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The Journal of Family Planning and... Jul 2016Presenting risk information to patients is an important part of clinical encounters. Good risk communication improves patient satisfaction with their care and the... (Review)
Review
OBJECTIVES
Presenting risk information to patients is an important part of clinical encounters. Good risk communication improves patient satisfaction with their care and the decisions they make. In sexual and reproductive healthcare (SRH), women frequently need to make decisions based on their perceived risk. Risk perception can be altered by how actual risk is presented to patients.
METHODS
Databases were searched using MeSH terms combined with a keyword search for articles relevant to SRH; the search was limited to English language.
RESULTS
Personalised risk communication where a risk score is provided, increases knowledge and slightly increases uptake of screening tests. Decision aids improve a patient's knowledge of the options, create realistic expectations of their benefits and harms, reduce difficulty with decision-making, and increase participation in the process. The most effective way to present risks uses a range of structured, tailored presentation styles; interactive formats are best. Framing the information improves patient understanding. Most people understand natural frequencies or event rates better than probability formats with varying denominators. Expressing changes in risk as an absolute risk reduction or relative risk reduction with baseline risk formats improves understanding. Descriptive terms such as 'low risk' or 'high risk' should be quantified as a frequency rather than a percentage. Using a consistent denominator to portray risk is recommended. Using the 'number needed to treat' and visual aids puts benefits or risks into perspective. The duration of risk should be presented.
CONCLUSION
Presenting risk information to patients can be optimised using a number of strategies.
PubMed: 27267797
DOI: 10.1136/jfprhc-2012-100301 -
Optimization Aug 2017In this paper, we propose two proximal-gradient algorithms for fractional programming problems in real Hilbert spaces, where the numerator is a proper, convex and lower...
In this paper, we propose two proximal-gradient algorithms for fractional programming problems in real Hilbert spaces, where the numerator is a proper, convex and lower semicontinuous function and the denominator is a smooth function, either concave or convex. In the iterative schemes, we perform a proximal step with respect to the nonsmooth numerator and a gradient step with respect to the smooth denominator. The algorithm in case of a concave denominator has the particularity that it generates sequences which approach both the (global) optimal solutions set and the optimal objective value of the underlying fractional programming problem. In case of a convex denominator the numerical scheme approaches the set of critical points of the objective function, provided the latter satisfies the Kurdyka-ᴌojasiewicz property.
PubMed: 33116346
DOI: 10.1080/02331934.2017.1294592 -
The Journal of Craniofacial Surgery Jun 2023Since it was proposed in this journal in 2001, the cranial vault asymmetry index (CVAI) has been an important parameter for assessing cranial shape. However, different...
Since it was proposed in this journal in 2001, the cranial vault asymmetry index (CVAI) has been an important parameter for assessing cranial shape. However, different publications currently use different variables in the denominator of the CVAI formula. We thus investigated the use of long and short diagonal lengths as variables in the denominator of the CVAI formula. We searched the databases of PubMed, Google Scholar, and Scopus for articles published between 2016 and 2022 that cited the original work article of CVAI. Articles were included if they were written in English and if the denominator of the CVAI formula was specified. For multiple articles by the same author, only the most recent article was included. In total, 30 articles were included; 10 articles used the longer diagonal length as the denominator and 20 articles used the shorter diagonal length. No uniform trend was observed by a country or journal of publication. Application of the CVAI formula using different denominators yielded interchangeable results, and the resulting values had only negligible differences clinically. However, it would be necessary to create a standard formula for using the CVAI as a parameter for reporting cranial shape assessments consistently.
Topics: Humans; Plagiocephaly, Nonsynostotic; Skull; Bibliometrics; Databases, Factual
PubMed: 36922383
DOI: 10.1097/SCS.0000000000009263 -
Journal of Hospital Medicine Jul 2021The Centers for Medicare & Medicaid Services (CMS) Hospital Readmissions Reduction Program (HRRP) penalizes hospitals having excess inpatient rehospitalizations within...
The Centers for Medicare & Medicaid Services (CMS) Hospital Readmissions Reduction Program (HRRP) penalizes hospitals having excess inpatient rehospitalizations within 30 days of index inpatient stays for targeted conditions. Observation hospitalizations are increasing in frequency and may clinically resemble inpatient hospitalizations, yet HRRP excludes observation in index and 30-day rehospitalization counts. Using 100% 2014 Medicare fee-for-service claims and CMS's 30-day rehospitalization methodology, we modeled how observation hospitalizations impact HRRP metrics when counted as index (denominator) and 30-day (numerator) rehospitalizations. Of 3,806,772 index hospitalizations for HRRP conditions, 418,923 (11%) were observation; 18% (155,553/876,033) of rehospitalizations were invisible to HRRP due to observation hospitalization as index (34%; 63,740/188,430), 30-day outcome (53%; 100,343/188,430), or both (13%; 24,347/188,430). By ignoring observation hospitalizations as index and 30-day events, nearly one of five HRRP rehospitalizations is missed. Policymakers might consider this an opportunity to address broad challenges of the two-tiered observation and inpatient hospital billing distinction.
