Shared decision making in patients with low risk chest pain: prospective randomized pragmatic trial.

OBJECTIVE: To compare the effectiveness of shared decision making with usual care in choice of admission for observation and further cardiac testing or for referral for outpatient evaluation in patients with possible acute coronary syndrome. DESIGN: Multicenter pragmatic parallel randomized controlled trial. SETTING: Six emergency departments in the United States. PARTICIPANTS: 898 adults (aged \u3e17 years) with a primary complaint of chest pain who were being considered for admission to an observation unit for cardiac testing (451 were allocated to the decision aid and 447 to usual care), and 361 emergency clinicians (emergency physicians, nurse practitioners, and physician assistants) caring for patients with chest pain. INTERVENTIONS: Patients were randomly assigned (1:1) by an electronic, web based system to shared decision making facilitated by a decision aid or to usual care. The primary outcome, selected by patient and caregiver advisers, was patient knowledge of their risk for acute coronary syndrome and options for care; secondary outcomes were involvement in the decision to be admitted, proportion of patients admitted for cardiac testing, and the 30 day rate of major adverse cardiac events. RESULTS: Compared with the usual care arm, patients in the decision aid arm had greater knowledge of their risk for acute coronary syndrome and options for care (questions correct: decision aid, 4.2 v usual care, 3.6; mean difference 0.66, 95% confidence interval 0.46 to 0.86), were more involved in the decision (observing patient involvement scores: decision aid, 18.3 v usual care, 7.9; 10.3, 9.1 to 11.5), and less frequently decided with their clinician to be admitted for cardiac testing (decision aid, 37% v usual care, 52%; absolute difference 15%; P CONCLUSIONS: Use of a decision aid in patients at low risk for acute coronary syndrome increased patient knowledge about their risk, increased engagement, and safely decreased the rate of admission to an observation unit for cardiac testing.Trial registration ClinicalTrials.gov NCT01969240

Die Intellektuellen. Roman

1. Kapitel. Die Verwandten; 2. Kapitel. Zwei Frauen; 3. Kapitel. Berlin; 4. Kapitel. Menschen; 5. Kapitel. Versuche und Kämpfe; 6. Kapitel. Finsternis; 7. Kapitel. Erfüllungen; 8. Kapitel. Begegnungen; 9. Kapitel. Der Kreis Lucinda; 10. Kapitel. Prüfungen; 11. Kapitel. Sammlung

Terminology of polymers and polymerization processes in dispersed systems (IUPAC Recommendations 2011)

A large group of industrially important polymerization processes is carried out in dispersed systems. These processes differ with respect to their physical nature, mechanism of particle formation, particle morphology, size, charge, types of interparticle interactions, and many other aspects. Polymer dispersions, and polymers derived from polymerization in dispersed systems, are used in diverse areas such as paints, adhesives, microelectronics, medicine, cosmetics, biotechnology, and others. Frequently, the same names are used for different processes and products or different names are used for the same processes and products. The document contains a list of recommended terms and definitions necessary for the unambiguous description of processes, products, parameters, and characteristic features relevant to polymers in dispersed systems

Die sexuelle Krise. Eine sozialpsychologische Untersuchung

Vorrede; 1. Kapitel. Die Sexualordnung unserer Kulturwelt; [Motto]; 1. Kritik der Ehe in ihrer heutigen Gestalt; 2. Das Wesen der ehelichen Gemeinschaft; 2. Kapitel. Die Ehe und die Formen und Folgen ihrer Umgehung; [Motto]; 1. Das legitime Moment der Ehe; 2. Das soziale Moment der Ehe; 3. Das Suggestionsmoment der Ehe; 3. Kapitel. Die Moral mit dem doppelten Boden; [Motto]; 1. Kant und die »Metaphysik der Sitten«; 2. Völkergeschichtliches zur Moralfrage; 3. Die Errichtung von Extremforderungen; 4. Kapitel. Die sexuelle Lüge; 5. Kapitel. Liebe; [Motto]; 1. Vom Wesen der Liebe; 2. Liebesspiel; 3. Das Dämonium der Liebe; 4. Der Liebeshaß; 5. Liebesnot; 6. Kapitel. Die Travestie der Liebe; [Motti]; 1. Wesen und Ursprung der Prostitution; 2. Die Nötigung zur Prostitution; 3. Die »melancholische Travestie«; 4. Der Geldpunkt; 5. Zur »Reform« der Prostitution; 7. Kapitel. Geschlechtsnot und Frauenbewegung; [Motto]; 1. Ursprung und Notwendigkeit der Frauenbewegung; 2. Die Bekämpfung der Frauenbewegung; 3. Die Berechtigung zum »tätigen Leben«; 4. Die schädigenden Momente der Frauenbewegung; 8. Kapitel. Sexualkrise und Rasse; [Motto]; 1. Allgemeine Rassenprobleme; 2. Der Sexualkampf; 3. Sozialismus und Selektionstheorie; 4. Zeugungsreformation; 9. Kapitel. Psychologie der Heutigen; [Motto]; 1. Psychologie des Geschlechtskampfes; 2. Geschlechtspsychologie des Mannes; 10. Kapitel. Das sexuelle Elend; [Motto]; 1. Die Berechtigung zum Sexualleben; 2. Die Ursachen des Elends; 3. Das besondere Sexualelend der Frau; 4. Die psychopathischen Folgen des sexuellen Elends; 5. Resolutionen; Anmerkun

