Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 101.972
Filtrar
1.
Adv Rheumatol ; 61(1): 55, 2021 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-34479631

RESUMO

BACKGROUND: Anti-rheumatic drugs can increase the predisposition to infection, and patients may be unaware of continuing their treatment during the COVID-19 pandemic. OBJECTIVE: This study aimed to assess whether patients maintain their treatment for rheumatic conditions during the pandemic period and determine the factors responsible for discontinuation. METHODS: Patients were randomly selected from the prospectively collected database of our tertiary referral center. The patients were interviewed by telephone through a standardized closed-ended questionnaire, which is targeting the continuity of the treatment plan and the considerations related to the individual choice. The patients were asked whether they hesitated to visit the hospital for follow-up or intravenous drug administration. RESULTS: A total of 278 patients completed the questionnaire. While 62 of the patients (22.3%) had reduced or interrupted the treatment, only 11 patients (3.9%) stopped the treatment completely. A significant difference was observed between the duration of illness and the discontinuation of treatment. (p = 0.023) There was a significant difference in disease activity between the group that stopped treatment and continued treatment. (p = 0.001) There was no statistically significant difference in other demographic characteristics. One hundred thirty-five patients (48.6%) made the treatment decision by themselves, and 80% continued the treatment. Reasons for stopping the treatment were anxiety (48.4%), not being able to go to the hospital for intravenous treatment (45.1%), and not being able to find the drug (6.5%). CONCLUSION: Since patients with long-term illnesses were found to be significantly more likely to stop their treatment, this group of patients should be monitored.


Assuntos
Antirreumáticos/uso terapêutico , Atitude Frente a Saúde , COVID-19/epidemiologia , Pandemias , Doenças Reumáticas/tratamento farmacológico , Suspensão de Tratamento/estatística & dados numéricos , Adulto , Idoso , Antirreumáticos/provisão & distribuição , Ansiedade , Continuidade da Assistência ao Paciente , Bases de Dados Factuais , Tomada de Decisões , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Reumáticas/psicologia , Inquéritos e Questionários/estatística & dados numéricos , Centros de Atenção Terciária , Adulto Jovem
2.
BMJ Open ; 11(9): e050054, 2021 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-34489287

RESUMO

OBJECTIVES: The healthcare system is characterised by a high degree of complexity and involves various actors at different institutional levels and in different care contexts. To implement patient-centred care (PCC) successfully, a multidimensional consideration of influencing factors is required. Our qualitative study aims to identify system-level determinants of PCC implementation from the perspective of different health and social care organisations (HSCOs). DESIGN: A qualitative study using n=20 semistructured face-to-face interviews with n=24 participants was carried out between August 2017 and May 2018. Interview data were analysed based on concepts of qualitative content analysis using an inductive and deductive approach. SETTING AND PARTICIPANTS: Interviews were conducted with clinical and managerial decision makers from multiple HSCOs in the model region of Cologne, Germany. Participants were recruited via networks of practice partners and cold calling. RESULTS: This study identified various determinants on the system level that are associated with PCC implementation. Decision makers described external regulations as generating an economically controlled alignment of the healthcare system. The availability and qualification of staff resources and patient-related incentives of financial resources were identified as an eminent requirement for providers to deliver PCC. Participants considered the strict separation of financing and delivery of healthcare into inpatient and outpatient sectors to be a barrier to PCC. Interorganisational collaboration and information exchange were identified as facilitators of PCC, as they enable continuous patient care cycles. CONCLUSION: The results showed the necessity of enforcing paradigm changes at the system level from disease-centredness to patient-centredness while aligning policy and reimbursement decisions directly with patient needs and values. A systematic, long-term planned strategy that extends across all organisations is lacking, rather each organisation seeks its own possibilities to implement PCC activities under external restrictions.Trial registration numberDRKS00011925.


Assuntos
Atenção à Saúde , Assistência Centrada no Paciente , Tomada de Decisões , Humanos , Pesquisa Qualitativa , Apoio Social
3.
Rev Med Chil ; 149(2): 196-202, 2021 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-34479263

RESUMO

BACKGROUND: Breast cancer (BC) has a high mortality rate in developing countries due to a scarcity of early detection. Risk communication is critical to support women who face the decision to undertake BC screening. Thus, they can balance their perceived and real risk, and make informed choices. AIM: To describe experts' views on how the provision of information related to BC screening should be made. MATERIAL AND METHODS: A qualitative study with focus groups with national experts was conducted. Open coding was performed. RESULTS: Four categories on the way information about BC screening should be provided emerged: to communicate about the need of the exam; the pros and cons of the test; fear as a barrier for understanding; and involving women in the decision-making process. CONCLUSIONS: These findings emphasize the need to include risk communication strategies in the patient-provider relationship and encourage and respect women's autonomy when facing the BC screening decision.


Assuntos
Neoplasias da Mama , Neoplasias da Mama/diagnóstico por imagem , Comunicação , Tomada de Decisões , Detecção Precoce de Câncer , Feminino , Humanos , Mamografia , Programas de Rastreamento , Medição de Risco
4.
Trials ; 22(1): 631, 2021 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-34530868

RESUMO

BACKGROUND: Metastatic prostate cancer remains a lethal malignancy that warrants novel supportive interventions for patients and their decision partners and proxies. Decision aids have been applied primarily to patients with localized disease, with minimal inclusion of patients with advanced prostate cancer and their decision partners. The use of a community patient navigator (CPN) has been shown to have a positive supportive role in health care, particularly with individuals from minority populations. Research is needed to evaluate decision support interventions tailored to the needs of advanced prostate cancer patients and their decision partners in diverse populations. METHODS: Guided by Janis and Mann's Conflict Model of Decision Making, the Cancer Health Aid to Manage Preferences and Improve Outcomes through Navigation (CHAMPION) is a randomized controlled trial to assess the feasibility and acceptability of a mobile health (mHealth), CPN-administered decision support intervention designed to facilitate communication between patients, their decision partners, and the healthcare team. Adult prostate cancer patients and their decision partners at three mid-Atlantic hospitals in the USA were randomized to receive enhanced usual care or the decision intervention. The CHAMPION intervention includes a theory-based decision-making process tutorial, immediate and health-related quality of life graphical summaries over time (using mHealth), values clarification via a balance sheet procedure with the CPN support during difficult decisions, and facilitated discussions with providers to enhance informed, shared decision-making. DISCUSSION: The CHAMPION intervention is designed to leverage dynamic resources, such as CPN teams, mHealth technology, and theory-based information, to support decision-making for advanced prostate cancer patients and their decision partners. This intervention is intended to engage decision partners in addition to patients and represents a novel, sustainable, and scalable way to build on individual and community strengths. Patients from minority populations, in particular, may face unique challenges during clinical communication. CHAMPION emphasizes the inclusion of decision partners and CPNs as facilitators to help address these barriers to care. Thus, the CHAMPION intervention has the potential to positively impact patient and decision partner well-being by reducing decisional conflict and decision regret related to complex, treatment-based decisions, and to reduce cancer health disparities. Trial registration ClinicalTrials.gov NCT03327103 . Registered on 31 October 2017-retrospectively registered. World Health Organization Trial Registration Data Set included in Supplementary Materials.


Assuntos
Neoplasias da Próstata , Telemedicina , Adulto , Tomada de Decisões , Técnicas de Apoio para a Decisão , Humanos , Masculino , Participação do Paciente , Neoplasias da Próstata/terapia , Qualidade de Vida
5.
BMJ Open ; 11(9): e047175, 2021 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-34475158

RESUMO

OBJECTIVES: The COVID-19 pandemic is unprecedented as a global crisis over the last century. How do specialist surgeons make decisions about patient care in these unprecedent times? DESIGN: Between April and May 2020, we conducted an international qualitative study. Sarcoma surgeons from diverse global settings participated in 60 min interviews exploring surgical decision making during COVID-19. Interview data were analysed using an inductive thematic analysis approach. SETTING: Participants represented public and private hospitals in 14 countries, in different phases of the first wave of the pandemic: Australia, Argentina, Canada, India, Italy, Japan, Nigeria, Singapore, Spain, South Africa, Switzerland, Turkey, UK and USA. PARTICIPANTS: From 22 invited sarcoma surgeons, 18 surgeons participated. Participants had an average of 19 years experience as a sarcoma surgeon. RESULTS: 17/18 participants described a decision they had made about patient care since the start of the pandemic that was unique to them, that is, without precedence. Common to 'unique' decisions about patient care was uncertainty about what was going on and what would happen in the future (theme 1: the context of uncertainty), the impact of the pandemic on resources or threat of the pandemic to overwhelm resources (theme 2: limited resources), perceived increased risk to self (theme 3: duty of care) and least-worst decision making, in which none of the options were perceived as ideal and participants settled on the least-worst option at that point in time (theme 4: least-worst decision making). CONCLUSIONS: In the context of rapidly changing standards of justice and beneficence in patient care, traditional decision-making frameworks may no longer apply. Based on the experiences of surgeons in this study, we describe a framework of least-worst decision making. This framework gives rise to actionable strategies that can support decision making in sarcoma and other specialised fields of surgery, both during the current crisis and beyond.


