Clinical Decision-Making Research Papers - Academia.edu (original) (raw)

Clinical Decision Support Systems (CDSS) provide aid in clinical decision making and therefore need to take into consideration human, data interactions, and cognitive functions of clinical decision makers. The objective of this paper is to introduce a high level reference model that is intended to be used as a foundation to design successful and contextually relevant CDSS systems. The paper begins by introducing the information flow, use, and sharing characteristics in a hospital setting, and then it outlines the referential context for the model, which are clinical decisions in a hospital setting. Important characteristics of the Clinical decision making process include: (i) Temporally ordered steps, each leading to new data, which in turn becomes useful for a new decision, (ii) Feedback loops where acquisition of new data improves certainty and generates new questions to examine, (iii) Combining different kinds of clinical data for decision making, (iv) Reusing the same data in two or more different decisions, and (v) Clinical decisions requiring human cognitive skills and knowledge, to process the available information. These characteristics form the foundation to delineate important considerations of Clinical Decision Support Systems design. The model includes six interacting and interconnected elements, which formulate the high-level reference model (CDSS-RM). These elements are introduced in the form of questions, as considerations, and are examined with the use of illustrated scenario-based and data-driven examples. The six elements /considerations of the reference model are: (i) Do CDSS mimic the cognitive process of clinical decision makers? (ii) Do CDSS provide recommendations with longitudinal insight? (iii) Is the model performance contextually realistic? (iv) Is the 'Historical Decision' bias taken into consideration in CDSS design? (v) Do CDSS integrate established clinical standards and protocols? (vi) Do CDSS utilize unstructured data? The CDSS-RM reference model can contribute to optimized design of modeling methodologies, in order to improve response of health systems to clinical decision-making challenges.

- by Dimitrios Zikos
- •
- Clinical Decision-Making, Healthcare, Reference model, Theoretical Framework

Nella pratica clinica è frequente imbattersi in situazioni che presentano una valenza etica, e non sempre si è preparati ad affrontarle o si è pienamente consapevoli dei valori in base ai quali si agisce. Questo libro si propone di fornire gli strumenti adeguati per far fronte a tali situazioni con un elevato livello di consapevolezza. Si rivolge quindi a medici, infermieri, operatori sanitari, pazienti, caregiver e a chiunque sia interessato alla riflessione bioetica.

- by Marco Vergano and +1
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- Communication, Clinical Decision-Making, Clinical Ethics, End of life care

There is limited understanding of how osteopaths make decisions in relation to clinical practice. The aim of this research was to construct an explanatory theory of the clinical decision-making and therapeutic approaches of experienced osteopaths in the UK. Twelve UK registered osteopaths participated in this constructivist grounded theory qualitative study. Purposive and theoretical sampling was used to select participants. Data was collected using semi-structured interviews which were audio-recorded and transcribed. As the study approached theoretical sufficiency, participants were observed and video-recorded during a patient appointment, which was followed by a video-prompted interview. Constant comparative analysis was used to analyse and code data. Data analysis resulted in the construction of three qualitatively different therapeutic approaches which characterised participants and their clinical practice, termed; Treater, Communicator and Educator. Participants' therapeutic approach influenced their approach to clinical decision-making, the level of patient involvement, their interaction with patients, and therapeutic goals. Participants' overall conception of practice lay on a continuum ranging from technical rationality to professional artistry, and contributed to their therapeutic approach. A range of factors were identified which influenced participants' conception of practice. The findings indicate that there is variation in osteopaths' therapeutic approaches to practice and clinical decision-making, which are influenced by their overall conception of practice. This study provides the first explanatory theory of the clinical decision-making and therapeutic approaches of osteopaths.

