Relevant bibliographies by topics / Triage (Medicine) Decision making

Academic literature on the topic 'Triage (Medicine) Decision making'

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Published: 10 December 2022
Last updated: 28 January 2023

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Journal articles on the topic "Triage (Medicine) Decision making"

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Mirhaghi, A., G. R. Mohammadi, and M. Asghari. "(A260) Triage Decision-Making in Intoxication." Prehospital and Disaster Medicine 26, S1 (May 2011): s71—s72. http://dx.doi.org/10.1017/s1049023x11002445.

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Background and AimsDecision-making is the major component in triaging EDs patients. EDs Triage systems have applied different approaches to triaging intoxicated patients. Pros & Cons for these approaches need to be identified. Aim is to analysis management of intoxicated patients during various triage process.MethodsCritical review includes five triage systems, Emergency Severity Index, Australasian Triage Scale, Canadian triage and Acuity Scale, Manchester Triage System and 5-tier Triage protocol. These systems have been analyzed via meta-synthesis in terms of evidence-based criteria, inclusiveness, specific application and practicability.ResultsGeneral physiologic signs & symptoms were the gold standard for determining acuity in patients that have been applied by all triage systems. