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Pretest 20: diagnostik, beslutsfattande & handledning
Version 160423
TOC \o "1-3" DEL I: DIAGNOSTIK PAGEREF _Toc323067434 \h 2
1-System 1 vs system 2 PAGEREF _Toc323067435 \h 2
2-Diagnostiska misstag PAGEREF _Toc323067436 \h 3
3-Kllor till diagnostiska misstag PAGEREF _Toc323067437 \h 4
4-Bayes teorem PAGEREF _Toc323067438 \h 6
5-Interrelaterade sannolikheter PAGEREF _Toc323067439 \h 8
6-Frebygga diagnostiska misstag PAGEREF _Toc323067440 \h 9
DEL II: BESLUTSFATTANDE PAGEREF _Toc323067441 \h 10
1-Introduktion PAGEREF _Toc323067442 \h 10
2-Relevanta faktorer vid beslutsfattande PAGEREF _Toc323067443 \h 11
3-Trsklar PAGEREF _Toc323067444 \h 12
DEL III: HANDLEDNING PAGEREF _Toc323067445 \h 13
1-Constructive Alignment PAGEREF _Toc323067446 \h 13
2-Inlrningsluckor PAGEREF _Toc323067447 \h 13
3-Kvalitn av rd man fr PAGEREF _Toc323067448 \h 13
4-Metacognition och handledning PAGEREF _Toc323067449 \h 14
5-Analogic Transfer PAGEREF _Toc323067450 \h 14
REFERENSER PAGEREF _Toc323067451 \h 15
DEL I: DIAGNOSTIK
1-System 1 vs system 2
a) Kognitiva studier talar fr att vra kognitiva processer vid diagnostik och beslutsfattande tillhr tv allmnna system. Vad har dessa system fr egenskaper? ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=19638766" Croskerry 2009 ADDIN EN.CITE Croskerry2009383[1]38338317Croskerry, P.Department of Emergency Medicine, Faculty of Medicine and Division of Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada. croskerry@eastlink.caA universal model of diagnostic reasoningAcad MedAcademic medicine : journal of the Association of American Medical CollegesAcad MedAcademic medicine : journal of the Association of American Medical CollegesAcad MedAcademic medicine : journal of the Association of American Medical Colleges1022-88482009/07/30Clinical Competence*Decision Making*Diagnosis, DifferentialHumans*JudgmentModels, TheoreticalPhysicians/*psychologyProblem Solving2009Aug1938-808X (Electronic)
1040-2446 (Linking)19638766http://www.ncbi.nlm.nih.gov/pubmed/1963876610.1097/ACM.0b013e3181ace703eng[ HYPERLINK \l "_ENREF_1" \o "Croskerry, 2009 #383" 1] s1023-4 + Table 1)
System 1System 2Hur funkar det (computational principle)?Pverkan av emotioner: mycket eller lite?Aktivering: passiv / omedveten eller aktiv / medveten?Frvrv: genom erfarenhet eller formell inlrning?Hastighet: snabb eller lngsam?Anstrngning: mycket eller lite?Risk fr misstag: strre eller mindre?
b) Vilket exempel ges av Croskerry et al av system 1 vs system 2? ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=17112936" Croskerry 2006 ADDIN EN.CITE Croskerry2006585[2]58558517Croskerry, P.Critical thinking and decisionmaking: avoiding the perils of thin-slicingAnn Emerg MedAnnals of emergency medicineAnn Emerg MedAnnals of emergency medicineAnn Emerg MedAnnals of emergency medicine720-24862006/11/23Clinical Competence*Cognition*DiagnosisEmergency Medicine/*educationHumans*Internship and Residency2006Dec1097-6760 (Electronic)
0196-0644 (Linking)17112936Comment
Editorialhttp://www.ncbi.nlm.nih.gov/pubmed/17112936http://ac.els-cdn.com/S0196064406004902/1-s2.0-S0196064406004902-main.pdf?_tid=ea21cb24-87ae-11e5-ab45-00000aacb361&acdnat=1447162282_b7adcc80617f06618873bec8fad1bbf510.1016/j.annemergmed.2006.03.030eng[ HYPERLINK \l "_ENREF_2" \o "Croskerry, 2006 #585" 2] s720)
2-Diagnostiska misstag
a) Vad r frekvensen av diagnostiska misstag p akuten? ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=18440350" Berner 2008 ADDIN EN.CITE ADDIN EN.CITE.DATA [ HYPERLINK \l "_ENREF_3" \o "Berner, 2008 #380" 3] S3)
b) Vad fr diagnostiska misstag fr konsekvenser inom sjukvrden? (HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=19278949"Newman-Toker 2009 ADDIN EN.CITE Newman-Toker2009571[4]57157117Newman-Toker, D. E.Pronovost, P. J.Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. toker@jhu.eduDiagnostic errors--the next frontier for patient safetyJAMAJamaJAMAJAMA : the journal of the American Medical AssociationJAMAJAMA : the journal of the American Medical Association1060-2301102009/03/13Decision Support TechniquesDiagnostic Errors/*prevention & control*Health PolicyHumans*Outcome and Process Assessment (Health Care)Safety ManagementUnited States2009Mar 111538-3598 (Electronic)
0098-7484 (Linking)19278949Research Support, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/pubmed/1927894910.1001/jama.2009.249eng[ HYPERLINK \l "_ENREF_4" \o "Newman-Toker, 2009 #571" 4] s1060, slutsats i brjan av s1061)
3-Kllor till diagnostiska misstag
a) Hur ofta bidrog kognitiva faktorer till diagnostiska misstag p akuten enligt Kachalia 2007? ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=16997424" Kachalia 2007 ADDIN EN.CITE ADDIN EN.CITE.DATA [ HYPERLINK \l "_ENREF_5" \o "Kachalia, 2007 #89" 5] abstract)?
b) Hur kategoriserar Graber et al kognitiva orsaker till diagnostiska misstag ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=16009864" Graber 2005 ADDIN EN.CITE Graber200590[6]909017Graber, M. L.Franklin, N.Gordon, R.Department of Veterans Affairs Medical Center, Northport, NY 11768, USA. mark.graber@med.va.govDiagnostic error in internal medicineArch Intern MedArchives of internal medicineArch Intern MedArchives of internal medicineArch Intern MedArchives of internal medicine1493-9165132005/07/13AustraliaCognitive Science/methods*Diagnostic Errors/classification/prevention & controlHumansInternal Medicine/*methods/statistics & numerical dataInterviews as TopicPhysician's Practice PatternsQuality Assurance, Health Care/methods2005Jul 110003-9926 (Print)
0003-9926 (Linking)16009864Comparative Study
Research Support, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/pubmed/1600986410.1001/archinte.165.13.1493eng[ HYPERLINK \l "_ENREF_6" \o "Graber, 2005 #90" 6] Table 2)?
c) En klla till diagnostiska misstag r skallad premature closure. Vad menas med det ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=16009864" Graber 2005 ADDIN EN.CITE Graber200590[6]909017Graber, M. L.Franklin, N.Gordon, R.Department of Veterans Affairs Medical Center, Northport, NY 11768, USA. mark.graber@med.va.govDiagnostic error in internal medicineArch Intern MedArchives of internal medicineArch Intern MedArchives of internal medicineArch Intern MedArchives of internal medicine1493-9165132005/07/13AustraliaCognitive Science/methods*Diagnostic Errors/classification/prevention & controlHumansInternal Medicine/*methods/statistics & numerical dataInterviews as TopicPhysician's Practice PatternsQuality Assurance, Health Care/methods2005Jul 110003-9926 (Print)
0003-9926 (Linking)16009864Comparative Study
Research Support, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/pubmed/1600986410.1001/archinte.165.13.1493eng[ HYPERLINK \l "_ENREF_6" \o "Graber, 2005 #90" 6] abstrakt; HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=18440350" Berner 2008 ADDIN EN.CITE ADDIN EN.CITE.DATA [ HYPERLINK \l "_ENREF_3" \o "Berner, 2008 #380" 3] S8)?
d) Graber et al granskade 100 fall med diagnostiska misstag. I hur mnga av dessa fall bidrog premature closure till misset ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=16009864" Graber 2005 ADDIN EN.CITE Graber200590[6]909017Graber, M. L.Franklin, N.Gordon, R.Department of Veterans Affairs Medical Center, Northport, NY 11768, USA. mark.graber@med.va.govDiagnostic error in internal medicineArch Intern MedArchives of internal medicineArch Intern MedArchives of internal medicineArch Intern MedArchives of internal medicine1493-9165132005/07/13AustraliaCognitive Science/methods*Diagnostic Errors/classification/prevention & controlHumansInternal Medicine/*methods/statistics & numerical dataInterviews as TopicPhysician's Practice PatternsQuality Assurance, Health Care/methods2005Jul 110003-9926 (Print)
0003-9926 (Linking)16009864Comparative Study
Research Support, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/pubmed/1600986410.1001/archinte.165.13.1493eng[ HYPERLINK \l "_ENREF_6" \o "Graber, 2005 #90" 6] Table 2)?
e) r erfarenhet ett skydd mot premature closure? r lkarens lder en riskfaktor fr premature closure ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=16009864" Graber 2005 ADDIN EN.CITE Graber200590[6]909017Graber, M. L.Franklin, N.Gordon, R.Department of Veterans Affairs Medical Center, Northport, NY 11768, USA. mark.graber@med.va.govDiagnostic error in internal medicineArch Intern MedArchives of internal medicineArch Intern MedArchives of internal medicineArch Intern MedArchives of internal medicine1493-9165132005/07/13AustraliaCognitive Science/methods*Diagnostic Errors/classification/prevention & controlHumansInternal Medicine/*methods/statistics & numerical dataInterviews as TopicPhysician's Practice PatternsQuality Assurance, Health Care/methods2005Jul 110003-9926 (Print)
0003-9926 (Linking)16009864Comparative Study
Research Support, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/pubmed/1600986410.1001/archinte.165.13.1493eng[ HYPERLINK \l "_ENREF_6" \o "Graber, 2005 #90" 6] s1498)?
f) Nmn 3 vriga kognitiva kllor till diagnostiska misstag ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=23417589" Phua 2013 ADDIN EN.CITE Phua2013570[7]57057017Phua, D. H.Tan, N. C.Emergency Department, Tan Tock Seng Hospital, Singapore. phuadh@gmail.comCognitive aspect of diagnostic errorsAnn Acad Med SingaporeAnnals of the Academy of Medicine, SingaporeAnn Acad Med SingaporeAnnals of the Academy of Medicine, SingaporeAnn Acad Med SingaporeAnnals of the Academy of Medicine, Singapore33-414212013/02/19AffectAttitude of Health Personnel*CognitionDiagnosis, DifferentialDiagnostic Errors/*psychologyHumansPhysicians/*psychologyPrejudice*Thinking2013Jan0304-4602 (Print)
0304-4602 (Linking)23417589Reviewhttp://www.ncbi.nlm.nih.gov/pubmed/23417589eng[ HYPERLINK \l "_ENREF_7" \o "Phua, 2013 #570" 7] s37)
g) Vad verkar vara orsaken till de diagnostiska misstagen i fljande HSAN fall?
fallKunskapsbristInkomplett info-samlingBristfllig info-tolkning HYPERLINK "http://www.lakartidningen.se/Functions/OldArticleView.aspx?articleId=8213" HSAN 770/07 ADDIN EN.CITE HSAN20071630[8]1630163017HSAN 770/07, God vrd frutstter knnedom om patientens tidigare besvr. Enklaste sttet r att frga patientenLakartidningenLakartidningenLakartidningen3684-3687104482007[ HYPERLINK \l "_ENREF_8" \o "HSAN 770/07, 2007 #1630" 8] HYPERLINK "http://www.lakartidningen.se/Functions/OldArticleView.aspx?articleId=10409" HSAN 4188/07 ADDIN EN.CITE HSAN 4188/0720081631[9]1631163117HSAN 4188/07,Magkatarr eller hjrtinfarkt? LakartidningenLakartidningenLakartidningen2786105402008[ HYPERLINK \l "_ENREF_9" \o "HSAN 4188/07, 2008 #1631" 9] HYPERLINK "http://ww2.lakartidningen.se/07engine.php?articleId=10412" HSAN 1879/07 ADDIN EN.CITE HSAN 1879/0720081632[10]1632163217HSAN 1879/07, Gastroenterit eller hjrtinfarkt? LakartidningenLakartidningenLakartidningen2786105402008[ HYPERLINK \l "_ENREF_10" \o "HSAN 1879/07, 2008 #1632" 10] HYPERLINK "http://www.lakartidningen.se/Functions/OldArticleView.aspx?articleId=4322" HSAN 1126/05 ADDIN EN.CITE HSAN 1126/0520061633[11]1633163317HSAN 1126/05, 14-ring frlorade testikel efter feldiagnos av underlkare. Vlkntatttestistorsion kan brja med buksmrtor, illamende och krkningar. LakartidningenLakartidningenLakartidningen103242006[ HYPERLINK \l "_ENREF_11" \o "HSAN 1126/05, 2006 #1633" 11] HYPERLINK "http://www.lakartidningen.se/Functions/OldArticleView.aspx?articleId=4062" HSAN 3506/05 ADDIN EN.CITE HSAN 3506/0520061634[12]1634163417HSAN 3506/05, Tidigare bukopererad patient skte med akuta buksmrtor och krkningar Tarmhinder mste vervgas och helstuteslutas.LakartidningenLakartidningenLakartidningen1624-1625103202006[ HYPERLINK \l "_ENREF_12" \o "HSAN 3506/05, 2006 #1634" 12] HYPERLINK "http://ww2.lakartidningen.se/07engine.php?articleId=10822" HSAN 0387/08 ADDIN EN.CITE HSAN 0387/0820081635[13]1635163517HSAN 0387/08, Waranmetabolismen hmmas av erytromycin.LakartidningenLakartidningenLakartidningen3558105482008[ HYPERLINK \l "_ENREF_13" \o "HSAN 0387/08, 2008 #1635" 13]