- by Dr Oliver Thomson and +1
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- Grounded Theory, Clinical Reasoning, Clinical Decision-Making, Manual Therapy
- by James Marcum
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- Epistemology, Virtue Epistemology, Clinical Decision-Making, Cardiovascular disease

In the last decades "shared decision-making" has been hailed as the new paradigm for the doctor-patient relationship. However, different models of clinical decision-making appear to be compatible with the core tenets of "shared decision-making". Reconsidering Emanuel and Emanuel (1992) classic analysis, in this paper we distinguish five possible models of clinical decision-making: (i) the 'instrumental'; (ii) the 'paternalistic'; (iii) the 'informative'; (iv) the 'interpretative'; and (v) the 'persuasive' models. For each model we present its fundamental assumptions as well as the role that patients and doctors are expected to play with respect to value-laden dilemmas. We argue that, with the exception of the instrumental model, each of the other four models may be appropriate depending on the circumstances. We conclude by highlighting the importance of structuring clinical care around actual persons-and their unique lives and philosophies-rather than around abstract frameworks.

- by Marco Annoni
- •
- Health Sciences, Ethics, Bioethics, Decision Making

- by Benny Goodman
- •
- Nursing, Clinical Decision-Making

Asthma is a disease characterized by wide variations in
pathogenesis that cause resistance to flow in intrapulmonary
airways. The dramatic changes in the architecture of the airway
walls are usually connected to allergic reaction or other forms of
hyper sensitivity, causing marked spasms that lead to difficulty in
breathing. It is possible to relieve or remove the symptoms in the
majority of patients by adopting the clinical guidelines for
pharmacotherapy of asthma which include inhaled corticosteroids,
long and short acting beta agonists, muscarinic antagonists,
leukotriene modifiers, xanthine drugs and some allergy medicines.
The proper use of these agents can aid in reducing or reversing
many symptoms of asthma. Certain methods of using medicines,
for example the correct use of the inhaler for relief and
maintenance therapy, are also associated with a significant
reduction in symptoms. This can be achieved by a pharmacist’s
intervention that can provide a detailed understanding of the
current rational drug choices and proper medication use to the
patient. Nowadays massive resources are being ploughed into
research in a concerted effort to halt the progress of this illness
that can strike in all ages.

This paper examines the components of decision making and the process of making clinical decisions. An issue to consider is to what degree do we make decisions based on systematic reasoning, rational enquiry, and the best available evidence? What are the thinking processes, i.e. cognition, that we use when making accountable decisions, bearing mind a key part of accountability is our ability to articulate and justify the decisions we make. This also leads us to consider errors in decision making and thus ways to reduce them.
What follows is by no means exhaustive, it is an introduction to the large study of decision making, reasoning and exercising clinical judgment. After a short exercise to define nursing clinical decision making, there are three sections:
1. Clinical Decision Making: Normative Theory, how it should be done.
2. Clinical Decision Making: Descriptive Theory, how it is done.
3. Clinical Decision Making: Prescriptive Theory, how it might be done better.

- by Benny Goodman
- •
- Nursing, Clinical Decision-Making

ABSTRACT
Effective clinical decision making is among the most important skills required by healthcare practitioners.
Making sound decisions while working collaboratively in interprofessional healthcare teams is
essential for modern healthcare planning, successful interventions, and patient care. The cognitive
continuum theory (CCT) is a model of human judgement and decision making aimed at orienting
decision-making processes. CCT has the potential to improve both individual health practitioner, and
interprofessional team understanding about, and communication of, clinical decision-making processes.
Examination of the current application of CCT indicates that this theory could strengthen interprofessional
team clinical decision making (CDM). However, further research is needed before extending the
use of this theoretical framework to a wider range of interprofessional healthcare team processes.
Implications for research, education, practice, and policy are addressed.

Determination of subjective weights, which are based on the opinions and preferences of decision-makers, is one of the most important matters in the process of multi-criteria decision-making (MCDM). Step-wise Weight Assessment Ratio Analysis (SWARA) is an efficient method for obtaining the subjective weights of criteria in the MCDM problems. On the other hand, decision-makers may express their opinions with a degree of uncertainty. Using the symmetric interval type-2 fuzzy sets enables us to not only capture the uncertainty of information flexibly but also to perform computations simply. In this paper, we propose an extended SWARA method with symmetric interval type-2 fuzzy sets to determine the weights of criteria based on the opinions of a group of decision-makers. The weights determined by the proposed approach involve the uncertainty of decision-makers' preferences and the symmetric form of the weights makes them more interpretable. To show the procedure of the proposed approach, it is used to determine the importance of intellectual capital dimensions and components in a company. The results show that the proposed approach is efficient in determining the subjective weights of criteria and capturing the uncertainty of information.

