly tells us this is what's wrong and here is how I will cure you--and our health has suffered for it. Brigham and Johns propose a new model of medicine, one that is comfortable with ambiguity and that centers on an equal partnership between patient and doctor. Uncertainty, properly embraced, opens a new universe of possibilities.
Moral Uncertainty by William MacAskill,Krister Bykvist,Toby Ord Pdf
About the bookToby Ord try to fill this gap. They argue that there are distinctive norms that govern how one ought to make decisions and defend an information-sensitive account of how to make such decisions. They do so by developing an analogy between moral uncertainty and social choice, noting that different moral views provide different amounts of information regarding our reasons for action, and arguing that the correct account of decision-making under moral uncertainty must be sensitive to that. Moral Uncertainty also tackles the problem of how to make intertheoretic comparisons, and addresses the implications of their view for metaethics and practical ethics. Very often we are uncertain about what we ought, morally, to do. We do not know how to weigh the interests of animals against humans, how strong our duties are to improve the lives of distant strangers, or how to think about the ethics of bringing new people into existence. But we still need to act. So how should we make decisions in the face of such uncertainty? Though economists and philosophers have extensively studied the issue of decision-making in the face of uncertainty about matters of fact, the question of decision-making given fundamental moral uncertainty has been neglected. In Moral Uncertainty, philosophers William MacAskill, Krister Bykvist, and Toby Ord try to fill this gap. They argue that there are distinctive norms that govern how one ought to make decisions and defend an information-sensitive account of how to make such decisions. They do so by developing an analogy between moral uncertainty and social choice, noting that different moral views provide different amounts of information regarding our reasons for action, and arguing that the correct account of decision-making under moral uncertainty must be sensitive to that. Moral Uncertainty also tackles the problem of how to make intertheoretic comparisons, and addresses the implications of their view for metaethics and practical ethics.
Institute of Medicine,LeighAnne M. Olsen,Elizabeth G. Nabel,J. Michael McGinnis,Mark B. McClellan
Author : Institute of Medicine,LeighAnne M. Olsen,Elizabeth G. Nabel,J. Michael McGinnis,Mark B. McClellan Publisher : National Academies Press Page : 202 pages File Size : 46,6 Mb Release : 2008-09-06 Category : Medical ISBN : 9780309113694
Evidence-Based Medicine and the Changing Nature of Health Care by Institute of Medicine,LeighAnne M. Olsen,Elizabeth G. Nabel,J. Michael McGinnis,Mark B. McClellan Pdf
Drawing on the work of the Roundtable on Evidence-Based Medicine, the 2007 IOM Annual Meeting assessed some of the rapidly occurring changes in health care related to new diagnostic and treatment tools, emerging genetic insights, the developments in information technology, and healthcare costs, and discussed the need for a stronger focus on evidence to ensure that the promise of scientific discovery and technological innovation is efficiently captured to provide the right care for the right patient at the right time. As new discoveries continue to expand the universe of medical interventions, treatments, and methods of care, the need for a more systematic approach to evidence development and application becomes increasingly critical. Without better information about the effectiveness of different treatment options, the resulting uncertainty can lead to the delivery of services that may be unnecessary, unproven, or even harmful. Improving the evidence-base for medicine holds great potential to increase the quality and efficiency of medical care. The Annual Meeting, held on October 8, 2007, brought together many of the nation's leading authorities on various aspects of the issues - both challenges and opportunities - to present their perspectives and engage in discussion with the IOM membership.