4-Bayes teorem
Bayes teorem spelar en central roll vid analytiskt diagnostiskt tnkande (system 2). Bayes teorem kan skrivas i olika former bl a:
P(A(B) = P(A) x P(B(A) / P(B)
a) Om A str fr att patienten har en lungemboli och B str fr att d-dimer var negativt, vad menas med fljande ( HYPERLINK "http://ww2.lakartidningen.se/07engine.php?articleId=11154" Frigyesi 2009 ADDIN EN.CITE Frigyesi20091636[14]1636163617Frigyesi, A.Universitetssjukhuset Lund. attila@frigyesi.se[All physicians should know the discussion around the Bayes theorem. When is a positive test really positive?]LakartidningenLakartidningenLakartidningenLakartidningenLakartidningenLakartidningen122-310632009/03/03*Bayes TheoremFalse Positive ReactionsHumansSensitivity and Specificity2009Jan 14-20Alla medicinare bor kanna till resonemanget kring Bayes' sats. Nar ar ett positivt test sant positivt?0023-7205 (Print)
0023-7205 (Linking)19248463http://www.ncbi.nlm.nih.gov/pubmed/19248463swe[ HYPERLINK \l "_ENREF_14" \o "Frigyesi, 2009 #1636" 14]):
P(A(B):
P(A):
P(B(A):
P(B):
b) Bayes teorem betonar vikten av sannolikheten fre-prov fr tillstndet P (A). Denna sannolikhet beror p epidemiologiska variabler (lder, tidigare sjukdomar, riskfaktorer) och vrdena kan inhmtas frn epidemiologiska studier. Fr att kunna gra en kvantitativ sannolikhetsbedmning med hjlp av Bayes teorem behver man uttrycka sannolikhet som ett odds istllet fr en procent. Gallagher visar hur man konverterar procent till odds ( HYPERLINK "http://www.annemergmed.com/article/S0196-0644(98)70352-X/fulltext" Gallagher 1998 ADDIN EN.CITE Gallagher1998550[15]55055017Gallagher, E. J.Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY 10467, USA. jgallagh@montefiore.orgClinical utility of likelihood ratiosAnn Emerg MedAnnals of emergency medicineAnn Emerg MedAnnals of emergency medicineAnn Emerg MedAnnals of emergency medicine391-73131998/03/20*Likelihood FunctionsOdds RatioPredictive Value of TestsROC CurveSensitivity and Specificity1998Mar0196-0644 (Print)
0196-0644 (Linking)9506499http://www.ncbi.nlm.nih.gov/pubmed/9506499eng[ HYPERLINK \l "_ENREF_15" \o "Gallagher, 1998 #550" 15] s394 i brjan av sektionen Odds and probabilities).
Han et als studie baserades p > 10,000 patienter som skte till akuten p grund av brstsmrta. Fyll i fljande tabell ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=17145112" Han 2007 ADDIN EN.CITE ADDIN EN.CITE.DATA [ HYPERLINK \l "_ENREF_16" \o "Han, 2007 #911" 16] s148).
lderSlutdiagnos AKS: PROCENTSLUTDIAGNOS AKS: ODDS< 40 r40 65 r> 65 r
c) Sannolikheten efter-prov beror p sannolikheten fre-prov multiplicerad med en faktor som beror p testens egenskaper och testens resultat P (B(A) / P(B). P (B(A) / P(B) r en likelihood ratio (LR) nr fre-prov och efter-prov uttrycks som odds. Vad r frdelen av LR jmfrt med PPV / NPV? ( HYPERLINK "http://www.annemergmed.com/article/S0196-0644(98)70352-X/fulltext" Gallagher 1998 ADDIN EN.CITE Gallagher1998550[15]55055017Gallagher, E. J.Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY 10467, USA. jgallagh@montefiore.orgClinical utility of likelihood ratiosAnn Emerg MedAnnals of emergency medicineAnn Emerg MedAnnals of emergency medicineAnn Emerg MedAnnals of emergency medicine391-73131998/03/20*Likelihood FunctionsOdds RatioPredictive Value of TestsROC CurveSensitivity and Specificity1998Mar0196-0644 (Print)
0196-0644 (Linking)9506499http://www.ncbi.nlm.nih.gov/pubmed/9506499eng[ HYPERLINK \l "_ENREF_15" \o "Gallagher, 1998 #550" 15] s395, section Comparison of LRs with other measures of test performance)
d) Vad r frdelen av LR jmfrt med sensitivitet och specificitet ( HYPERLINK "http://www.annemergmed.com/article/S0196-0644(98)70352-X/fulltext" Gallagher 1998 ADDIN EN.CITE Gallagher1998550[15]55055017Gallagher, E. J.Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY 10467, USA. jgallagh@montefiore.orgClinical utility of likelihood ratiosAnn Emerg MedAnnals of emergency medicineAnn Emerg MedAnnals of emergency medicineAnn Emerg MedAnnals of emergency medicine391-73131998/03/20*Likelihood FunctionsOdds RatioPredictive Value of TestsROC CurveSensitivity and Specificity1998Mar0196-0644 (Print)
0196-0644 (Linking)9506499http://www.ncbi.nlm.nih.gov/pubmed/9506499eng[ HYPERLINK \l "_ENREF_15" \o "Gallagher, 1998 #550" 15] s395, section Comparison of LRs with other measures of test performance)
e) Du trffar en 55 rig kvinna som sker till akuten pga brstsmrta. Enligt Han 2007 r hennes sannolikhet fre-prov fr AKS P(A) 8%, vilket motsvarar ett odds p 0,09. Vid anamnesen fr du fram att patientens brstsmrta blir vrre nr hon andas in (pleuritic pain).
Vilken LR r associerad till denna information enligt Fanaroff 2015? ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=26547467" Fanaroff 2015 ADDIN EN.CITE Fanaroff20151478[17]1478147817Fanaroff, A. C.Rymer, J. A.Goldstein, S. A.Simel, D. L.Newby, L. K.Division of Cardiology, Duke University, Durham, North Carolina2Department of Medicine, Duke University, Durham, North Carolina.
Department of Medicine, Duke University, Durham, North Carolina.
Durham Veterans Affairs Medical Center, Durham, North Carolina.
Division of Cardiology, Duke University, Durham, North Carolina2Department of Medicine, Duke University, Durham, North Carolina4Duke Clinical Research Institute, Duke University, Durham, North Carolina.Does This Patient With Chest Pain Have Acute Coronary Syndrome?: The Rational Clinical Examination Systematic ReviewJAMAJamaJAMAJAMA : the journal of the American Medical AssociationJAMAJAMA : the journal of the American Medical Association1955-65314182015/11/102015Nov 101538-3598 (Electronic)
0098-7484 (Linking)26547467Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov'thttp://www.ncbi.nlm.nih.gov/pubmed/2654746710.1001/jama.2015.12735eng[ HYPERLINK \l "_ENREF_17" \o "Fanaroff, 2015 #1478" 17] s1960 Table 2)?
Vad blir d sannolikheten fr AKS nu som odds?