Selection of appropriate subcontractors for outsourcing is very important for the success of construction projects. This can improve the overall quality of projects and promote the qualification and reputation of the main contractors. The evaluation of subcontractors can be made by some experts or decision-makers with respect to some criteria. If this process is done in different time periods, it can be defined as a dynamic multi-criteria group decision-making (MCGDM) problem. In this study, we propose a new fuzzy dynamic MCGDM approach based on the EDAS (Evaluation based on Distance from Average Solution) method for subcontractor evaluation. In the procedure of the proposed approach, the sets of alternatives, criteria and decision-makers can be changed at different time periods. Also, the proposed approach gives more weight to newer decision information for aggregating the overall performance of alternatives. A numerical example is used to illustrate the proposed approach and show the application of it in subcontractor evaluation. The results demonstrate that the proposed approach is efficient and useful in real-world decision-making problems.

In the real-world problems, we are likely confronted with some alternatives that need to be evaluated with respect to multiple conflicting criteria. Multi-criteria decision-making (MCDM) refers to making decisions in such a situation. There are many methods and techniques available for solving MCDM problems. The evaluation based on distance from average solution (EDAS) method is an efficient multi-criteria decision-making method. Because the uncertainty is usually an inevitable part of the MCDM problems, fuzzy MCDM methods can be very useful for dealing with the real-world decision-making problems. In this study, we extend the EDAS method to handle the MCDM problems in the fuzzy environment. A case study of supplier selection is used to show the procedure of the proposed method and applicability of it. Also, we perform a sensitivity analysis by using simulated weights for criteria to examine the stability and validity of the results of the proposed method. The results of this study show that the extended fuzzy EDAS method is efficient and has good stability for solving MCDM problems.

Abstract
Guidelines are ubiquitous but inconsistently used in UK mental health services. Clinical psychologists are often influential in guideline development and implementation, but opinion within the profession is divided. This study utilised grounded theory methodology to examine clinical psychologists’ beliefs about, and use of NICE guidelines. Eleven clinical psychologists working in the NHS were interviewed. The overall emerging theme was; NICE guidelines are considered to have benefits but to be fraught with dangers. Participants were concerned that guidelines can create an unhelpful illusion of neatness. They managed the tension between the helpful and unhelpful aspects of guidelines by relating to them in a flexible manner. The participants reported drawing on specialist skills such as idiosyncratic formulation and integration. However, due to the pressures and dominant discourses within services they tended to practice in ways that prevent these skills from being recognised. This led to fears that their professional identity was threatened, which impacted upon perceptions of the guidelines. To our knowledge, the theoretical framework presented in this paper is the first that attempts to explain why NICE guidelines are not consistently utilised in UK mental health services. The current need for services to demonstrate ‘NICE compliance’ may be leading to a perverse incentive for clinical psychologists in particular to do one thing but say another and for specialist skills to be obscured. If borne out by future studies, this represents a threat to continued quality improvement and also to the profession.

- by Anne Cooke
- •
- Clinical Psychology, Decision Making, Mental Health, Grounded Theory

While most of healthcare research and practice fully endorses evidence-based healthcare, a minority view borrows popular themes from philosophy of science like underdetermination
and value-ladenness to question the legitimacy of the evidence-based movement’s philosophical underpinnings. While the feminist origins go unacknowledged, those critics adopt a feminist reading of the “gap argument” to challenge the perceived objectivism of evidence-based practice. From there, the critics seem to despair over the “subjective elements” that values introduce to clinical reasoning, demonstrating that they do not subscribe to feminist science studies’ normative program——where
contextual values can enable good science and justified decisions. In this paper, I investigate why it is that the critics of evidence-based medicine adopt feminist science’s characterization of the problem but resist the productive solutions offered by those same theorists. I suggest that the common feminist empiricist appeal to idealized epistemic communities is impractical for those working within the current biomedical
context and instead offer an alternate stream of feminist research into the empirical content of values (found in the work of Elizabeth Anderson and Sharyn Clough) as a more helpful recourse for facilitating the important task of legitimate and justified clinical decision-making. I use a case study on clinical decision-making to illustrate the fruitfulness of the latter feminist empiricist framework.

