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2.
Radiol Clin North Am ; 58(6): 1147-1159, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33040854

RESUMO

Neuroendocrine tumors are rare solid tumors with an estimated 12,000 people in the United States diagnosed each year. Neuroendocrine tumors can occur in any part of the body. There is a wide spectrum of disease, ranging from slow-growing and indolent tumors found incidentally to highly aggressive malignancies with a poor prognosis. Knowledge of neuroendocrine tumor pathology is essential in the diagnostic workup of these patients. This article focuses on the evaluation, detection, and staging of common neuroendocrine tumors with multiple imaging modalities; the information gained with a multimodality approach is often complementary and leads to image-guided treatment decision making.


Assuntos
Tomada de Decisão Clínica/métodos , Imagem Multimodal/métodos , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/cirurgia , Cirurgia Assistida por Computador/métodos , Intervalo Livre de Doença , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Tumores Neuroendócrinos/mortalidade , Tumores Neuroendócrinos/patologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Análise de Sobrevida , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Estados Unidos
4.
Curr Med Res Opin ; 36(11): 1753-1759, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32945707

RESUMO

BACKGROUND: Since December 2019, the cumulative number of coronavirus disease 2019 (COVID-19) deaths worldwide has reached 1,013,100 and continues to increase as of writing. Of these deaths, more than 90% are people aged 60 and older. Therefore, there is a need for an easy-to-use clinically predictive tool for predicting mortality risk in older individuals with COVID-19. OBJECTIVE: To explore an easy-to-use clinically predictive tool that may be utilized in predicting mortality risk in older patients with COVID-19. METHODS: A retrospective analysis of 118 older patients with COVID-19 admitted to the Union Dongxihu Hospital, Huazhong University of Science and Technology, Wuhan, China from 12 January to 26 February 2020. The main results of epidemiological, demographic, clinical and laboratory tests on admission were collected and compared between dying and discharged patients. RESULTS: No difference in major symptoms was observed between dying and discharged patients. Among the results of laboratory tests, neutrophil-to-lymphocyte ratio (NLR), lactate dehydrogenase, albumin, urea nitrogen and D-dimer (NLAUD) show greater differences and have better regression coefficients (ß) when using hierarchical comparisons in a multivariate logistic regression model. Predictors of mortality based on better regression coefficients (ß) included NLR (OR = 31.2, 95% CI 6.7-144.5, p < .0001), lactate dehydrogenase (OR = 73.4, 95% CI 11.8-456.8, p < .0001), albumin (OR < 0.1, 95% CI <0.1-0.2, p < .0001), urea nitrogen (OR = 12.0, 95% CI 3.0-48.4, p = .0005), and D-dimer (OR = 13.6, 95% CI 3.4-54.9, p = .0003). According to the above indicators, a predictive NLAUD score was calculated on the basis of a multivariate logistic regression model to predict mortality. This model showed a sensitivity of 0.889, specificity of 0.984 and a better predictive ability than CURB-65 (AUROC = 0.955 vs. 0.703, p < .001). Bootstrap validation generated the similar sensitivity and specificity. CONCLUSIONS: We designed an easy-to-use clinically predictive tool for early identification and stratified treatment of older patients with severe COVID-19.


Assuntos
Betacoronavirus , Regras de Decisão Clínica , Tomada de Decisão Clínica/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Infecções por Coronavirus/terapia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/terapia , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade
6.
BMJ Open Qual ; 9(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32988831

RESUMO

The COVID-19 pandemic has led to significant morbidity and mortality globally. As health systems grapple with caring for patients affected with COVID-19, cardiovascular procedures that are deemed 'elective' have been postponed. Guidelines concerning which cardiac procedures should be performed during the pandemic vary by specialty and geography in the USA. We propose a clinical heuristic to guide individual physicians and governing bodies in their decision making regarding which cardiac procedures should be performed during the COVID-19 pandemic using the behavioural economics concept of heuristics and ecological rationality.