Assuntos
COVID-19 , Sarcoma , Tomada de Decisões , Humanos , Pandemias , SARS-CoV-2 , Sarcoma/epidemiologia , Sarcoma/cirurgia
6.
Nonlinear Dynamics Psychol Life Sci ; 25(4): 385-394, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34516941

RESUMO

Since the pioneering work of Herbert A. Simon, bounded rationality (BR) constitutes a viable alternative to utility maximization in settings characterized by uncertainty about the possible emergence of novel events, missing information, and limitations to human reasoning. Because of its realism, BR gained consensus in organization and management studies. However, BR is a theory of individual decision-making. Substantial extensions are required in order to turn it into a tool to analyze collective decision processes. Following an intuition by the late Simon himself, we submit that organizations channel information flows in ways that alleviate human BR. Thus, analysis and reconstruction of their structure as well as differential degrees and qualities of individual BR within organizations is key to extend this concept to collective decision-making. In this special issue we collected contributions where instances of BR couple with interaction structures to yield collective behavior. Tools range from mathematical models to experimental settings to computational models, testifying to the value of multiple approaches and perspectives.


Assuntos
Cognição , Tomada de Decisões , Processos Grupais , Humanos , Relações Interpessoais , Resolução de Problemas
7.
Nat Neurosci ; 24(9): 1292-1301, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34465915

RESUMO

Generalizing experiences to guide decision-making in novel situations is a hallmark of flexible behavior. Cognitive maps of an environment or task can theoretically afford such flexibility, but direct evidence has proven elusive. In this study, we found that discretely sampled abstract relationships between entities in an unseen two-dimensional social hierarchy are reconstructed into a unitary two-dimensional cognitive map in the hippocampus and entorhinal cortex. We further show that humans use a grid-like code in entorhinal cortex and medial prefrontal cortex for inferred direct trajectories between entities in the reconstructed abstract space during discrete decisions. These grid-like representations in the entorhinal cortex are associated with decision value computations in the medial prefrontal cortex and temporoparietal junction. Collectively, these findings show that grid-like representations are used by the human brain to infer novel solutions, even in abstract and discrete problems, and suggest a general mechanism underpinning flexible decision-making and generalization.


Assuntos
Encéfalo/fisiologia , Tomada de Decisões/fisiologia , Hierarquia Social , Aprendizagem/fisiologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Adulto Jovem
8.
Law Hum Behav ; 45(3): 215-228, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34351204

RESUMO

OBJECTIVE: The present study integrates several distinct lines of jury decision-making research by examining how the racial identities of the defendant and an informant witness interact in a federal drug conspiracy trial scenario and by assessing whether jurors' individual racial identity and jury group racial composition influence their judgments. HYPOTHESES: We predicted that jurors would be biased against the Black defendant and would be more likely to convict after exposure to a White informant, among other hypotheses. METHOD: We recruited 822 nonstudent jury-eligible participants assigned to 144 jury groups. Each group was assigned to one of four onditions where defendant race (Black or White) and informant race (Black or White) was manipulated. Each group watched a realistic audio-visual trial presentation, then deliberated as a group to render a verdict. RESULTS: Contrary to expectations, the conditions depicting a Black defendant yielded lower conviction rates compared to those with a White defendant-at both the predeliberation individual (odds ratio [OR] = 1.54) and postdeliberation group level (OR = 2.91)-while the informant race did not influence verdict outcomes. We also found that jurors rated the government witnesses as more credible when the defendant was White compared to when he was Black. Credibility ratings and verdict outcomes were also predicted by jurors' own race, although juror race did not interact with the race conditions when predicting verdicts. CONCLUSIONS: Jurors are sensitive to defendant race, and this sensitivity appears to strengthen after deliberation-but in a direction opposite to what was expected. One potential implication of our findings is that juries may operate as a check on system bias by applying greater scrutiny to law enforcement-derived evidence when the defendant is Black. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Tomada de Decisões , Tráfico de Drogas/legislação & jurisprudência , Julgamento , Função Jurisdicional , Fatores Raciais , Racismo/psicologia , Adulto , Grupo com Ancestrais do Continente Africano , Idoso , Idoso de 80 Anos ou mais , Direito Penal , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Aplicação da Lei , Masculino , Pessoa de Meia-Idade
9.
Hum Mov Sci ; 79: 102856, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34391110