""As a profession nursing needs to develop not only academically at all levels, but also in professional relationships both among the same discipline members as well as with other members of the Inter Disciplinary Team (IDT).
This dictum which held good in 1996 when I did this assignment as part of my nurse education course still holds good today I feel.
Good management at whatever level, autonomy of the various health sectors and lifelong education for the health care team all go a long way towards furthering professional development for nurses. Nonetheless to facilitate this process for nurses, be they students or qualified staff, support or, using the current buzzword, supervision, is a necessity.
However this has its advantages as well as disadvantages as this short article will demonstrate.""

- by Paula Aquilina
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- Clinical Decision-Making
- by Albert Figueras and +1
- •
- Clinical Decision-Making, Rational Use of Medicine, Rational drug use

This paper presents a systematic account of ethical issues actualised in different areas, as well as at different levels and stages of health care, by introducing organisational and other procedures that embody a shift towards person centred care and shared decision-making (PCC/SDM). The analysis builds on general ethical theory and earlier work on aspects of PCC/SDM relevant from an ethics perspective. This account leads up to a number of theoretical as well as empirical and practice oriented issues that, in view of broad advancements towards PCC/SDM, need to be considered by health care ethics researchers. Given a PCC/SDM-based reorientation of health care practice, such ethics research is essential from a quality assurance perspective.

- by Lars Sandman and +1
- •
- Nursing, Philosophy, Applied Philosophy, Ethics

This paper arises from the need to explain expert decision-making in professional environments from a plural and interdisciplinary perspective. An extended review of Rational Choice Theory (RCT) from its first developments to current trends makes explicit the mismatch between RCT and empirical work settings. A review of recent theories on the cognitive abilities of agents makes clear the lack of integration between findings in evolutionary psychology, cognitive science, perceptual psychology and neurology, and those proposed by RCT. We will examine the causes for the failure of Good Old Fashioned Artificial Intelligence (GOFAI), the strongest empirical program for testing RCT premises. Contributions from the cognitive and social sciences put forward the weaknesses of analytical sociology at all four levels: the biological, the psychological, the epistemological, and the ontological. Alternative explanations from contemporary cognitive science will be put forward.

- by Dafne Muntanyola-Saura
- •
- Cognitive Science, Artificial Intelligence, Epistemology, Decision Making

"The clinical bacteria of multi-drug resistant to some antibiotics are
considered a common problem in the world wide. Alternative
antibacterial strategies are urgently needed, and thus this situation
has led to a re-evaluation of the therapeutic use of ancient
remedies, such as plants and plant-based products, including
Nigella sativa (N. sativa). This study aimed to evaluate the
antibacterial activity of Yemeni N. sativa oil against some Clinical
Bacterial Isolates (CBI) and Control Strains of Bacteria (CSB) in
comparison with Augmentin® (Amoxicillin and Clavulanic Acid).
This study was carried out in Sana’a city during the period of one
year from May 2012 to April 2013. The antibacterial activity of oil
with different concentrations was determined by using disc agar
diffusion technique against CBI (Staphylococcus aureus and
Pseudomonas aeruginosa) and CSB (Staphylococcus aureus
ATCC25619, Pseudomonas aeruginosa ATCC29737), also the
Minimum Inhibition Concentration (MIC) of oil extract was
determined. The results indicated that, the highest significant
antibacterial activity was at the maximum concentration of the oil
against Staphylococcus aureus and Pseudomonas aeruginosa in
comparison with Augmentin ® discs (p < 0.05) respectively. This
study observed that, there was strong positive correlation between
the diameter zone (DZ-mm) and oil concentrations (%). In
addition, the DZ (mm) of the oil for CSB was higher than CBI.
Also the oil activity was found to be more effective against
Staphylococcus aureus than Pseudomonas aeruginosa. On the
other hand, the MIC of the oil against CBI were ranged between ≥
0.5% and 4%. Whereas, the CSB particularly Staphylococcus
aureus were sensitive to low concentrations of oil. It could be
concluded that, the oil had high antibacterial effect against CSB
and CBI with high concentration and more effective than
Augmentin® discs."