Assuntos
Procedimentos Cirúrgicos Cardiovasculares/psicologia , Tomada de Decisão Clínica/métodos , Infecções por Coronavirus/prevenção & controle , Economia Comportamental , Procedimentos Cirúrgicos Eletivos/psicologia , Heurística , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus , Contraindicações de Procedimentos , Humanos , Estados Unidos
7.
West J Emerg Med ; 21(5): 1042-1045, 2020 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-32970551

RESUMO

The novel coronavirus disease of 2019 (COVID-19) is associated with significant morbidity and mortality, as well as large numbers of patients requiring endotracheal intubation. While much of the literature has focused on the intubation technique, there is scant discussion of intubation confirmation. Herein, we discuss the limitations of traditional confirmatory approaches, summarize the literature supporting a role for point-of-care ultrasound in this application, and propose an algorithm for intubation confirmation among COVID-19 patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Intubação Intratraqueal/métodos , Pneumonia Viral/terapia , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia de Intervenção/métodos , Algoritmos , Tomada de Decisão Clínica/métodos , Infecções por Coronavirus/diagnóstico por imagem , Humanos , Pandemias , Pneumonia Viral/diagnóstico por imagem
8.
West J Emerg Med ; 21(5): 1076-1079, 2020 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-32970557

RESUMO

The current global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has magnified the risk to healthcare providers when inititiating airway management, and safe tracheal intubation has become of paramount importance. Mitigation of risk to frontline providers requires airway management to be an orchestrated exercise based on training and purposeful simulation. Role allocation and closed-loop communication form the foundation of this exercise. We describe a methodical, 10-step approach from decision-making and meticulous drug and equipment choices to donning of personal protective equipment, and procedural concerns. This bundled approach will help reduce unplanned actions, which in turn may reduce the risk of aerosol transmission during airway management in resource-limited settings.


Assuntos
Manuseio das Vias Aéreas/métodos , Betacoronavirus , Tomada de Decisão Clínica/métodos , Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pacotes de Assistência ao Paciente/métodos , Pneumonia Viral/transmissão , Aerossóis , Manuseio das Vias Aéreas/instrumentação , Manuseio das Vias Aéreas/normas , Infecções por Coronavirus/terapia , Países em Desenvolvimento , Humanos , Relações Interprofissionais , Pandemias , Pacotes de Assistência ao Paciente/instrumentação , Pacotes de Assistência ao Paciente/normas , Equipe de Assistência ao Paciente/organização & administração , Equipamento de Proteção Individual , Pneumonia Viral/terapia
9.
West J Emerg Med ; 21(5): 1095-1101, 2020 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-32970560

RESUMO

The unprecedented COVID-19 pandemic has resulted in rapidly evolving best practices for transmission reduction, diagnosis, and treatment. A regular influx of new information has upended traditionally static hospital protocols, adding additional stress and potential for error to an already overextended system. To help equip frontline emergency clinicians with up-to-date protocols throughout the evolving COVID-19 crisis, our team set out to create a dynamic digital tool that centralized and standardized resources from a broad range of platforms across our hospital. Using a design thinking approach, we rapidly built, tested, and deployed a solution using simple, out-of-the-box web technology that enables clinicians to access the specific information they seek within moments. This platform has been rapidly adopted throughout the emergency department, with up to 70% of clinicians using the digital tool on any given shift and 78.6% of users reporting that they "agree" or "strongly agree" that the platform has affected their management of COVID-19 patients. The tool has also proven easily adaptable, with multiple protocols being updated nearly 20 times over two months without issue. This paper describes our development process, challenges, and results to enable other institutions to replicate this process to ensure consistent, high-quality care for patients as the COVID-19 pandemic continues its unpredictable course.