Vad blir d sannolikheten fr AKS nu som procent? ( HYPERLINK "http://www.annemergmed.com/article/S0196-0644(98)70352-X/fulltext" Gallagher 1998 ADDIN EN.CITE Gallagher1998550[15]55055017Gallagher, E. J.Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY 10467, USA. jgallagh@montefiore.orgClinical utility of likelihood ratiosAnn Emerg MedAnnals of emergency medicineAnn Emerg MedAnnals of emergency medicineAnn Emerg MedAnnals of emergency medicine391-73131998/03/20*Likelihood FunctionsOdds RatioPredictive Value of TestsROC CurveSensitivity and Specificity1998Mar0196-0644 (Print)
0196-0644 (Linking)9506499http://www.ncbi.nlm.nih.gov/pubmed/9506499eng[ HYPERLINK \l "_ENREF_15" \o "Gallagher, 1998 #550" 15] s394, i brjan av sektionen Odds and probabilities, fr att konvertera odds till procent)
g) Bayes teorem kan anvndas konceptuellt ven om man inte har tillgng till exakta siffror. Du arbetar p akuten med en AT-lkare. AT-lkaren har bedmt en patient som sker pga huvudvrk. Patienten har ven hypertoni (160/90) och nr lkaren frgar patienten om hon fr hjrtklappningsepisoder svarar patienten ibland. AT-lkaren misstnker ett feokromocytom men du r mindre entusiastisk fr denna diagnostiska hypotes. Hur skulle du anvnda Bayes teorem fr att motivera din sannolikhetsbedmning fr AT-lkaren?
5-Interrelaterade sannolikheter
a) En 55 rig patient sker till akuten pga buksmrta. Buksmrtan hade en tydlig debut fr 4 timmar sedan. Vad r sannolikheten fr att patienten har en akut appendicit och samtidigt en rupturerat bukaorta aneurysm?
b) Beror sannolikheten fr att patientens problem orsakas av en diagnos jmfrt med ett flertal samtidiga diagnoser p patientens lder och sjukdom prevalens? ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=14762188" Hilliard 2004 ADDIN EN.CITE ADDIN EN.CITE.DATA [ HYPERLINK \l "_ENREF_18" \o "Hilliard, 2004 #559" 18] s602-3 Discussion)
c) Du trffar en patient p akuten som sker pga brstsmrta. Brstsmrtan brjade fr 6 timmar sedan. Du misstnker att patientens symtom beror p en diagnos (och inte 2 eller 3). Du uppskattar utifrn epidemiologiska faktorer att patientens sannolikhet fr AKS r kring 8%, sannolikhet fr lungemboli r kring 2% och att sannolikheten fr en alternativ diagnos r sledes kring 90%. Du frgar patienten om smrtan blir vrre med djup andning. Patienten svarar med ett bestmt JA. Du vet frn Fanaroff 2015 s1960 Table 2 att smrtfrvrring vid djup andning minskar sannolikheten fr AKS (LR cirka 0,5) och du vet att lungemboli kan orsaka pleuritisk smrta. Vad har hnt med sannolikheterna fr lungemboli och muskuloskelettal smrta?
d) F kliniska parametrar hjlper till vid sannolikhetsbedmning av akut kolecystit ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=12503981" Trowbridge 2003 ADDIN EN.CITE Trowbridge2003557[19]55755717Trowbridge, R. L.Rutkowski, N. K.Shojania, K. G.Department of Medicine, University of California, San Francisco 94143-0120 , USA.Does this patient have acute cholecystitis?JAMAJamaJAMAJAMA : the journal of the American Medical AssociationJAMAJAMA : the journal of the American Medical Association80-628912002/12/31Abdomen, Acute/*etiology/ultrasonographyAcute DiseaseCholecystitis/*diagnosis/ultrasonographyDiagnosis, DifferentialDiagnostic ImagingHumansPhysical ExaminationSensitivity and Specificity2003Jan 10098-7484 (Print)
0098-7484 (Linking)12503981Research Support, Non-U.S. Gov't
Reviewhttp://www.ncbi.nlm.nih.gov/pubmed/12503981eng[ HYPERLINK \l "_ENREF_19" \o "Trowbridge, 2003 #557" 19] Abstract). Dremot motsvarar den kliniska misstanken om akut kolecystit en LR av 25 30. Hur frklarar du det?
6-Frebygga diagnostiska misstag
a) Sandhu et al menar att 'metacognition' kan minska risken fr diagnostiska misstag. Vad menar de med metacognition och varfr tycker de att de r viktig ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=17112935" Sandhu 2006 ADDIN EN.CITE Sandhu2006584[20]58458417Sandhu, H.Carpenter, C.Freeman, K.Nabors, S. G.Olson, A.Division of Emergency Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA. sandhuh@msnotes.wustl.eduClinical decisionmaking: opening the black box of cognitive reasoningAnn Emerg MedAnnals of emergency medicineAnn Emerg MedAnnals of emergency medicineAnn Emerg MedAnnals of emergency medicine713-94862006/11/23*Algorithms*Cognition*DiagnosisDiagnostic Errors*Emergency MedicineHumansInternship and ResidencyMaleMiddle AgedPattern Recognition, Physiological2006Dec1097-6760 (Electronic)
0196-0644 (Linking)17112935http://www.ncbi.nlm.nih.gov/pubmed/1711293510.1016/j.annemergmed.2006.03.011eng[ HYPERLINK \l "_ENREF_20" \o "Sandhu, 2006 #584" 20] s715)?
b) Croskerry pratar om 'debiasing strategies.' Vad drar han fr slutsatser om effektiviteten av debiasing strategies fr att frebygga diagnostiska misstag ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=23802513" Croskerry 2013 ADDIN EN.CITE Croskerry2013384[21]38438417Croskerry, P.Division of Medical Education, Dalhousie University, Halifax, NS, Canada.From mindless to mindful practice--cognitive bias and clinical decision makingN Engl J MedThe New England journal of medicineN Engl J MedThe New England journal of medicineN Engl J MedThe New England journal of medicine2445-8368262013/06/28CognitionDecision Making*Diagnosis, DifferentialDiagnostic Errors/prevention & control/*psychologyHumansPrejudice*Thinking2013Jun 271533-4406 (Electronic)
0028-4793 (Linking)23802513http://www.ncbi.nlm.nih.gov/pubmed/23802513http://www.nejm.org/doi/pdf/10.1056/NEJMp130371210.1056/NEJMp1303712eng[ HYPERLINK \l "_ENREF_21" \o "Croskerry, 2013 #384" 21] s2447)?
c) Newman-Toker och Pronovost menar att det r mer lovande att utveckla "system solutions" till cognitiva misstag istllet fr att frska pverka tnkandet hos individuella lkare. Vilka strategier freslr de fr att minska diagnostiska fel hos "routine ambulatory patient--e.g. headache, fatigue"? Diagnostiska fel hos komplexa patienter--"e.g. critical illness, major trauma" (HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=19278949"Newman-Toker 2009 ADDIN EN.CITE Newman-Toker2009571[4]57157117Newman-Toker, D. E.Pronovost, P. J.Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. toker@jhu.eduDiagnostic errors--the next frontier for patient safetyJAMAJamaJAMAJAMA : the journal of the American Medical AssociationJAMAJAMA : the journal of the American Medical Association1060-2301102009/03/13Decision Support TechniquesDiagnostic Errors/*prevention & control*Health PolicyHumans*Outcome and Process Assessment (Health Care)Safety ManagementUnited States2009Mar 111538-3598 (Electronic)
0098-7484 (Linking)19278949Research Support, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/pubmed/1927894910.1001/jama.2009.249eng[ HYPERLINK \l "_ENREF_4" \o "Newman-Toker, 2009 #571" 4] Table 1061)?