Several attempts have been made at creating mobile solutions for patients with mental disorders. A preemptive approach would definitely outdo a reactive one. This project seeks to ensure better crisis detection, by assigning patients (veterans) to caregivers (mentors). This is called the mentor-mentee approach. Enhanced with the use of mobile technology, veterans can stay connected in their daily lives to mentors, who have gone through the same traumatic experiences and have overcome them. A mobile application for communication between veterans and their mentors has been developed, which helps mentors get constant feedback from their mentees about their state of well-being. However, being able to make good deductions from the data given as feedback is of great importance. Under-representing or over-representing the data could be dangerously misleading. This paper

- by Katinka C Hooyer and +3
- •
- Visualization, Military Veterans, Crisis Management, Clinical Decision-Making

In this brief paper, I discuss the importance of the patient's story and having the space to listen to it.
The way doctors come to their diagnoses, how they listen to patient’s stories, how they decide what to treat, is not a straight forward process though it might seem so. Take a history-perform a physical examination-order tests-analyse results-diagnose-treat-evaluate treatment. It looks linear. It is supposed that the hypothetico-deductive method accurately describes this thinking. However, the objective gathering of data, the analysis of that data to produce a hypothesis, the testing and revision of that hypothesis and subsequent diagnosis could be more an objective academic description of a process rather than an accurate description of what happens in actuality.

- by Benny Goodman
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- Nursing, Narrative Medicine, Clinical Decision-Making, Cognitive Bias
- by Peter A Facione
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- Critical Thinking, Clinical Decision-Making
- by Ozen B Demir
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- Clinical Decision-Making, Hippocratic Corpus

Opening chapter of "Critical Thinking and Clinical Reasoning in the Health Sciences: A Teaching Anthology," 2008. Published by Insight Assessment. © 2008 NC Facione & PA Facione, Hermosa Beach, CA. This essay surveys how health... more

- by Peter A Facione
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- Clinical Decision-Making

Recent literature suggests that disparities in prescribed treatments may exist for youth with type 1 diabetes. There is limited research to date examining factors associated with prescribed regimen intensity in this population. In this study, we examined racial/ethnic differences in regimen intensity and predictors of regimen intensity in youth with type 1 diabetes. We expected that minority youth would have less intensive regimens and that caregiver and physician perceptions would be associated with regimen intensity. This cross-sectional study included 178 families of 10- to 17-yr-old youth at three endocrinology clinics. Caregivers reported perceived costs and benefits of intensive regimens. Physicians described the prescribed treatment and their perceptions of family/child competence and self-management. Analyses included analysis of covariance and hierarchical multiple linear regression. Findings indicate a disparity in regimen intensity for minority youth. Caregiver perceptions of costs associated with intensive regimens and physician perceptions of family competence are associated with prescribed regimen intensity. Interventions targeting disparities in prescribed regimen intensity should be considered. Further research is needed to understand the role of family perceptions of treatments and physician clinical decision making in addressing health disparities in type 1 diabetes.

- by Jessica Valenzuela
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- Pediatric Psychology, Diabetes, Health Disparities, Clinical Decision-Making

Medical data can be mined for patterns, which may be used to predict candidate diagnoses according to symptoms and other parameters of care. Our hypothesis is that the admission (initial) patient assessment, when combined with seasonal information can provide more accurate insights for the patient diagnosis. For instance, when cough is the symptom, the probability for flu could be higher during the winter (flu season). We hereby present a method to estimate the temporal variation of the probability for a diagnosis, when the initial patient assessment is known. In order to develop the model, we utilized a large synthetic medical claims dataset from the Centers for Medicare and Medicaid Services. We used the Apriori algorithm to calculate the support and confidence for each 'admission_diagnosis → final_diagnosis' itemset. For each itemset, 52 rules were generated, one for each week of a calendar year. The Apriori output was filtered so that only itemsets with the 'admission diagnosis' on the LHS are extracted. We furthermore smoothened, using the EWMA algorithm, and then visualized the week-by-week variability of confidence, for any 'admission_diagnosis → final_diagnosis' pair of interest. With our approach, researchers can observe seasonal variations of the diagnosis element, and further study these variations for causal knowledge discovery. CCS CONCEPTS • Human-centered computing → Visualization → Visualization design and evaluation methods • Computing methodologies → Machine learning → Machine learning approaches