Topics: Aged; Humans; Medicare; Patient Readmission; United States
PubMed: 34197304
DOI: 10.12788/jhm.3634 -
PloS One 2016To correct the incongruence of document types between the numerator and denominator in the traditional impact factor (IF), we make a corresponding adjustment to its... (Comparative Study)
Comparative Study
To correct the incongruence of document types between the numerator and denominator in the traditional impact factor (IF), we make a corresponding adjustment to its formula and present five corrective IFs: IFTotal/Total, IFTotal/AREL, IFAR/AR, IFAREL/AR, and IFAREL/AREL. Based on a survey of researchers in the fields of ophthalmology and mathematics, we obtained the real impact ranking of sample journals in the minds of peer experts. The correlations between various IFs and questionnaire score were analyzed to verify their journal evaluation effects. The results show that it is scientific and reasonable to use five corrective IFs for journal evaluation for both ophthalmology and mathematics. For ophthalmology, the journal evaluation effects of the five corrective IFs are superior than those of traditional IF: the corrective effect of IFAR/AR is the best, IFAREL/AR is better than IFTotal/Total, followed by IFTotal/AREL, and IFAREL/AREL. For mathematics, the journal evaluation effect of traditional IF is superior than those of the five corrective IFs: the corrective effect of IFTotal/Total is best, IFAREL/AR is better than IFTotal/AREL and IFAREL/AREL, and the corrective effect of IFAR/AR is the worst. In conclusion, not all disciplinary journal IF need correction. The results in the current paper show that to correct the IF of ophthalmologic journals may be valuable, but it seems to be meaningless for mathematic journals.
Topics: Algorithms; Journal Impact Factor; Mathematics; Ophthalmology; Periodicals as Topic; Surveys and Questionnaires; United States
PubMed: 26977697
DOI: 10.1371/journal.pone.0151414 -
Frontiers in Microbiology 2018The morphology of bacterial species shows a wealth of variation from star-shaped to spherical and rod- to spiral-shaped, to mention a few. Their mode of growth and... (Review)
Review
The morphology of bacterial species shows a wealth of variation from star-shaped to spherical and rod- to spiral-shaped, to mention a few. Their mode of growth and division is also very diverse and flexible ranging from polar growth and lateral surface increase to midcell expansion and from perpendicular to longitudinal asymmetric division. Gammaproteobacterial rod-shaped species such as divide perpendicularly and grow in length, whereas the genetically very similar rod-shaped symbiotic divide longitudinally, and some species even divide asynchronously while growing in width. The ovococcal also lengthens and divides perpendicularly, yet it is genetically very different from . Are these differences as dramatic as is suggested by visual inspection, or can they all be achieved by subtle variation in the regulation of the same protein complexes that synthesize the cell envelope? Most bacteria rely on the cytoskeletal polymer FtsZ to organize cell division, but only a subset of species use the actin homolog MreB for length growth, although some of them are morphologically not that different. Poles are usually negative determinant for cell division. Curved cell poles can be inert or active with respect to peptidoglycan synthesis, can localize chemotaxis and other sensing proteins or other bacterial equipment, such as pili, depending on the species. But what is actually the definition of a pole? This review discusses the possible common denominators for growth and division of distinct and similar bacterial species.
PubMed: 29867786
DOI: 10.3389/fmicb.2018.00822 -
PLoS Medicine Nov 2022We previously reported on a randomised trial demonstrating the effectiveness and cost-effectiveness of a pharmacist-led information technology intervention (PINCER). We... (Observational Study)
Observational Study
BACKGROUND
We previously reported on a randomised trial demonstrating the effectiveness and cost-effectiveness of a pharmacist-led information technology intervention (PINCER). We sought to investigate whether PINCER was effective in reducing hazardous prescribing when rolled out at scale in UK general practices.