d) Hur skulle checklistor kunna frebygga diagnostiska misstag som beror p bristfllig informationsinhmtning och premature closure ( HYPERLINK "http://www.lakartidningen.se/Functions/OldArticleView.aspx?articleId=19399" Sundblom 2013 ADDIN EN.CITE Sundblom2013285[22]28528517Sundblom, E.Dryver, E.Skanes universitetssjukhus, Lund.ABC om beslutsfattande pa akuten.LakartidningenLakartidningenLakartidningenLakartidningenLakartidningenLakartidningen631-5110122013/04/26AlgorithmsChecklist*Decision Making*DiagnosisDiagnostic Errors*Emergency Medical ServicesHumansTriage2013Mar 20-26Beslutsfattande pa akuten.0023-7205 (Print)
0023-7205 (Linking)23614210http://www.ncbi.nlm.nih.gov/pubmed/23614210swe[ HYPERLINK \l "_ENREF_22" \o "Sundblom, 2013 #285" 22] s632 & s633)?
DEL II: BESLUTSFATTANDE
1-Introduktion
a) Fattar vi mnga beslut inom akutsjukvrd? ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=17112935" Sandhu 2006 ADDIN EN.CITE Sandhu2006584[20]58458417Sandhu, H.Carpenter, C.Freeman, K.Nabors, S. G.Olson, A.Division of Emergency Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA. sandhuh@msnotes.wustl.eduClinical decisionmaking: opening the black box of cognitive reasoningAnn Emerg MedAnnals of emergency medicineAnn Emerg MedAnnals of emergency medicineAnn Emerg MedAnnals of emergency medicine713-94862006/11/23*Algorithms*Cognition*DiagnosisDiagnostic Errors*Emergency MedicineHumansInternship and ResidencyMaleMiddle AgedPattern Recognition, Physiological2006Dec1097-6760 (Electronic)
0196-0644 (Linking)17112935http://www.ncbi.nlm.nih.gov/pubmed/1711293510.1016/j.annemergmed.2006.03.011eng[ HYPERLINK \l "_ENREF_20" \o "Sandhu, 2006 #584" 20] s714 Introduction)
b) r beslutsfattande ngot som borde lyftas fram vid utbildning i akutsjukvrd enligt Croskerry ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=17112936" Croskerry 2006 ADDIN EN.CITE Croskerry2006585[2]58558517Croskerry, P.Critical thinking and decisionmaking: avoiding the perils of thin-slicingAnn Emerg MedAnnals of emergency medicineAnn Emerg MedAnnals of emergency medicineAnn Emerg MedAnnals of emergency medicine720-24862006/11/23Clinical Competence*Cognition*DiagnosisEmergency Medicine/*educationHumans*Internship and Residency2006Dec1097-6760 (Electronic)
0196-0644 (Linking)17112936Comment
Editorialhttp://www.ncbi.nlm.nih.gov/pubmed/17112936http://ac.els-cdn.com/S0196064406004902/1-s2.0-S0196064406004902-main.pdf?_tid=ea21cb24-87ae-11e5-ab45-00000aacb361&acdnat=1447162282_b7adcc80617f06618873bec8fad1bbf510.1016/j.annemergmed.2006.03.030eng[ HYPERLINK \l "_ENREF_2" \o "Croskerry, 2006 #585" 2] sista tv paragraf)?
c) Nmn 10 faktorer som frsvrar beslutsfattande p akuten.
d) Westbrook et al granskade avbrytningar av lkare som arbetar p en akutmottagning. Hur ofta blev lkarna avbryten inom loppet av 60 minuter? Hur ofta slutfrde lkarna ej uppgifterna som blev avbrytna? Vad kan task shortening ha fr frklaring? ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=20463369" Westbrook 2010 ADDIN EN.CITE ADDIN EN.CITE.DATA [ HYPERLINK \l "_ENREF_23" \o "Westbrook, 2010 #382" 23] abstract och s4 Discussion)
2-Relevanta faktorer vid beslutsfattande
a) Vad r huvudmlet vid utredning p akuten ( HYPERLINK "http://www.lakartidningen.se/Functions/OldArticleView.aspx?articleId=19399" Sundblom 2013 ADDIN EN.CITE Sundblom2013285[22]28528517Sundblom, E.Dryver, E.Skanes universitetssjukhus, Lund.ABC om beslutsfattande pa akuten.LakartidningenLakartidningenLakartidningenLakartidningenLakartidningenLakartidningen631-5110122013/04/26AlgorithmsChecklist*Decision Making*DiagnosisDiagnostic Errors*Emergency Medical ServicesHumansTriage2013Mar 20-26Beslutsfattande pa akuten.0023-7205 (Print)
0023-7205 (Linking)23614210http://www.ncbi.nlm.nih.gov/pubmed/23614210swe[ HYPERLINK \l "_ENREF_22" \o "Sundblom, 2013 #285" 22] s631)?
b) Vad r mlet med handlggningen inom sjukvrden rent allmnt ( HYPERLINK "http://www.lakartidningen.se/Functions/OldArticleView.aspx?articleId=19399" Sundblom 2013 ADDIN EN.CITE Sundblom2013285[22]28528517Sundblom, E.Dryver, E.Skanes universitetssjukhus, Lund.ABC om beslutsfattande pa akuten.LakartidningenLakartidningenLakartidningenLakartidningenLakartidningenLakartidningen631-5110122013/04/26AlgorithmsChecklist*Decision Making*DiagnosisDiagnostic Errors*Emergency Medical ServicesHumansTriage2013Mar 20-26Beslutsfattande pa akuten.0023-7205 (Print)
0023-7205 (Linking)23614210http://www.ncbi.nlm.nih.gov/pubmed/23614210swe[ HYPERLINK \l "_ENREF_22" \o "Sundblom, 2013 #285" 22] s635)?
c) Vilka faktorer br vi ta hnsyn till vid beslut om utredning, behandling och inlggning ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=18546805" Woolever 2008 ADDIN EN.CITE Woolever20081637[24]1637163717Woolever, D. R.Central Maine Medical Center Family Medicine Residency Program, Lewiston, Maine, USA.The art and science of clinical decision makingFam Pract ManagFamily practice managementFam Pract ManagFamily practice managementFam Pract ManagFamily practice management31-61552008/06/13*Decision MakingDecision Support Systems, Clinical/*organization & administrationDiagnosis, DifferentialDiagnostic Tests, Routine*Evidence-Based MedicineHumansPractice Management, MedicalPractice Patterns, Physicians'2008May1069-5648 (Print)
1069-5648 (Linking)18546805http://www.ncbi.nlm.nih.gov/pubmed/18546805eng[ HYPERLINK \l "_ENREF_24" \o "Woolever, 2008 #1637" 24])?