Assuntos
Betacoronavirus , Tomada de Decisão Clínica/métodos , Infecções por Coronavirus/terapia , Sistemas de Apoio a Decisões Clínicas , Serviços Médicos de Emergência/métodos , Pneumonia Viral/terapia , Atitude do Pessoal de Saúde , Protocolos Clínicos , Árvores de Decisões , Eficiência , Emergências , Humanos , Internet , Pandemias , Padrões de Prática em Enfermagem/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Desenvolvimento de Programas , São Francisco
10.
J Healthc Eng ; 2020: 8835258, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32850105

RESUMO

In this study, a hesitant fuzzy AHP method is presented to help decision makers (DMs), especially policymakers, governors, and physicians, evaluate the importance of intervention strategy alternatives applied by various countries for the COVID-19 pandemic. In this research, a hesitant fuzzy multicriteria decision making (MCDM) method, hesitant fuzzy Analytic Hierarchy Process (hesitant F-AHP), is implemented to make pairwise comparison of COVID-19 country-level intervention strategies applied by various countries and determine relative importance scores. An illustrative study is presented where fifteen intervention strategies applied by various countries in the world during the COVID-19 pandemic are evaluated by seven physicians (a professor of infectious diseases and clinical microbiology, an infectious disease physician, a clinical microbiology physician, two internal medicine physicians, an anesthesiology and reanimation physician, and a family physician) in Turkey who act as DMs in the process.


Assuntos
Tomada de Decisão Clínica/métodos , Infecções por Coronavirus , Tomada de Decisões , Lógica Fuzzy , Pandemias , Pneumonia Viral , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Humanos , Pandemias/prevenção & controle , Médicos , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Projetos de Pesquisa
11.
Front Immunol ; 11: 1648, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32754159

RESUMO

Cytokine storm is an acute hyperinflammatory response that may be responsible for critical illness in many conditions including viral infections, cancer, sepsis, and multi-organ failure. The phenomenon has been implicated in critically ill patients infected with SARS-CoV-2, the novel coronavirus implicated in COVID-19. Critically ill COVID-19 patients experiencing cytokine storm are believed to have a worse prognosis and increased fatality rate. In SARS-CoV-2 infected patients, cytokine storm appears important to the pathogenesis of several severe manifestations of COVID-19: acute respiratory distress syndrome, thromboembolic diseases such as acute ischemic strokes caused by large vessel occlusion and myocardial infarction, encephalitis, acute kidney injury, and vasculitis (Kawasaki-like syndrome in children and renal vasculitis in adult). Understanding the pathogenesis of cytokine storm will help unravel not only risk factors for the condition but also therapeutic strategies to modulate the immune response and deliver improved outcomes in COVID-19 patients at high risk for severe disease. In this article, we present an overview of the cytokine storm and its implications in COVID-19 settings and identify potential pathways or biomarkers that could be targeted for therapy. Leveraging expert opinion, emerging evidence, and a case-based approach, this position paper provides critical insights on cytokine storm from both a prognostic and therapeutic standpoint.


Assuntos
Betacoronavirus/imunologia , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/imunologia , Cuidados Críticos/métodos , Citocinas/sangue , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/imunologia , Corticosteroides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Relação CD4-CD8 , Linfócitos T CD4-Positivos/imunologia , Linfócitos T CD8-Positivos/imunologia , Tomada de Decisão Clínica/métodos , Infecções por Coronavirus/sangue , Infecções por Coronavirus/mortalidade , Estado Terminal , Células Endoteliais/metabolismo , Feminino , Humanos , Hospedeiro Imunocomprometido , Interleucina-6/antagonistas & inibidores , Inibidores de Janus Quinases/uso terapêutico , Masculino , Pandemias , Peptidil Dipeptidase A/metabolismo , Pneumonia Viral/sangue , Pneumonia Viral/mortalidade , Fatores Sexuais , Trombose
12.
Am Surg ; 86(8): 991-995, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32757761