- by Dimitrios Zikos
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- Health Informatics, Clinical Decision-Making, Association Rules Mining, Apriori

Aims and objectives To explore whether there is a correlation between critical thinking ability and clinical decision-making among nurses. Background Critical thinking is currently considered as an essential component of nurses’ professional judgment and clinical decision-making. If confirmed, nursing curricula may be revised emphasizing on critical thinking with the expectation to improve clinical decision-making and thus better healthcare. Design Integrated literature review. Methods The integrative review was carried out after a comprehensive literature search using electronic databases Ovid, EBESCO Medline, EBESCO CINAHL, PROQuest and internet search engine Google Scholar. Two hundred and twenty two articles from January 1980 to end of 2015 were retrieved. All studies evaluating the relationship between critical thinking and clinical decision-making, published in English language with nurses or nursing students as the study population, were included. No qualitative studies were found investigating the relationship between critical thinking and clinical decision-making, while ten quantitative studies met the inclusion criteria and were further evaluated using the Quality Assessment and Validity Tool. As a result one study was excluded due to a low quality score, with the remaining nine accepted for this review. Results Four out of nine studies established a positive relationship between critical thinking and clinical decision-making. Another five studies did not demonstrate a significant correlation. The lack of refinement in studies’ design and instrumentation were arguably the main reasons for the inconsistent results. Conclusions Research studies yielded contradictory results as regard to the relationship between critical thinking and clinical decision-making, therefore the evidence is not convincing. Future quantitative studies should have representative sample size, use critical thinking measurement tools related to the healthcare sector and evaluate the predisposition of test takers towards their willingness and ability to think. There is also a need for qualitative studies to provide a fresh approach in exploring the relationship between these variables uncovering currently unknown contributing factors. Relevance to clinical practice This review confirmed that evidence to support the existence of relationships between critical thinking and clinical decision-making are still unsubstantiated. Therefore, it serves as a call for nurse leaders and nursing academics to produce quality studies in order to firmly support or reject the hypothesis that there is a statistically significant correlation between critical thinking and clinical decision-making.

- by Robert Thomas Bachmann and +1
- •
- Nursing, Clinical Decision-Making, Criticial Thinking

Computer-based learning has numerous advantages. It gives students the chance to accommodate and solve problems independently, it can increase motivation during the learning process, and it offers students direct feedback. Students will also receive an authentic learning
experience, increasing their level of knowledge retention. It can assist nursing educators in improving learning outcomes. Aim: This study aimed to investigate and evaluate the impact of computer-based scenarios on undergraduate nursing students’ decision-making skills. Sample: There was a total sample of 112 nursing students who were enrolled in a critical care nursing course at the College of Applied Medical Sciences in Saudi Arabia. These students were divided into two groups. Methods: The two groups were taught the same topic for one week. Two case scenarios were given to each group during the clinical rotation. The study group used the computer-based case scenario, and the control group used the paper-based case scenario. The two groups were compared regarding their decision-making skills. The student’s feedback about the computer-based case scenarios was also investigated. Results: The study group scored significantly higher in their decision-making skills when compared to the control group. In addition, the study group reported that they highly agreed that their general learning and specific nursing abilities improved after using computer-based case scenarios.

Nowadays, healthcare and medical education is qualified by test scores and competitiveness. This article considers its quality in terms of improving the moral competence of future healthcare providers. Objectives. Examining the relevance of moral competence in medico-clinical decision-making despite the paradigm shift and discussing the up-to-date findings on healthcare students (Polish sample). Design and method. N=115 participants were surveyed with a standard Moral Competence Test to examine how their moral competence development was affected by the learning environment and further important factors. Results. The sample allowed the identification of a regress in moral competence during students’ preclinical
curriculum, and progress during their clinical curriculum. A gender-related bias, a segmentation effect, and a pronunciation effect were noticed. Explanations. Scholarly literature usually reports a linear decrease of medical students’ C-scores resulting from, e.g., competitive
trends in education. We identified such trends in terms of gender-specific competitive tactics. Religious and ethical affiliations were discussed to explain the unexpected gender bias and the
related segmentation and pronunciation effects. The findings can be regarded as predictive for similar developments in educational institutions regardless of cultural contexts as the sample examined in this article represents medical education in a country facing a transition from a noncompetitive to competitive tertiary education model, and between presecular and monocultural to secular and pluralist social ethics.