JaNej1-Den mest sannolika diagnosen2-Alternativa diagnoser och hur sannolika de betraktas vara3-Patientens lder4-Patientens tidigare sjukdomar5-Patientens lkemedel6-Patientens verknsligheter7-Stdet patienten behver och kan f hemma8-Patientens vrderingar9-Anhrigas vrderingar10-Antal & typ av vrdplatser11-sikter av inremitterande vrdpersonal
d) Etiska principer spelar en roll vid beslutsfattande, t ex vid beslut om hjrt- lungrddning. Truogs artikel ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=20147712" Truog 2010 ADDIN EN.CITE Truog2010576[25]57657617Truog, R. D.Department of Anaesthesia, Harvard Medical School, and Division of Critical Care Medicine, Children's Hospital Boston, Boston, USA.Is it always wrong to perform futile CPR?N Engl J MedThe New England journal of medicineN Engl J MedThe New England journal of medicineN Engl J MedThe New England journal of medicine477-936262010/02/12Cardiopulmonary Resuscitation/*ethicsChild, PreschoolEncephaloceleFamily/*psychologyHumansMaleMedical Futility/*ethicsProfessional-Family Relations2010Feb 111533-4406 (Electronic)
0028-4793 (Linking)20147712http://www.ncbi.nlm.nih.gov/pubmed/2014771210.1056/NEJMp0908464eng[ HYPERLINK \l "_ENREF_25" \o "Truog, 2010 #576" 25]) handlar om att hjrt-lungrddning ibland kan motiveras ven nr det r uppenbart att det inte gagnar patienten. Artikeln var kontroversiell. Fine menar att det gr emot Kants andra maxim att gra HLR som inte gagnar patienten. Vad r Kants andra maxim? ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=20518107" Fine 2010 ADDIN EN.CITE Fine20101638[26]1638163817Fine, R. L.Is it always wrong to perform futile CPR?N Engl J MedThe New England journal of medicineN Engl J MedThe New England journal of medicineN Engl J MedThe New England journal of medicine2035; author reply 2036-7362212010/06/03Cardiopulmonary Resuscitation/*ethics*Family/psychologyHumansMedical Futility/*ethics2010May 271533-4406 (Electronic)
0028-4793 (Linking)20518107Comment
Letterhttp://www.ncbi.nlm.nih.gov/pubmed/20518107eng[ HYPERLINK \l "_ENREF_26" \o "Fine, 2010 #1638" 26] s2035)
e) Truog svarar: As author Thomas Mann famously observed, A mans dying is more the survivors affair than his own. . . . Although the use of futile mechanical ventilation, CPR, and other treatments is uniformly condemned according to a pristine ethic of treat only the patient, not the family, the prevalence of these practices suggests that clinicians are actually engaged in a more complex ethical calculus in which the interests of family members may have weight in the decision-making process, sometimes on the basis of views explicitly expressed by the patient and at other times implied by the nature of familial bonds. In either case, simplistic ethical rules and principles may not do justice to the complex dynamics that are often at play in end-of-life care.
Truogs ethical calculus liknar ngon form av utilitarianism. Vad innebr utilitarianism? ( HYPERLINK "http://en.wikipedia.org/wiki/Utilitarianism" http://en.wikipedia.org/wiki/Utilitarianism)
3-Trsklar
a) Kan vi uppn 100% diagnostisk skerhet? ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=2497349" Kassirer 1989 ADDIN EN.CITE Kassirer1989534[27]53453417Kassirer, J. P.New England Medical Center, Boston, MA 02111.Our stubborn quest for diagnostic certainty. A cause of excessive testingN Engl J MedThe New England journal of medicineN Engl J MedThe New England journal of medicineN Engl J MedThe New England journal of medicine1489-91320221989/06/01Attitude of Health Personnel*DiagnosisHealth Expenditures1989Jun 10028-4793 (Print)
0028-4793 (Linking)2497349http://www.ncbi.nlm.nih.gov/pubmed/249734910.1056/NEJM198906013202211eng[ HYPERLINK \l "_ENREF_27" \o "Kassirer, 1989 #534" 27] frsta meningen)
b) Vad r mlet med informationsinsamling? ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=2497349" Kassirer 1989 ADDIN EN.CITE Kassirer1989534[27]53453417Kassirer, J. P.New England Medical Center, Boston, MA 02111.Our stubborn quest for diagnostic certainty. A cause of excessive testingN Engl J MedThe New England journal of medicineN Engl J MedThe New England journal of medicineN Engl J MedThe New England journal of medicine1489-91320221989/06/01Attitude of Health Personnel*DiagnosisHealth Expenditures1989Jun 10028-4793 (Print)
0028-4793 (Linking)2497349http://www.ncbi.nlm.nih.gov/pubmed/249734910.1056/NEJM198906013202211eng[ HYPERLINK \l "_ENREF_27" \o "Kassirer, 1989 #534" 27] sista meningen, frsta paragraf)
c) Vad menas med testtrskel? ( HYPERLINK "http://ebp.uga.edu/courses/Chapter%204%20-%20Diagnosis%20I/2%20-%20Threshold%20model.html" http://ebp.uga.edu/courses/Chapter%204%20-%20Diagnosis%20I/2%20-%20Threshold%20model.html)
d) Vad menas med behandlingstrskel? ( HYPERLINK "http://ebp.uga.edu/courses/Chapter%204%20-%20Diagnosis%20I/2%20-%20Threshold%20model.html" http://ebp.uga.edu/courses/Chapter%204%20-%20Diagnosis%20I/2%20-%20Threshold%20model.html)
e) Var br diagnosens sannolikhet ligga relativ till dessa trsklar nr man bestller ett prov? ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=7366635" Pauker 1980 ADDIN EN.CITE Pauker1980535[28]53553517Pauker, S. G.Kassirer, J. P.The threshold approach to clinical decision makingN Engl J MedThe New England journal of medicineN Engl J MedThe New England journal of medicineN Engl J MedThe New England journal of medicine1109-17302201980/05/15*Decision Making*DiagnosisHumansMaleMathematicsMiddle Aged*Models, Theoretical*ProbabilityRisk*Therapeutics1980May 150028-4793 (Print)
0028-4793 (Linking)7366635Case Reports
Research Support, U.S. Gov't, P.H.S.http://www.ncbi.nlm.nih.gov/pubmed/736663510.1056/NEJM198005153022003eng[ HYPERLINK \l "_ENREF_28" \o "Pauker, 1980 #535" 28] Abstract)
f) Vad r testtrskeln fr lungemboli? (Rosen's 8th ed Chapter 88 s1162) Varfr r testtrskeln inte 0%? Vilka r risker vid utredning fr misstnkt lungemboli? (Rosen's 8th ed Chapter 88 s1162)
g) Finns det nackdelar med bestllningen av ett flertal allmnna prov ("shot-gun approach") nr man inte r sker p patientens diagnos? ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=18546805" Woolever 2008 ADDIN EN.CITE Woolever20081637[24]1637163717Woolever, D. R.Central Maine Medical Center Family Medicine Residency Program, Lewiston, Maine, USA.The art and science of clinical decision makingFam Pract ManagFamily practice managementFam Pract ManagFamily practice managementFam Pract ManagFamily practice management31-61552008/06/13*Decision MakingDecision Support Systems, Clinical/*organization & administrationDiagnosis, DifferentialDiagnostic Tests, Routine*Evidence-Based MedicineHumansPractice Management, MedicalPractice Patterns, Physicians'2008May1069-5648 (Print)
