Lecture 1 Recognising and capturing clinical ncertainty讲座1识别和捕获的临床的不确定性.pptVIP

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Lecture 1 Recognising and capturing clinical ncertainty讲座1识别和捕获的临床的不确定性.ppt

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Lecture 1 Recognising and capturing clinical ncertainty讲座1识别和捕获的临床的不确定性

Dr Carl Thompson, University of York Lecture 1Recognising and capturing clinical uncertainty Foreground and background knowledge clarification Clinical uncertainty Clinical judgement Clinical decision making Evidence based decision making Clinical uncertainty Not certainly knowing or known Sources Defining a disease Making a diagnosis Selecting an intervention Observing outcomes Assessing patient preferences Combing information in a decision Quantifying Uncertainty True state of the patient cannot be directly observed Clinician must use imperfect external cues Probability as a language for expressing uncertainty Probability Fundamentals Strength of belief A number between 0 and1 that expresses an opinion about the likelihood of an event Probability of an event that is certain to occur is 1 Probability of an event that is certain to NOT occur is 0 Types of probability Components of Probability Estimates Personal experience Published experience - evidence Attributes of the patient Clinical decision and judgement Clinical judgement Assessment of alternatives Clinical decision Choosing between alternatives (Dowie 1988) The decisions clinicians make. Diagnosis and test ordering (Dx) Treatment (Rx) Targeting Timing referral Communicating (risks and benefit info) Seeking more information S.D.O. (service delivery and organisation) Clinical uncertainty – the good news Aeschylus – ‘hope comes from the lack of certainty of fate’ Complete certainty = lack of hope Examination results predicted life success (100% accurately) Learning at age 12 that you possess the Alzheimer’s gene Adaptation to Huntington’s and HIV status Asking questions Background questions: General knowledge about a disorder A root (who, what, when, how, and why) a verb A disorder or aspect of a disorder E.g. ‘what causes angina?’ Foreground questions P.I.C.O. Specific knowledge about management of people with a disorder Population: the people who are on the receiving end of your judge