RESUMO

BACKGROUND: The modified brain injury guidelines (mBIG) provide an algorithm for surgeons to manage some mild traumatic brain injury (TBI) with intracranial hemorrhage (ICH) without neurosurgical consultation or repeat imaging. Currently, antiplatelet use among patients with any ICH classifies a patient at the highest level, mBIG 3. This study assesses the risk of clinical progression among patients taking antiplatelet medications with mild TBI with ICH. METHODS: A retrospective analysis of patients with traumatic ICH over a 5-year period was conducted. Demographics, injury severity, and outcome data were collected for each patient. Patients taking antiplatelet agents were reclassified as if they were not taking these medications. Patients who would have met criteria for a lower classification (mBIG 1 or 2) without antiplatelet agents were designated mBIG 3 Antiplatelet and compared with all other mBIG 1 and 2 patients. RESULTS: 736 patients met the inclusion criteria. 158 patients were taking antiplatelet medications and 53 were reclassified as mBIG 3 Antiplatelet. When comparing mBIG 3 Antiplatelet to the 226 patients originally classified as mBIG 1 and 2, mBIG 3 Antiplatelet patients were more likely to undergo repeat head computed tomography (98.1% vs 76.6%; P < .001) and neurosurgical consultation (94.2% vs 76.5%; P < .001) but had no significant differences in outcomes. No mBIG 3 Antiplatelet patients had a worsening examination or needed operative intervention. DISCUSSION: This data suggests that antiplatelet medication use should not automatically classify a patient as mBIG 3. Adoption of this strategy would better utilize resources and avoid unnecessary costs without sacrificing care.


Assuntos
Concussão Encefálica/complicações , Tomada de Decisão Clínica/métodos , Hemorragia Intracraniana Traumática/etiologia , Inibidores da Agregação de Plaquetas/efeitos adversos , Índices de Gravidade do Trauma , Algoritmos , Concussão Encefálica/diagnóstico , Concussão Encefálica/terapia , Feminino , Humanos , Hemorragia Intracraniana Traumática/diagnóstico , Hemorragia Intracraniana Traumática/terapia , Masculino , Guias de Prática Clínica como Assunto , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
13.
Am Surg ; 86(8): 1032-1035, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32757764

RESUMO

BACKGROUND: Laparoendoscopic transhiatal esophagectomy (THE) provides advantages over traditional THE by not only avoiding laparotomy but by also allowing more precise esophageal mobilization. Occasionally, the length of the gastric conduit is insufficient to allow delivery into the neck after laparoscopic mobilization and requires laparotomy to complete the procedure. We hypothesize that the need for laparotomy will correlate with the measurement of mediastinal height (distance from thoracic vertebrae T1-T12) on chest CT. METHODS: Medical records of all patients who underwent attempted laparoendoscopic-assisted THE at a tertiary referral center between March 1, 2003 and January 31, 2019 were reviewed. Patients' mediastinal height was measured using computed tomography (CT) imaging of the chest by investigators and analyzed for correlation between mediastinal height and successful completion of a totally laparoendoscopic procedure. RESULTS: A total of 21 cases met inclusion criteria: 9 successful laparoendoscopic THE procedures and 12 failed laparoendoscopic THE procedures (those requiring addition of a mini-laparotomy or thoracotomy). The mean mediastinal length for successful laparoendoscopic surgery was 23.5 cm, whereas the mean mediastinal length for failed laparoscopic surgeries was 24.8 cm (P = .03). Patient's overall height was not found to correlate with the need for conversion. CONCLUSIONS: Shorter mediastinal length is associated with successful laparoendoscopic or laparoscopic THE. This information is readily available to clinicians from routine preoperative staging studies (chest CT) and may be used to potentially predict the success rate of a totally laparoendoscopic approach and aid in patient selection. Further prospective evaluation of these findings is warranted.


Assuntos
Regras de Decisão Clínica , Conversão para Cirurgia Aberta , Esofagectomia/métodos , Laparoscopia/métodos , Laparotomia , Mediastino/anatomia & histologia , Adulto , Idoso , Tomada de Decisão Clínica/métodos , Feminino , Humanos , Masculino , Mediastino/diagnóstico por imagem , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Seleção de Pacientes , Cuidados Pré-Operatórios , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
14.
Am Surg ; 86(8): 937-943, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32762468