RESUMO

Background The literature has shown the positive effect of virtual reality (VR) in percepto-cognitive skills. However, the literature lacks findings about at what extent VR would be better than video. Purpose This study aimed to analyze the chronic effect of VR and video-stimulation screen training on passing decision-making, visual search behavior, and inhibitory control performance in young soccer athletes. Method A total of 26 young soccer players underwent an 8-week training protocol after being randomly assigned to the VR (n = 13) or video-screen (VID, n = 13) group. Passing decision-making, visual search behavior, and inhibitory control performance were measured before and after both interventions. Results A group x time interaction was found for decision-making performance (p < 0.01) and visual search behavior (p < 0.01). Both groups improved both decision-making performance (p < 0.01) and visual search behavior (p < 0.01); however, greater improvements were verified in VR (p < 0.01). Both VR and VID improved inhibitory control (p < 0.01), but no group interaction effect was observed (p > 0.05). Conclusion Our results suggest that VR leads to greater improvements in decision-making and visual search behavior in young soccer athletes than VID.


Assuntos
Futebol , Realidade Virtual , Atletas , Cognição , Tomada de Decisões , Humanos
10.
Comput Intell Neurosci ; 2021: 9315700, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34367272

RESUMO

At present, machine learning artificial neural network technology, as one of the core technologies of enterprises, has received unprecedented attention. This technology is widely used in automatic driving, pattern recognition, teaching aid, product modeling, and other fields. According to the development of product design, this paper analyzes the factors that affect the decision-making of product design. The neural network optimized by genetic algorithm is studied, and the technical analysis of neural network algorithm before and after optimization is mainly carried out. The basic process of product modeling design model based on image processing under the background of big data is introduced. The multidirectional group decision-making model of product modeling design scheme in big data cloud environment is constructed. The final decision model can improve the overall design efficiency, shorten the manufacturing period, and provide a new idea for product modeling design.


Assuntos
Big Data , Redes Neurais de Computação , Algoritmos , Tomada de Decisões , Humanos , Aprendizado de Máquina
11.
J Law Med ; 28(3): 813-830, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34369132

RESUMO

The law regulating medical end-of-life decisions aims to support patients to receive high-quality health care. It does so through ensuring treatment received reflects the person's wishes and values and protecting health professionals who provide adequate pain and symptom relief even if that treatment may coincidentally hasten death. However, good decision-making is predicated by those involved, including patients themselves and those supporting patients, being familiar with the law and the role it plays in the decision-making process. This article reports on a study exploring the role that law plays in end-of-life decision-making from the perspective of terminally-ill patients, their substitute decision-makers and family members. While participants' decision-making practices were often underpinned by a legal framework, the role of the law was largely invisible. Community education is needed for the public to know their legal rights and responsibilities, and to understand that the law plays a role in supporting end-of-life decision-making.


Assuntos
Assistência Terminal , Morte , Tomada de Decisões , Pessoal de Saúde , Humanos
12.
Artigo em Inglês | MEDLINE | ID: mdl-34360370

RESUMO

In December 2019, a new infectious respiratory disease called COVID-19 was identified in Wuhan, Hubei province, in China and quickly reached pandemic status in March 2020, in uncertain and frightening situation. The objective of this study was to analyze the epidemiological curves from the fight against COVID-19 in China and Italy, establishing parameters that can assist with the decisions of health-planning managers. This study was conducted using the principles of the grounded theory methodology and a practical method of comparison between the real and ideal curves, based on the contamination and death data by SARS-CoV-2 in China and Italy. For this purpose, we built graphs, including parameters, such as, among others, amplitude, height, saturation point, acceleration, lethality, event, risk, and efficiency. The results of our study showed that China exhibited amplitude and height of the active contamination and death curve 2 times smaller than those of Italy which exhibited several saturations. It was investigated that Italy presented a qualitative risk of 5-6, whereas for China it was 4. According to the parameters, China and Italy presented health management that was able to reduce the impact caused by the virus. The implementation of adequate health management with these practical tools can guide perception of the crisis critical levels, avoiding major disasters. We intend to continue to validate the method in the analysis of data from Brazil and the USA.