1069-5648 (Linking)18546805http://www.ncbi.nlm.nih.gov/pubmed/18546805eng[ HYPERLINK \l "_ENREF_24" \o "Woolever, 2008 #1637" 24] under Probabilities; HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=19033501" Smith 2008 ADDIN EN.CITE Smith20081639[29]1639163917Smith, J. E.Higginson, I.Guly, H. R.Grant, I. C.Belsham, P.Hicks, A.Alao, D.Boon, D.Emergency Department, Derriford Hospital, Plymouth PL6 8DH, UK. jasonesmith@doctors.org.ukThe Derriford twelve commandments of emergency medicine: a model for good practice in a changing world, or a survival guide for new medical staffEmerg Med JEmergency medicine journal : EMJEmerg Med JEmergency medicine journal : EMJEmerg Med JEmergency medicine journal : EMJ824-625122008/11/27Age FactorsDiagnosis, DifferentialEmergency Medicine/education/*standards*Emergency Service, HospitalHumansMedical Staff, Hospital/education/*standardsProfessional Practice/*standards2008Dec1472-0213 (Electronic)
1472-0205 (Linking)19033501http://www.ncbi.nlm.nih.gov/pubmed/1903350110.1136/emj.2007.055483eng[ HYPERLINK \l "_ENREF_29" \o "Smith, 2008 #1639" 29] Commandment #3)
h) Vilka r risker med verbehandling av lungemboli ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=23820021" Wiener 2013 ADDIN EN.CITE Wiener20131640[30]1640164017Wiener, R. S.Schwartz, L. M.Woloshin, S.Pulmonary Center, Boston University School of Medicine, Boston, MA, USA. rwiener@bu.eduWhen a test is too good: how CT pulmonary angiograms find pulmonary emboli that do not need to be foundBMJBMJf33683472013/07/04Health Care CostsHumansPulmonary Embolism/economics/*radiographyPulmonary Veins/*radiography*Tomography, X-Ray Computed/adverse effects/economics/utilization20131756-1833 (Electronic)
0959-535X (Linking)23820021Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.http://www.ncbi.nlm.nih.gov/pubmed/23820021468854910.1136/bmj.f3368eng[ HYPERLINK \l "_ENREF_30" \o "Wiener, 2013 #1640" 30] s5/7)?
DEL III: HANDLEDNING
1-Constructive Alignment
Constructive Alignment r en pedagogisk modell som bestr av en sammansttning av konstruktivism och alignment.
a) Vad menas med konstruktivism? ( HYPERLINK "http://www.jstor.org/stable/3448076?seq=1" \l "page_scan_tab_contents" Biggs 1996 ADDIN EN.CITE Biggs199636[31]363617Biggs, JEnhancing teaching through constructive alignmentHigher EducationHigher Education347-364321996[ HYPERLINK \l "_ENREF_31" \o "Biggs, 1996 #36" 31] s348 sista paragraf och citat s349)
b) Vad menas med alignment? ( HYPERLINK "http://www.lakartidningen.se/Functions/OldArticleView.aspx?articleId=16548" Dryver 2011 ADDIN EN.CITE Dryver20111423[32]1423142317Dryver, E.Andersson, N.Friberg, H.e_dryver@hotmail.comUtbildning av akutlkare enligt modern pedagogik. Basen r scenariovningar och klinisk tjnstgring under handledning.LakartidningenLakartidningenLakartidningenLakartidningenLakartidningenLakartidningen1183-6108212011/08/05Clinical CompetenceEmergency Medicine/*educationHumansLearningModels, EducationalPreceptorshipTeaching/methods2011May 25-31Utbildning av akutlakare enligt modern pedagogik. Basen ar scenarioovningar och klinisk tjanstgoring under handledning.0023-7205 (Print)
0023-7205 (Linking)21812241http://www.ncbi.nlm.nih.gov/pubmed/21812241swe[ HYPERLINK \l "_ENREF_32" \o "Dryver, 2011 #1423" 32] s1183)
c) Under vilka frutsttningar r handledning p akuten frenlig med constructive alignment?
2-Inlrningsluckor
Sren Kierkegaard skrev fljande 1851:
Om jag vill fra en annan mnniska till ett bestmt ml mste jag frst finna henne dr hon r. Och brja just dr. Kan jag inte det lurar jag mig sjlv nr jag tror att jag kan hjlpa andra. Fr att hjlpa andra mste jag visserligen frst mer n vad de gr, men frst och frmst frst det som de frstr. Om jag inte kan det, s hjlper det inte att jag kan och vet mera.
Hur fr man reda p vad lkaren eller kandidaten man handledare p akuten kan?
3-Kvalitn av rd man fr
Schaafsma et al granskade om rdet specialister i yrkesmedicin fr frn kollegor stmmer med evidensen i den medicinska litteraturen.
a) Hur ofta var rdet annorlunda n den som fanns i den medicinska litteraturen? ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=16131405" Schaafsma 2005 ADDIN EN.CITE ADDIN EN.CITE.DATA [ HYPERLINK \l "_ENREF_33" \o "Schaafsma, 2005 #1642" 33])
b) Vad ger studiens frfattare fr rd till dessa lkare ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=16131405" Schaafsma 2005 ADDIN EN.CITE ADDIN EN.CITE.DATA [ HYPERLINK \l "_ENREF_33" \o "Schaafsma, 2005 #1642" 33] Abstract, conclusion)?
4-Metacognition och handledning
r metacognition viktig vid handledning? ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=17112935" Sandhu 2006 ADDIN EN.CITE Sandhu2006584[20]58458417Sandhu, H.Carpenter, C.Freeman, K.Nabors, S. G.Olson, A.Division of Emergency Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA. sandhuh@msnotes.wustl.eduClinical decisionmaking: opening the black box of cognitive reasoningAnn Emerg MedAnnals of emergency medicineAnn Emerg MedAnnals of emergency medicineAnn Emerg MedAnnals of emergency medicine713-94862006/11/23*Algorithms*Cognition*DiagnosisDiagnostic Errors*Emergency MedicineHumansInternship and ResidencyMaleMiddle AgedPattern Recognition, Physiological2006Dec1097-6760 (Electronic)
0196-0644 (Linking)17112935http://www.ncbi.nlm.nih.gov/pubmed/1711293510.1016/j.annemergmed.2006.03.011eng[ HYPERLINK \l "_ENREF_20" \o "Sandhu, 2006 #584" 20] s718)
5-Analogic Transfer
a) Vad menas med analogic transfer ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=9795635" Eva 1998 ADDIN EN.CITE Eva199837[34]373717Eva, K. W.Neville, A. J.Norman, G. R.Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.Exploring the etiology of content specificity: factors influencing analogic transfer and problem solvingAcad MedAcademic medicine : journal of the Association of American Medical CollegesAcad MedAcademic medicine : journal of the Association of American Medical CollegesAcad MedAcademic medicine : journal of the Association of American Medical CollegesS1-57310 Suppl1998/10/31*Education, MedicalHumans*Problem SolvingProblem-Based LearningTask Performance and Analysis*Transfer (Psychology)1998Oct1040-2446 (Print)
1040-2446 (Linking)9795635Reviewhttp://www.ncbi.nlm.nih.gov/pubmed/9795635eng[ HYPERLINK \l "_ENREF_34" \o "Eva, 1998 #37" 34] S2 under paragraph Content Specificity and Analogous Transfer)?