RESUMO

INTRODUCTION: There is disagreement in the trauma community concerning the extent to which emergency medical services (EMS) should perform on-scene interventions. Additionally, in recent years the "ABC" algorithm has been questioned in hypotensive patients. The objective of this study was to quantify the delay introduced by different on-scene interventions. METHODS: A retrospective analysis of hypotensive trauma patients brought to an urban level 1 trauma center by EMS from 2007 to 2018 was performed, and patients were stratified by mechanism of injury and new injury severity score (NISS). Independent samples median tests were used to compare median on-scene times. RESULTS: Among 982 trauma patients, median on-scene time was 5 minutes (interquartile range 3-8). In penetrating trauma patients (n = 488) with NISS of 16-25, intubation significantly increased scene time from 4 to 6 minutes (P < .05). In penetrating trauma patients with NISS of 10-15, wound care significantly increased scene time from 3 to 6 minutes (P < .05). Tourniquet use, interosseous (IO) access, intravenous (IV) access, and needle decompression did not significantly increase scene time. CONCLUSION: Understanding that intubation increases scene time in penetrating trauma, while IV and IO access do not, alterations to the traditional "ABC" algorithm may be warranted. Further investigation of prehospital interventions is needed to determine which are appropriate on-scene.


Assuntos
Algoritmos , Tomada de Decisão Clínica/métodos , Serviços Médicos de Emergência/métodos , Hipotensão/terapia , Tempo para o Tratamento/estatística & dados numéricos , Ferimentos e Lesões/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos Clínicos , Feminino , Mortalidade Hospitalar , Humanos , Hipotensão/etiologia , Hipotensão/mortalidade , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Transporte de Pacientes , Centros de Traumatologia , Ferimentos e Lesões/complicações , Ferimentos e Lesões/mortalidade
16.
Spine (Phila Pa 1976) ; 45(19): 1386-1394, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32756271

RESUMO

STUDY DESIGN: Case series. OBJECTIVE: For each of the most frequent clinical scenarios, the authors reached a consensus on how should be timing and indications be optimized to reduce risk while maintaining the expected outcomes under the Covid-19 pandemics. SUMMARY OF BACKGROUND DATA: The organization of health care has been changed by the Covid-19 pandemic with a direct impact on Spine Oncology Surgery. Emergency surgery is still a priority, but in case of spinal tumors it should be better defined which conditions require emergency treatment. METHODS: An expert panel with general spine surgeons, oncological spine surgeons, and radiation oncologists was formed to analyze the most frequent scenarios in spinal musculoskeletal oncology during Covid-19 pandemics. RESULTS: Spine metastases can be found incidentally during follow-up or can clinically occur by increasing pain, pathologic fracture, and/or neurological symptoms. Primary spine tumors are much more rare and very rarely present with acute onset. The first step is to suspect this rare condition, to avoid to treat a primary tumor as it were a metastasis. Most complex surgery, like en bloc resection, associated with high morbidity and mortality rate for the treatment of low grade malignancy like chordoma or chondrosarcomas, if intensive care unit availability is reduced, can be best delayed some weeks, as not impacting on prognosis, due to the slow growth rate of these conditions. The currently accepted protocols for Ewing sarcoma (ES) and osteogenic sarcoma must be performed for local and systemic disease control. For ES, after the first courses of chemotherapy, radiotherapy can be selected instead of surgery, during Covid-19, to the end of the full course of chemotherapy. In immunocompromised patients, (treated by chemotherapy), it is necessary to avoid contact with affected or exposed people. CONCLUSION: Even more than during normal times, a multidisciplinary approach is mandatory to share the decision to modify a treatment strategy. LEVEL OF EVIDENCE: 5.


Assuntos
Betacoronavirus , Infecções por Coronavirus/cirurgia , Oncologia/normas , Pandemias , Pneumonia Viral/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Cirurgiões/normas , Adulto , Tomada de Decisão Clínica/métodos , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Oncologia/métodos , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Equipe de Assistência ao Paciente/normas , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/epidemiologia , Prognóstico , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/normas , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/epidemiologia , Cirurgiões/psicologia
17.
Neurol Sci ; 41(9): 2353-2366, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32767055