Assuntos
COVID-19 , China/epidemiologia , Tomada de Decisões , Humanos , Itália/epidemiologia , SARS-CoV-2
13.
14.
Malawi Med J ; 33(1): 28-36, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-34422231

RESUMO

Background: Preventing prolongation of the decision-to-delivery interval (DDI) for emergency caesarean delivery (CD) remains central to improving perinatal health. This study evaluated the effects of the DDI on perinatal outcome following emergency CD. Methods: A prospective cross-sectional study involving 205 consenting women who had emergency CD at a tertiary hospital in Nigeria was conducted. The time-motion documentation of events from decision to delivery was documented; the outcome measures were perinatal morbidity (neonatal resuscitation, 5-minute Apgar score, neonatal intensive admission) and mortality. Data analysis was performed with IBM SPSS Statistics version 20.0, and P<0.05 was considered significant. Results: The overall mean DDI was 233.99±132.61 minutes (range 44-725 minutes); the mean DDI was shortest for cord prolapse (86.25±86.25 minutes) and was shorter for booked participants compared with unbooked participants (207.19±13.88 minutes vs 249.25±12.05 minutes; P=0.030) and for general anaesthesia compared with spinal anaesthesia (219.48±128.60 minutes vs 236.19±133.42 minutes; P=0.543). All neonatal parameters were significantly worse for unbooked women compared with booked women, including perinatal mortality (10.8% vs 1.3%; P=0.012). Neonatal morbidity increased with DDI for clinical indications, UK National Institute of Health and Care Excellence (NICE) and Robson classification for CDs; perinatal mortality was 73.2 per 1000 live births, all were category 1 CDs and all except one occurred with DDI greater than 90 minutes. Severe preeclampsia/eclampsia, obstructed labour and placenta praevia tolerated DDI greater than 90 minutes compared with abruptio placentae and umbilical cord prolapse. However, logistic regression showed no statistical correlation between the DDI and neonatal outcomes. Conclusion: Perinatal morbidity and mortality increased with DDI relative to the clinical urgency but perinatal deaths were increased with DDI greater than 90 minutes. For no category of emergency CD should the DDI exceed 90 minutes, while patient and institutional factors should be addressed to reduce the DDI.


Assuntos
Cesárea/estatística & dados numéricos , Tomada de Decisões , Tratamento de Emergência/métodos , Adulto , Índice de Apgar , Estudos Transversais , Tratamento de Emergência/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Nigéria/epidemiologia , Mortalidade Perinatal , Médicos , Gravidez , Resultado da Gravidez , Estudos Prospectivos , Fatores de Tempo
15.
PLoS One ; 16(8): e0256871, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34464430

RESUMO

BACKGROUND: Clinical research has been central to the global response to COVID-19, and the United Kingdom (UK), with its research system embedded within the National Health Service (NHS), has been singled out globally for the scale and speed of its COVID-19 research response. This paper explores the impacts of COVID-19 on clinical research in an NHS Trust and how the embedded research system was adapted and repurposed to support the COVID-19 response. METHODS AND FINDINGS: Using a multi-method qualitative case study of a research-intensive NHS Trust in London UK, we collected data through a questionnaire (n = 170) and semi-structured interviews (n = 24) with research staff working in four areas: research governance; research leadership; research delivery; and patient and public involvement. We also observed key NHS Trust research prioritisation meetings (40 hours) and PPI activity (4.5 hours) and analysed documents produced by the Trust and national organisation relating to COVID-19 research. Data were analysed for a descriptive account of the Trust's COVID-19 research response and research staff's experiences. Data were then analysed thematically. Our analysis identifies three core themes: centralisation; pace of work; and new (temporary) work practices. By centralising research prioritisation at both national and Trust levels, halting non-COVID-19 research and redeploying research staff, an increased pace in the setup and delivery of COVID-19-related research was possible. National and Trust-level responses also led to widescale changes in working practices by adapting protocols and developing local processes to maintain and deliver research. These were effective practical solutions borne out of necessity and point to how the research system was able to adapt to the requirements of the pandemic. CONCLUSION: The Trust and national COVID-19 response entailed a rapid large-scale reorganisation of research staff, research infrastructures and research priorities. The Trust's local processes that enabled them to enact national policy prioritising COVID-19 research worked well, especially in managing finite resources, and also demonstrate the importance and adaptability of the research workforce. Such findings are useful as we consider how to adapt our healthcare delivery and research practices both at the national and global level for the future. However, as the pandemic continues, research leaders and policymakers must also take into account the short and long term impact of COVID-19 prioritisation on non-COVID-19 health research and the toll of the emergency response on research staff.