METHODS AND FINDINGS
We used a multiple interrupted time series design whereby successive groups of general practices received the PINCER intervention between September 2015 and April 2017. We used 11 prescribing safety indicators to identify potentially hazardous prescribing and collected data over a maximum of 16 quarterly time periods. The primary outcome was a composite of all the indicators; a composite for indicators associated with gastrointestinal (GI) bleeding was also reported, along with 11 individual indicators of hazardous prescribing. Data were analysed using logistic mixed models for the quarterly event numbers with the appropriate denominator, and calendar time included as a covariate. PINCER was implemented in 370 (94.1%) of 393 general practices covering a population of almost 3 million patients in the East Midlands region of England; data were successfully extracted from 343 (92.7%) of these practices. For the primary composite outcome, the PINCER intervention was associated with a decrease in the rate of hazardous prescribing of 16.7% (adjusted odds ratio (aOR) 0.83, 95% confidence interval (CI) 0.80 to 0.86) at 6 months and 15.3% (aOR 0.85, 95% CI 0.80 to 0.90) at 12 months postintervention. The unadjusted rate of hazardous prescribing reduced from 26.4% (22,503 patients in the numerator/853,631 patients in the denominator) to 20.1% (11,901 patients in the numerator/591,364 patients in the denominator) at 6 months and 19.1% (3,868 patients in the numerator/201,992 patients in the denominator). The greatest reduction in hazardous prescribing associated with the intervention was observed for the indicators associated with GI bleeding; for the GI composite indicator, there was a decrease of 23.9% at both 6 months (aOR 0.76, 95% CI 0.73 to 0.80) and 12 months (aOR 0.76, 95% CI 0.70 to 0.82) postintervention. The unadjusted rate of hazardous prescribing reduced from 31.4 (16,185 patients in the numerator/515,879 patients in the denominator) to 21.2% (7,607 patients in the numerator/358,349 patients in the denominator) at 6 months and 19.5% (2,369 patients in the numerator/121,534 patients in the denominator). We adjusted for calendar time and practice, but since this was an observational study, the findings may have been influenced by unknown confounding factors or behavioural changes unrelated to the PINCER intervention. Data were also not collected for all practices at 6 months and 12 months postintervention.
CONCLUSIONS
The PINCER intervention, when rolled out at scale in routine clinical practice, was associated with a reduction in hazardous prescribing by 17% and 15% at 6 and 12 months postintervention. The greatest reductions in hazardous prescribing were for indicators associated with risk of GI bleeding. These findings support the wider national rollout of PINCER in England.
Topics: Humans; Pharmacists; Interrupted Time Series Analysis; Information Technology; Medication Errors; General Practice
PubMed: 36383560
DOI: 10.1371/journal.pmed.1004133 -
International Journal of Molecular... Aug 2020Ataxia is a common clinical feature in inherited metabolic disorders. There are more than 150 inherited metabolic disorders in patients presenting with ataxia in... (Review)
Review
Ataxia is a common clinical feature in inherited metabolic disorders. There are more than 150 inherited metabolic disorders in patients presenting with ataxia in addition to global developmental delay, encephalopathy episodes, a history of developmental regression, coarse facial features, seizures, and other types of movement disorders. Seizures and a history of developmental regression especially are important clinical denominators to consider an underlying inherited metabolic disorder in a patient with ataxia. Some of the inherited metabolic disorders have disease specific treatments to improve outcomes or prevent early death. Early diagnosis and treatment affect positive neurodevelopmental outcomes, so it is important to think of inherited metabolic disorders in the differential diagnosis of ataxia.
Topics: Ataxia; Developmental Disabilities; Genetic Predisposition to Disease; Genetic Testing; High-Throughput Nucleotide Sequencing; Humans; Metabolic Diseases; Seizures; Treatment Outcome
PubMed: 32752260
DOI: 10.3390/ijms21155519 -
Minerva Anestesiologica Feb 2016
Topics: Humans; Ice Cover
PubMed: 26449778
DOI: No ID Found -
TheScientificWorldJournal 2012Recent research has shown that patients frequently experience difficulties understanding health-relevant numerical concepts. A prominent example is denominator neglect,... (Review)
Review
Recent research has shown that patients frequently experience difficulties understanding health-relevant numerical concepts. A prominent example is denominator neglect, or the tendency to pay too much attention to numerators in ratios (e.g., number of treated patients who died) with insufficient attention to denominators (e.g., overall number of treated patients). Denominator neglect can lead to inaccurate assessments of treatment risk reduction and thus can have important consequences for decisions about health. Here, we reviewed a series of studies investigating (1) different factors that can influence patients' susceptibility to denominator neglect in medical decision making--including numerical or language-related abilities; (2) the extent to which denominator neglect can be attenuated by using visual aids; and (3) a factor that moderates the effectiveness of such aids (i.e., graph literacy). The review spans probabilistic national U.S. and German samples, as well as immigrant (i.e., Polish people living in the United Kingdom) and undergraduate samples in Spain. Theoretical and prescriptive implications are discussed.
Topics: Audiovisual Aids; Communication; Decision Support Techniques; Germany; Informed Consent; Patient Education as Topic; Patient Participation; Risk Assessment
PubMed: 22629146
DOI: 10.1100/2012/562637