Medical Decision Making

How health professionals and patients make treatment decisions, and the barriers to, and facilitators of, effective decision making.

Racial Bias in Mortality Prediction Scores

Mar. 31, 2021

The COVID-19 pandemic has forced us to face many uncomfortable realities. As critical care physicians, my colleagues and I work in intensive care units (ICUs) that have grown to accommodate the large numbers of patients who have become seriously ill from COVID-19 during the past year. However, the specter of scarcity has been looming. We know that a day may come when there are not enough ICU beds or ventilators for all the patients who need them.

Predicting Survival After Liver Transplantation in Patients With Hepatocellular Carcinoma Using the LiTES-HCC Score

David Goldberg, MD, MSCE
Jan. 13, 2021

David Goldberg, Alejandro Mantero, Craig Newcomb, Cindy Delgado, Kimberly A. Forde, David E. Kaplan, Binu John, Nadine Nuchovich, Barbara Dominguez, Ezekiel EmanuelPeter P. Reese

Abstract [from journal]

Background & aims: Liver transplant priority in the US and Europe follows the 'sickest-first 'principle. However, for patients with hepatocellular carcinoma (HCC), priority is based on binary tumor criteria (e.g., Milan) to expedite transplant for patients with 'acceptable' post-transplant outcomes. Newer risk scores developed to overcome limitations of these binary criteria (e.g., Metroticket, HALT-HCC) are insufficient to be used for waitlist priority as they focus solely on HCC-related pre-transplant variables


Umbilical Cord Milking Versus Delayed Cord Clamping and Associations With In-Hospital Outcomes Among Extremely Premature Infants

Jan. 5, 2021

Neha Kumbhat, Barry Eggleston, Alexis S. Davis, Sara DeMauro, Krisa P. Van Meurs, Elizabeth E. Foglia, Satyan Lakshminrusimha, Michele C. Walsh, Kristi L. Watterberg, Myra H. Wyckoff, Abhik Das, Sara C. Handley

Abstract [from journal]

Objective: To compare in-hospital outcomes after umbilical cord milking versus delayed cord clamping among infants <29 weeks' gestation.

Study design: Multicenter retrospective study of infants born <29 weeks' gestation from 2016 to 2018 without congenital anomalies who received active treatment at delivery and were exposed to UCM or DCC. The primary outcome was mortality or severe (grade III or IV) intraventricular hemorrhage (IVH) by 36 weeks postmenstrual age (PMA). Secondary outcomes


The Changing Landscape of Community Mental Health Care: Availability of Treatment Services in National Data, 2010-2017

Dec. 18, 2020

Janet R. Cummings, Joseph L. Smith, Sara W. Cullen, Steven C. Marcus

Abstract [from journal]

Objective: The authors sought to describe changes in availability of crisis and substance use treatment services in U.S. mental health facilities (including outpatient and inpatient facilities) from 2010 to 2017.

Methods: Using National Mental Health Services Survey data, the authors of this descriptive study examined changes in the proportion of facilities providing crisis and substance use treatment services during the 2010-2017 period.



Changes in Driving Behaviors After Concussion in Adolescents

Dec. 4, 2020

Catherine C. McDonald, Divya Jain, Eileen P. Storey, Madeline Gonzalez, Christina L. Master, Kristy B. Arbogast

Abstract [from journal]

Purpose: Although return to learn, exercise, and sports have evidence-based guidelines, there is limited research investigating return to driving after concussion. The purpose was to characterize and compare adolescent driving behaviors after concussion.

Methods: Using the Minds Matter Concussion Registry, we queried data of adolescents, aged 16-19 years, diagnosed with a concussion ≤28 days of injury and seen between January 31, 2017 and August 31, 2018 at the specialty care concussion


Beyond Survival: The Broader Consequences of Prehospital Transport by Police for Penetrating Trauma

Nov. 26, 2020

Sara F. JacobyCharles C. BranasDaniel N. HolenaElinore J. Kaufman

Abstract [from journal]

Background: Time to definitive hemorrhage control is a primary driver of survival after penetrating injury. For these injuries, mortality outcomes after prehospital transport by police and emergency medical service (EMS) providers are comparable. In this study we identify patient and geographic predictors of police transport relative to EMS transport and describe perceptions of police transport elicited from key stakeholders.