- by Ethics in Progress - Research Journal and +1
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- Philosophy, Ethics, Education, Medical Education

Recent decades have seen a move toward evidence-based medicine to inform the clinical decision-making process with reproducible findings from high-quality research studies. There is a need for objective, quantitative measurement tools to increase the reliability and reproducibility of studies evaluating the efficacy of healthcare interventions, particularly in the field of physical and rehabilitative medicine. Surface electromyography (sEMG) is a non-invasive measure of muscle activity that is widely used in research but is under-utilized as a clinical tool in rehabilitative medicine. Other types of electrophysiological signals (e.g., electrocardiography, electroencephalography, intramuscular EMG) are commonly recorded by healthcare practitioners, however, sEMG has yet to successfully transition to clinical practice. Surface EMG has clear clinical potential as an indicator of muscle activation, however reliable extraction of information requires knowledge of the appropriate methods for recording and analyzing sEMG and an understanding of the underlying biophysics. These concepts are generally not covered in sufficient depth in the standard curriculum for physiotherapists and kinesiologists to encourage a confident use of sEMG in clinical practice. In addition, the common perception of sEMG as a specialized topic means that the clinical potential of sEMG and the pathways to application in practice are often not apparent. The aim of this paper is to address barriers to the translation of sEMG by emphasizing its benefits as an objective clinical tool and by overcoming its perceived complexity. The many useful clinical applications of sEMG are highlighted and examples provided to illustrate how it can be implemented in practice. The paper outlines how fundamental biophysics and EMG signal processing concepts could be presented to a non-technical audience. An accompanying tutorial with sample data and code is provided which could be used as a tool for teaching or self-guided learning. The importance of observing sEMG in routine use in clinic is identified as an essential part of the effective communication of sEMG recording and signal analysis methods. Highlighting the advantages of sEMG as a clinical tool and reducing its perceived complexity could bridge the gap between theoretical knowledge and practical application and provide the impetus for the widespread use of sEMG in clinic.

- by Lara McManus
- •
- Physiology, Physiotherapy, Signal Processing, Rehabilitation

The goal of this project is to develop and utilize a microfluidic device to isolate and enrich tumor cells circulating in peripheral blood. Circulating tumor cells (CTCs) have been used as biomarkers for cancer diagnostics and prognosis. However, the rarity of these cells (roughly 1 in a billion) poses a technological challenge to sort and concentrate them. CTCs hold potential sources for early detection, characterization, monitoring of cancers, and development of personalized treatment. The project is currently funded by the US National Cancer Institute (NCI) of the National Institutes of Health (NIH).

- by Jose I Varillas
- •
- Health Sciences, Medical Sciences, Technology, Biomedicine

"4E" cognitive science has demonstrated that embodied coupling offers powerful resources for reasoning. Despite a surge of studies, little empirical attention is paid to discussing the precise scope of these resources and their possible complementariness with traditional knowledge-based inference. We use decision-making in Shiatsu practicea bodywork method that employs hands-on interaction with a clientto showcase how the two types of cognitive resources can mesh and offer alternative paths to a task: "Local" resources such as embodied presence, empathy, attunement, as well as skilled perception-action coupling are not only central for implementing a successful therapeutic intervention. The immediate coupling with a client also offers basic means of deciding about fitting and meaningful interventions. Yet, when comprehensive intervention strategies are at stake, Shiatsu decision making must be complemented through "non-local" resources, notably inferences rooted in anatomy/ physiology knowledge, categories, heuristics, and mental models. To draw out implications for "4E" cognitive science, we argue that "local" embodied coupling and "nonlocal" conceptual inferences can functionally complement, inform, and scaffold each other in a dialectic process.