b) Vad kan lraren gra fr att underltta frmgan att lsa nya fall? ( HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=9795635" Eva 1998 ADDIN EN.CITE Eva199837[34]373717Eva, K. W.Neville, A. J.Norman, G. R.Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.Exploring the etiology of content specificity: factors influencing analogic transfer and problem solvingAcad MedAcademic medicine : journal of the Association of American Medical CollegesAcad MedAcademic medicine : journal of the Association of American Medical CollegesAcad MedAcademic medicine : journal of the Association of American Medical CollegesS1-57310 Suppl1998/10/31*Education, MedicalHumans*Problem SolvingProblem-Based LearningTask Performance and Analysis*Transfer (Psychology)1998Oct1040-2446 (Print)
1040-2446 (Linking)9795635Reviewhttp://www.ncbi.nlm.nih.gov/pubmed/9795635eng[ HYPERLINK \l "_ENREF_34" \o "Eva, 1998 #37" 34] S5 Conclusions punkt 1)
REFERENSER
ADDIN EN.REFLIST 1. Croskerry, P., A universal model of diagnostic reasoning. Acad Med, 2009. 84(8): p. 1022-8.
2. Croskerry, P., Critical thinking and decisionmaking: avoiding the perils of thin-slicing. Ann Emerg Med, 2006. 48(6): p. 720-2.
3. Berner, E.S. and M.L. Graber, Overconfidence as a cause of diagnostic error in medicine. Am J Med, 2008. 121(5 Suppl): p. S2-23.
4. Newman-Toker, D.E. and P.J. Pronovost, Diagnostic errors--the next frontier for patient safety. JAMA, 2009. 301(10): p. 1060-2.
5. Kachalia, A., et al., Missed and delayed diagnoses in the emergency department: a study of closed malpractice claims from 4 liability insurers. Ann Emerg Med, 2007. 49(2): p. 196-205.
6. Graber, M.L., N. Franklin, and R. Gordon, Diagnostic error in internal medicine. Arch Intern Med, 2005. 165(13): p. 1493-9.
7. Phua, D.H. and N.C. Tan, Cognitive aspect of diagnostic errors. Ann Acad Med Singapore, 2013. 42(1): p. 33-41.
8. HSAN 770/07, God vrd frutstter knnedom om patientens tidigare besvr. Enklaste sttet r att frga patienten. Lakartidningen, 2007. 104(48): p. 3684-3687.
9. HSAN 4188/07, Magkatarr eller hjrtinfarkt? . Lakartidningen, 2008. 105(40): p. 2786.
10. HSAN 1879/07, Gastroenterit eller hjrtinfarkt? . Lakartidningen, 2008. 105(40): p. 2786.
11. HSAN 1126/05, 14-ring frlorade testikel efter feldiagnos av underlkare. Vlkntatttestistorsion kan brja med buksmrtor, illamende och krkningar. . Lakartidningen, 2006. 103(24).
12. HSAN 3506/05, Tidigare bukopererad patient skte med akuta buksmrtor och krkningar Tarmhinder mste vervgas och helstuteslutas. Lakartidningen, 2006. 103(20): p. 1624-1625.
13. HSAN 0387/08, Waranmetabolismen hmmas av erytromycin. Lakartidningen, 2008. 105(48): p. 3558.
14. Frigyesi, A., [All physicians should know the discussion around the Bayes theorem. When is a positive test really positive?]. Lakartidningen, 2009. 106(3): p. 122-3.
15. Gallagher, E.J., Clinical utility of likelihood ratios. Ann Emerg Med, 1998. 31(3): p. 391-7.
16. Han, J.H., et al., The role of cardiac risk factor burden in diagnosing acute coronary syndromes in the emergency department setting. Ann Emerg Med, 2007. 49(2): p. 145-52, 152 e1.
17. Fanaroff, A.C., et al., Does This Patient With Chest Pain Have Acute Coronary Syndrome?: The Rational Clinical Examination Systematic Review. JAMA, 2015. 314(18): p. 1955-65.
18. Hilliard, A.A., et al., Clinical problem-solving. Occam's razor versus Saint's Triad. N Engl J Med, 2004. 350(6): p. 599-603.
19. Trowbridge, R.L., N.K. Rutkowski, and K.G. Shojania, Does this patient have acute cholecystitis? JAMA, 2003. 289(1): p. 80-6.
20. Sandhu, H., et al., Clinical decisionmaking: opening the black box of cognitive reasoning. Ann Emerg Med, 2006. 48(6): p. 713-9.
21. Croskerry, P., From mindless to mindful practice--cognitive bias and clinical decision making. N Engl J Med, 2013. 368(26): p. 2445-8.
22. Sundblom, E. and E. Dryver, ABC om beslutsfattande pa akuten. Lakartidningen, 2013. 110(12): p. 631-5.
23. Westbrook, J.I., et al., The impact of interruptions on clinical task completion. Qual Saf Health Care, 2010. 19(4): p. 284-9.
24. Woolever, D.R., The art and science of clinical decision making. Fam Pract Manag, 2008. 15(5): p. 31-6.
25. Truog, R.D., Is it always wrong to perform futile CPR? N Engl J Med, 2010. 362(6): p. 477-9.
26. Fine, R.L., Is it always wrong to perform futile CPR? N Engl J Med, 2010. 362(21): p. 2035; author reply 2036-7.
27. Kassirer, J.P., Our stubborn quest for diagnostic certainty. A cause of excessive testing. N Engl J Med, 1989. 320(22): p. 1489-91.
28. Pauker, S.G. and J.P. Kassirer, The threshold approach to clinical decision making. N Engl J Med, 1980. 302(20): p. 1109-17.
29. Smith, J.E., et al., The Derriford twelve commandments of emergency medicine: a model for good practice in a changing world, or a survival guide for new medical staff. Emerg Med J, 2008. 25(12): p. 824-6.
30. Wiener, R.S., L.M. Schwartz, and S. Woloshin, When a test is too good: how CT pulmonary angiograms find pulmonary emboli that do not need to be found. BMJ, 2013. 347: p. f3368.
31. Biggs, J., Enhancing teaching through constructive alignment. Higher Education, 1996. 32: p. 347-364.
32. Dryver, E., N. Andersson, and H. Friberg, Utbildning av akutlkare enligt modern pedagogik. Basen r scenariovningar och klinisk tjnstgring under handledning. Lakartidningen, 2011. 108(21): p. 1183-6.
33. Schaafsma, F., et al., Caution required when relying on a colleague's advice; a comparison between professional advice and evidence from the literature. BMC Health Serv Res, 2005. 5: p. 59.
34. Eva, K.W., A.J. Neville, and G.R. Norman, Exploring the etiology of content specificity: factors influencing analogic transfer and problem solving. Acad Med, 1998. 73(10 Suppl): p. S1-5.
Eric Dryver, SUS Lund
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