Stories to communicate individual risk for opioid prescriptions for back and kidney stone pain: Protocol for the life storried multicenter randomized clinical trial

© 2020 JMIR Publications. All rights reserved. Background: Prescription opioid misuse in the United States is a devastating public health crisis; many chronic opioid users were originally prescribed this class of medication for acute pain. Video narrative-enhanced risk communication may improve patient outcomes, such as knowledge of opioid risk and opioid use behaviors after an episode of acute pain. Objective: Our objective is to assess the effect of probabilistic and narrative-enhanced opioid risk communication on patient-reported outcomes, including knowledge, opioid use, and patient preferences, for patients who present to emergency departments with back pain and kidney stone pain. Methods: This is a multisite randomized controlled trial. Patients presenting to the acute care facilities of four geographically and ethnically diverse US hospital centers with acute renal colic pain or musculoskeletal back and/or neck pain are eligible for this randomized controlled trial. A control group of patients receiving general risk information is compared to two intervention groups: One receiving the risk information sheet plus an individualized, visual probabilistic Opioid Risk Tool (ORT) and another receiving the risk information sheet plus a video narrative-enhanced probabilistic ORT. We will study the effect of probabilistic and narrative-enhanced opioid risk communication on the following: Risk awareness and recall at 14 days postenrollment, reduced use or preferences for opioids after the emergency department episode, and alignment with patient preference and provider prescription. To assess these outcomes, we administer baseline patient surveys during acute care admission and follow-up surveys at predetermined times during the 3 months after discharge. Results: A total of 1302 patients were enrolled over 24 months. The mean age of the participants was 40 years (SD 14), 692 out of 1302 (53.15%) were female, 556 out of 1302 (42.70%) were White, 498 out of 1302 (38.25%) were Black, 1002 out of 1302 (76.96%) had back pain, and 334 out of 1302 (25.65%) were at medium or high risk. Demographics and ORT scores were equally distributed across arms. Conclusions: This study seeks to assess the potential clinical role of narrative-enhanced, risk-informed communication for acute pain management in acute care settings. This paper outlines the protocol used to implement the study and highlights crucial methodological, statistical, and stakeholder involvement as well as dissemination considerations

Geister : Novellen

von Grete Meisel-He fIn Fraktu

Geister : Novellen

von Grete Meisel-HeßIn Fraktu

Die Intellektuellen

DIE INTELLEKTUELLEN Die Intellektuellen / Meisel-Hess, Grete (Public Domain) ( - ) Cover front ( - ) Zitat / Feuchtersleben, Ernst von ( - ) Title page ( - ) Erstes Kapitel. Die Verwandten ( - ) Zweites Kapitel. Zwei Frauen ([81]) Drittes Kapitel. Berlin ([131]) Viertes Kapitel. Menschen ([163]) Fünftes Kapitel. Versuche und Kämpfe ([223]) Sechstes Kapitel. Finsternis ([297]) Siebentes Kapitel. Erfüllungen ([355]) Achtes Kapitel. Begegnungen ([387]) Neuntes Kapitel. Der Kreis Lucinda (Ein Intermezzo) ([429]) Zehntes Kapitel. Prüfungen ([451]) Elftes Kapitel. Sammlung ([487]) Advertising ( - ) Cover back ( - ) ColorChart ( -

Das Wesen der Geschlechtlichkeit : die sexuelle Krise in ihren Beziehungen zus socialen Frage & zum Krieg, zu Moral, Rasse & Religion & insbesondere zur Monogamie /

Photocopy.Includes index.Includes bibliographical references.Mode of access: Internet