Assuntos
COVID-19/epidemiologia , Pesquisa/estatística & dados numéricos , COVID-19/virologia , Tomada de Decisões , Humanos , Entrevistas como Assunto , Pesquisadores/psicologia , SARS-CoV-2/isolamento & purificação , Reino Unido/epidemiologia
16.
Ned Tijdschr Geneeskd ; 1652021 06 10.
Artigo em Holandês | MEDLINE | ID: mdl-34346637

RESUMO

In January 2020, the Dutch law on the medical treatment agreement was updated. In this update, shared decision-making is explicitly mentioned as a prerequisite during doctor-patient encounters. This entails explicit exploration of the patient's wishes, views and preferences and their integration in medical decision-making. There is growing interest in shared decision-making from patient advocacy and professional societies, the government, and healthcare insurers. However, both care professionals and patients are not yet used to applying this in their encounters. Creating awareness, training and organisational changes are essential aspects to foster shared decision-making. Various (umbrella) organisations in healthcare have developed (digital) tools for both care professionals and patients to support shared decision-making. This article addresses these tools to nudge all stakeholders towards shared decision-making.


Assuntos
Tomada de Decisões , Participação do Paciente , Tomada de Decisão Clínica , Tomada de Decisão Compartilhada , Humanos
17.
Ned Tijdschr Geneeskd ; 1652021 06 24.
Artigo em Holandês | MEDLINE | ID: mdl-34346660

RESUMO

Traditionally, diagnosis is the basis for clinical decision-making and regarded as the guide to prognosis and treatment. Although some patients may particularly benefit such a diagnosis-oriented approach (e.g., patients with acute pathology for which effective treatment is available), this approach is not suitable or sufficient for others (e.g., patients without a diagnosis, patients with a diagnosis for which no treatment is available, and patients for whom the current treatment is insufficient). Furthermore, other factors than diagnosis or diagnosis-guided treatment are likely to influence an individual's outcome (prognosis), including biological, clinical, and social factors. The authors propose a prognosis-oriented approach as an alternative starting point for medical decision-making: not only ask yourself 'what is the explanation for my patient's complaint?', but also 'which factors contribute to the future outcome of this complaint?' and 'can I address these to benefit my patient's outcome?'.


Assuntos
Tomada de Decisão Clínica , Tomada de Decisões , Previsões , Humanos , Prognóstico
18.
Nat Commun ; 12(1): 4788, 2021 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-34373454

RESUMO

Activity in numerous brain regions drives heroin seeking, but no circuits that limit heroin seeking have been identified. Furthermore, the neural circuits controlling opioid choice are unknown. In this study, we examined the role of the infralimbic cortex (IL) to nucleus accumbens shell (NAshell) pathway during heroin choice and relapse. This model yielded subpopulations of heroin versus food preferring rats during choice, and choice was unrelated to subsequent relapse rates to heroin versus food cues, suggesting that choice and relapse are distinct behavioral constructs. Supporting this, inactivation of the IL with muscimol produced differential effects on opioid choice versus relapse. A pathway-specific chemogenetic approach revealed, however, that the IL-NAshell pathway acts as a common limiter of opioid choice and relapse. Furthermore, dendritic spines in IL-NAshell neurons encode distinct aspects of heroin versus food reinforcement. Thus, opioid choice and relapse share a common addiction-limiting circuit in the IL-NAshell pathway.


Assuntos
Analgésicos Opioides/farmacologia , Comportamento Aditivo , Comportamento de Procura de Droga/efeitos dos fármacos , Transtornos Relacionados ao Uso de Opioides , Animais , Comportamento Animal , Encéfalo/patologia , Córtex Cerebral/efeitos dos fármacos , Córtex Cerebral/fisiologia , Sinais (Psicologia) , Tomada de Decisões/efeitos dos fármacos , Ingestão de Alimentos/psicologia , Extinção Psicológica/fisiologia , Alimentos , Heroína/farmacologia , Dependência de Heroína , Masculino , Vias Neurais/fisiologia , Núcleo Accumbens/metabolismo , Ratos , Recidiva , Reforço Psicológico , Roedores , Autoadministração
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...