RESUMO

COVID-19 is a pandemic caused by human coronavirus (HCoV) SARS-CoV-2, which originated in Wuhan, China, at the end of 2019 and spread globally during 2020. Due to the difficulty of clinical decision-making during this period, our study group reviewed current literature focusing on the neurological and psychiatric aspects of COVID-19. Despite the knowledge on this newly discovered virus which is constantly evolving, different pieces of evidence reported an association between COVID-19 and neurological symptoms like headache, dizziness, taste and smell disorders and complications involving the nervous system eventually triggered by the pathologic processes elicited by SARS-CoV-2. It seems that younger patients are less prone to develop severe forms of COVID-19. However, neurological signs have been reported in paediatric patients as well, and in some cases, the infection presented neurological sequelae. Furthermore, children with particular neurological diseases or treated with specific drugs (e.g. immune-suppressant therapies) must be carefully monitored during this pandemic. Neurologists should be aware of the main drug-drug interactions and the neurological side effects of COVID-19 treatments. Notably, adverse mental health impact has been reported in patients with SARS-CoV-2, which could be related either to the social strain or to the eventual neurotropic effects of the virus, which in other infections have been proven to promote the onset of psychiatric symptoms. Further, psychiatric population may be more vulnerable to the infection and at higher risk for adverse outcomes.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Gerenciamento Clínico , Transtornos Mentais/epidemiologia , Doenças do Sistema Nervoso/epidemiologia , Pneumonia Viral/epidemiologia , Tomada de Decisão Clínica/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/terapia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia
18.
Acad Med ; 95(10): 1524-1528, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32675791

RESUMO

This initial, exploratory study on gender bias in collaborative medical decision making examined the degree to which physicians' reliance on a team member's patient care advice differs as a function of the gender of the advice giver. In 2018, 283 anesthesiologists read a brief, online clinical vignette and were randomly assigned to receive treatment advice from 1 of 8 possible sources (physician or nurse, man or woman, experienced or inexperienced). They then indicated their treatment decision, as well as the degree to which they relied upon the advice given.The results revealed 2 patterns consistent with gender bias in participants' advice taking. First, when treatment advice was delivered by an inexperienced physician, participants reported replying significantly more on the advice of a man versus a woman, F(1,61) = 4.24, P = .04. Second, participants' reliance on the advice of the woman physician was a function of her experience, F(1,62) = 6.96, P = .01, whereas reliance on the advice of the man physician was not, F(1,60) = 0.21, P = .65.These findings suggest women physicians, relative to men, may encounter additional hurdles to performing their jobs, especially at early stages in their careers. These hurdles are rooted in psychological biases of others, rather than objective features of cases or treatment settings. Cultural stereotypes may shape physicians' information use and decision-making processes (and hinder collaboration), even in contexts that appear to have little to do with social category membership. The authors recommend institutions adopt policies and practices encouraging equal attention to advice, regardless of the source, to help ensure advice taking is a function of information quality rather than the attributes of the advice giver. Such policies and practices may help surface and implement diverse expert perspectives in collaborative medical decision making, promoting better and more effective patient care.


Assuntos
Tomada de Decisão Clínica/métodos , Equipe de Assistência ao Paciente , Médicos/psicologia , Sexismo/psicologia , Adulto , Anestesiologistas/psicologia , Competência Clínica , Feminino , Processos Grupais , Humanos , Masculino , Pessoa de Meia-Idade
20.
Rev Bras Ter Intensiva ; 32(2): 308-311, 2020 Jun.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32667435

RESUMO

The disease pandemic caused by the novel coronavirus has triggered significant changes in the medical decision-making process relating to critically ill patients. Admissions to intensive care units have suddenly increased, but many of these patients do not present with clinical manifestations related to the viral infection but rather exacerbation of preexisting diseases. In this context, we must prevent intuitive decision-making and insecurity from leading us to exhaust the available critical-care beds before they are truly necessary, while still recognizing the importance of rapid decision-making in emergency situations. One of the best ways to achieve this goal may be by practicing metacognition and establishing ways for regular feedback to be provided to professionals engaged in inherently rapid decision-making processes.


Assuntos
Betacoronavirus , Tomada de Decisão Clínica/métodos , Infecções por Coronavirus/epidemiologia , Metacognição , Pneumonia Viral/epidemiologia , Progressão da Doença , Emergências , Retroalimentação , Heurística , Humanos , Unidades de Terapia Intensiva , Pandemias
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