Methods: This mixed methods study was conducted in Philadelphia,


Risk Of Non-infectious Uveitis Or Myasthenia Gravis In Patients On Checkpoint Inhibitors In A Large Healthcare Claims Database

Brian L. Vanderbeek, MD, MPH
Oct. 21, 2020

Tian Xia, Alexander J. Brucker, Brendan McGeehan, Brian L. VanderBeek

Abstract [from journal]

Aim: To determine if checkpoint inhibitors (CPIs) confer an increased risk of non-infectious uveitis or myasthenia gravis (MG) compared to patients on non-checkpoint inhibitor (N-CPI) chemotherapy.

Methods: A retrospective cohort study was performed comparing patients in a large commercial and Medicare advantage database exposed to CPI compared to N-CPI. All patients who initiated a CPI (ipilimumab, pembrolizumab, nivolumab, atezolizumab, avelumab, cemiplimab and durvalumab) were eligible.


Pulmonary Complications In Trauma: Another Bellwether For Failure To Rescue?

Sep. 19, 2020

Dane Scantling, Justin Hatchimonji, Elinore Kaufman, Ruiying Xiong, Wei Yang, Daniel N. Holena

Abstract [from journal]

Background: Pulmonary complications are the most common adverse event after injury and second greatest cause of failure to rescue (death after pulmonary complications). It is not known whether readily accessible trauma center data can be used to stratify center-level performance for various complications. Performance variation between trauma centers would allow sharing of best practices among otherwise similar hospitals. We hypothesized that high-, average-, and low-performing centers for pulmonary complication and


Healthy Behaviors Are Associated With Positive Outcomes For Cancer Survivors With Ostomies: A Cross-Sectional Study

Sep. 17, 2020

Julia Mo, Cynthia A. Thomson, Virginia Sun, Christopher S. Wendel, Mark C. Hornbrook, Ronald S. Weinstein, Elizabeth Ercolano, Marcia Grant, Zuleyha Cidav, Ruth C. McCorkle, Robert S. Krouse 

Abstract [from journal]

Background: Cancer survivors (CS) with ostomies may face challenges in sustaining physical activity (PA) levels and maintaining healthy diets. This analysis describes lifestyle behaviors and their relationships with health-related quality of life (HRQOL) in CS with ostomies.

Methods: This is a cross-sectional, secondary analysis of a multisite randomized self-management education trial for CS with ostomies. The baseline self-reported measures were queried on aerobic PA and diet using the City


The Role Of Oxytocin In Primary Cesarean Birth Among Low-Risk Women

Sep. 15, 2020

Rebecca R. S. Clark, Nicole Warren, Kenneth M. Shermock, Nancy Perrin, Eileen Lake, Phyllis W. Sharps

Abstract [from journal]

Introduction: To examine whether there is a threshold of oxytocin exposure at which the risk for primary cesarean increases among women who are nulliparous with a term, singleton, vertex fetus (NTSV) and how oxytocin interacts with other risk factors to contribute to this outcome.

Methods: This was a secondary analysis of the Consortium on Safe Labor data set that used a retrospective cohort study design. Women who met the criteria for NTSV who were not admitted for a prelabor cesarean and for


Hospital Readmission and Post-Acute Care Use After Intensive Care Unit Admissions: New ICU Quality Metrics?

Christopher Chesley
Sep. 10, 2020

Christopher F. ChesleyMichael O. HarhayDylan S. Small, Asaf Hanish, Hallie C. Prescott, Mark E. Mikkelsen

Abstract [from journal]

Objective: Care coordination is a national priority. Post-acute care use and hospital readmission appear to be common after critical illness. It is unknown whether specialty critical care units have different readmission rates and what these trends have been over time.

Methods: In this retrospective cohort study, a cohort of 53,539 medical/surgical patients who were treated in a critical care unit during their index admission were compared with 209,686 patients who were not treated in a