Medical Decision Making

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

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


Designing Nudges For Success In Health Care

Sep. 1, 2020

Joseph D. Harrison and Mitesh S. Patel

Abstract [from journal]

Nudges are subtle changes to the design of the environment or the framing of information that can influence our behaviors. There is significant potential to use nudges in health care to improve patient outcomes and transform health care delivery. However, these interventions must be tested and implemented using a systematic approach. In this article, we describe several ways to design nudges for success by focusing on optimizing and fitting them into the clinical workflow, engaging the right stakeholders, and rapid experimentation.

Improving Child Behaviors And Parental Stress: A Randomized Trial Of Child Adult Relationship Enhancement In Primary Care

Joanne Wood, MD
Aug. 10, 2020

Joanne N. Wood, Devon Kratchman, Philip V. Scribano, Steven Berkowitz, Samantha Schilling

Abstract [from journal]

Background: Prior single site evaluations of PriCARE, a 6-session group parent training, demonstrated reductions in child behavioral problems and improvements in positive parenting attitudes.

Objective: To measure the impact of PriCARE on disruptive child behaviors, parenting stress, and parenting attitudes in a multisite study.

Methods: Caregivers of children 2- to 6-years-old with behavior concerns recruited from 4 pediatric primary care practices were randomized 2:1


Implementing Couple's Human Immunodeficiency Virus Testing And Counseling In The Antenatal Care Setting

Florence Marie Momplaisir, MD, MSHP, FACP
Aug. 6, 2020

Florence Momplaisir, Emily Finley, Sandra Wolf, Erika Aaron, Itoro Inoyo, David Bennett, Sara Seyedroudbari, Allison Groves

Abstract [from journal]

Objective: To describe a pilot implementation of couple's human immunodeficiency virus (HIV) testing and counseling in an antenatal care clinic in the United States.

Methods: We used a cross-sectional study design. Couples were recruited from an antenatal care clinic of a large, urban, tertiary medical center, and were eligible if both partners agreed to receive HIV test results together and reported no coercion to participate in testing and counseling and no intimate partner violence. We


Informal and Formal Home Care For Older Adults With Disabilities Increased, 2004-16

Aug. 1, 2020

Courtney H. Van Houtven, R. Tamara Konetzka, Elizabeth Taggert, Norma B. Coe

Abstract [from journal]

Rates of informal home care use among older adults with disabilities increased from 2004 to 2016, such that in 2016 almost three-quarters of these adults received informal home care. Informal care remains the most common source of home care, even though formal home care use grew at almost twice the rate, with a 6-percentage-point increase to 36.9 percent in 2016.

Efficacy Of An Enhanced Recovery After Surgery (ERAS) Pathway In Elderly Patients Undergoing Spine And Peripheral Nerve Surgery

Jul. 31, 2020

Joseph Ifrach, Rohan Basu, Disha S. Joshi, Tracy M. Flanders, Ali K. Ozturk, Neil R. Malhotra, Rachel Pessoa, Michael J. Kallan, Eileen Maloney, William C. Welch, Zarina S. Ali 

Abstract [from journal]

Objective: Elderly patients are a vulnerable patient population in elective spinal surgery. Older patients have more medical comorbidities and are also more sensitive to opiate medications. Despite this, spine and peripheral nerve surgery is still feasible in these patients, and an Enhanced Recovery After Surgery (ERAS) regimen can further enhance the safety profile.

Methods: This is a before and after cohort study at a single institution on elderly patients who underwent elective spine and


Concordance Of Confirmatory Prostate Biopsy In Active Surveillance With National Guidelines: An Analysis From The Multi-Institutional PURC Cohort

Jul. 29, 2020

Ruchika Talwar, Brian Friel, Sameer Mittal, Leilei Xia, Claudette Fonshell, John Danella, Bruce Jacobs, Thomas Lanchoney, Jay Raman, Jeffrey Tomaszewski, Edouard Trabulsi, Adam Reese, Eric Singer, Serge Ginzburg, Marc Smaldone, Robert Uzzo, Phillip Mucksavage, Thomas J. Guzzo, ...

Abstract [from journal]

Purpose: National Comprehensive Cancer Network (NCCN) guidelines recommend confirmatory biopsy within 12 months of active surveillance (AS) enrollment. With <10 cores on initial biopsy, re-biopsy should occur within 6 months. Our objective was to determine if patients on AS within practices in the Pennsylvania Urologic Regional Collaborative (PURC) receive guideline concordant confirmatory biopsies.

Materials and methods: Within PURC, a prospective collaborative of diverse urology practices


Ethics And Informatics In The Age Of COVID-19: Challenges And Recommendations For Public Health Organization And Public Policy

Ross Koppel, PhD
Jul. 28, 2020

Vignesh Subbian, Anthony Solomonides, Melissa Clarkson, Vasiliki Nataly Rahimzadeh, Carolyn Petersen, Richard Schreiber, Paul R. DeMuro, Prerna Dua, Kenneth W. Goodman, Bonnie Kaplan, Ross Koppel, Christoph U. Lehmann, Eric Pan, Yalini Senathirajah

Abstract [from journal]

The COVID-19 pandemic response in the United States has exposed significant gaps in information systems and processes to enable timely clinical and public health decision-making. Specifically, the use of informatics to mitigate the spread of SARS-CoV-2, support COVID-19 care delivery, and accelerate knowledge discovery bring to the forefront issues of privacy, surveillance, limits of state powers, and interoperability between public health and clinical information systems. Using a consensus building process, we critically analyze