外科临床决策

决策是人们为了达到一定的目标而选定行动方案并付诸实施的过程。外科临床决策（clinical decision making）是指在外科临床实践中我们该做什么，不该做什么，怎样做会取得更好的效果。应该指出，决策与技术相比，虽然二者缺一不可，但决策是第一位的，技术是第二位的，决策正确才有成功的希望。决策失误，不论有多么高的技术也不会取得满意的结果，甚至技术越高损失反而会更大。     

Surgical decision making

Decision making is an integral part of surgical practice and is a skill that is as important as the ability to operate. Sound decision making is the result of acquiring ‘surgical wisdom’, which is achieved through learning, experience and reflection. This paper reviews the processes of surgical decision making with respect to choosing the correct procedure and deciding when to operate, and how operative decisions are made, together with the factors that influence our surgical decisions.     

外科决定

外科决策与外科决定是2种不同层次的策略。前者是领导和管理人员决定外科整体发展方向和水平定位,不在本文讨论之中。后者是外科医师在治疗时所作的决定。这些决定有对有错,外科医师只能希望决定对时多,错时少。但是否每一个错误的决定,都是外科医师医疗疏忽所致呢？     

外科决定

In managing their patients,surgeons have to make clinical decisions.Looking back,some decisions are correct,while others are incorrect.Does making a wrong clinical decision by a surgeon constitute prof...     

Emotion, decision making and the orbitofrontal cortex

The somatic marker hypothesis provides a systems-level neuroanatomical and cognitive framework for decision making and the influence on it by emotion. The key idea of this hypothesis is that decision making is a process that is influenced by marker signals that arise in bioregulatory processes, including those that express themselves in emotions and feelings. This influence can occur at multiple levels of operation, some of which occur consciously and some of which occur non-consciously. Here we review studies that confirm various predictions from the hypothesis. The orbitofrontal cortex represents one critical structure in a neural system subserving decision making. Decision making is not mediated by the orbitofrontal cortex alone, but arises from large-scale systems that include other cortical and subcortical components. Such structures include the amygdala, the somatosensory/insular cortices and the peripheral nervous system. Here we focus only on the role of the orbitofrontal cortex in decision making and emotional processing, and the relationship between emotion, decision making and other cognitive functions of the frontal lobe, namely working memory.     

Patient-centered management of atrial fibrillation: applying evidence-based care to the individual patient

Atrial fibrillation is the most common arrhythmia encountered in clinical practice, and it is one of the most common cardiac conditions requiring hospitalization of a patient. Several national organizations have developed guidelines for the management of atrial fibrillation. These guidelines were updated in 2011 to incorporate new advances in antiarrhythmic drug therapy and anticoagulant therapy, as well as progress in the field of catheter ablation. Many decisions about patient care involve consideration of issues related to lifestyle and quality of life rather than survival. These decisions also involve addressing the key topics of heart rate control, heart rhythm control, and stroke prevention. During the past decade, important advances in the management of atrial fibrillation have created a number of treatment options that have roughly equivalent therapeutic efficacies when they are used for several common clinical situations encountered in clinical practice. The range of available treatments for patients with atrial fibrillation provides an important opportunity for the physician to deliver patient-centered care, which uses patient values to determine the best course of treatment.     

Principles of medical decision making

The consequences of medical decisions are inherently uncertain at the decisive moment. Using clinical examples related to the diagnosis and management of low back pain, the authors review some principles that can help physicians deal with this uncertainty. This article addresses the following: the use of probability as a useful representation of uncertainty, the use of Bayes' theorem to update probability estimates when new information is obtained, the measurement of a diagnostic test's accuracy, the use of the threshold model for choosing a diagnostic test, the principles of expected-value decision making, the use of utility assessment as a way of attaching value to outcomes, and the use of quality-adjusted life years as a measure of value. These principles can aid physicians in approaching complex and uncertain decisions with their patients. As the use of computers becomes more integrated into the process of care, the opportunity exists to move formal decision models from the policy level to the patient care level.     

Elementary clinical decision analysis in evidence-based nephrology

To assess the potential contribution of elementary decision analysis to evidence-based medicine in nephrology, the treatment of primary membranous nephropathy with nephrotic syndrome is taken as an example involving quantity and quality of life, and the treatment of uremic anemia in hemodialysis patients as an example involving economic constraints of interventions. Technical details on decision tree calculation procedures, outcome quantitative assessment, and probability assignment to branches are outlined. Indications strictly based on significance tests of individual outcomes of randomized controlled trials can either miss clinical advantages or disregard economic constraints that can be easily established by decision analysis and that may have a major impact in practice.