- by Michael Kimmel and +1
- •
- Heuristics, Clinical Decision-Making, Decision-Making, Affordances

Given that organ transplant is a standard medical technology admitted in medical practice, and taking into consideration that Polish transplantology is regarded among the most advanced in the world one should expect to find similarly high levels of acceptance in interviewees asked for their opinion on vital organ transplantation and their willingness to donate a paired organ ex vivo, or a vital organ ex mortuo in order to rescue the life of a recipient with a missing vital organ. The paper presents research build on the societal assessment of vital organ donation and transplant policies in Poland with the focus on students. Data have been collected at three different universities (Boratyński et al., Questionnaire on the Bases of Transplantation Medicine 2016/7). Various assessments concerning a vital organ donation have been observed. The authors discuss educational factors contributing to these variety including factual knowledge and ethical issues.

Background, Purpose & Methodology – Even though Healthcare (HC) is an expensive investment, its quality suffers today, due to lacking evidence-based clinical decision support (CDS) during patient-care. This theoretical research examines thoughts on knowledge management (KM), electronic health record (EHR), decision support system (DSS), clinical practice guidelines (CPGs) and ontologies to narrow the decision-making gap. Findings & Research limitations– This paper develops a pragmatic and strategically viable conceptual grounded in theory architecture model that needs testing in a real/simulated and transcultural HC environments. This model illustrates how EHR and KM facilitate DSS to effectively facilitate decisions making or CDS. Practical implications & Originality/Value – The expressed harmonious relation between KM and EHR is a relation that is under researched and hence a soft area of KM. Its absence is the reason for the costly medical errors that continue to raise HC costs today.
Keywords- Healthcare Knowledge Management; Electronic Health Record; Personal Health Record; Clinical Practice Guidelines; Ontology; e-Health;

Current research studies have emphasized various barriers in electronic health record (EHR) adoptability
and interoperability. Lack of EHR adaptability has a negative impact on medical decision making (DM).
Even though through EHR practitioners can manage information overload, it is underutilized.
Consequently, medical errors as well as healthcare (HC) costs increase. Up-to-date research on
application of knowledge management (KM) to enhance EHR adoptability and interoperability is limited.
On the contrary, researchers focus on adapting electronic patient record (EPR) within KM. HC KM is a
very important tool to facilitate interoperability and adaptability of EHR. Its advantages have been proven
in other areas. This paper proposes a solution - a conceptual HC KM infrastructure for EHR
interoperability and adaptability. This solution reduces EHR adaptability barriers by improving
interoperability and enhancing user interaction using KM tools within an e-health environment.
Keywords: Healthcare; Electronic Health Record (EHR); Electronic Patient Record (EPR); Knowledge
Management; Decision-making; EHR Interoperability; EHR Adaptability.

- by Tillal Eldabi and +1
- •
- Knowledge Management, Judgment and decision making, Knowledge sharing, Electronic Health Records
- by Nicolás Schöngut-Grollmus and +1
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- Actor Network Theory, Public Health, Clinical Decision-Making, Rare diseases

While the vast majority of preterm births globally occur in low and middle-income countries (LMICs), existing published guidelines relating to decision-making and resuscitation of extremely preterm infants (EPI) largely focus on High-Income Countries.
In 2018/2019, a working group of the Philippine Society of Newborn Medicine aimed to develop the first national guideline relating to the care of EPI. The working group reviewed data on the outcome for EPI in the Philippines, surveyed paediatricians and neonatologists in the Philippines about current practice, and held a consensus workshop.
This paper describes the guideline development process and presents a summary of the guidelines. The national guidelines endorse consistency in decision making. Health professionals should take into consideration the views and wishes of the infant’s parents, and the availability of resources to treat the newborn infant. Active management would be appropriate to provide for potentially viable preterm infants at moderate to high risk of poor outcome, where parents have expressed their wish for this (and where there are resources available to provide this treatment). For such infants, where parents have expressed their wish to withhold active management, palliative management would also be appropriate to provide.
The guideline endorses a grey zone for neonatal resuscitation from approximately 24-28 weeks gestation in the Philippines, reflecting the context for resuscitation in a LMIC. Disparities in resource availability are themselves an ethical concern for neonatologists and should be a stimulus for advocacy, and improvements in health care delivery.

- by Dominic Wilkinson and +1
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- Medical Ethics, Clinical Decision-Making, Prematurity, Clinical Practice Guidelines

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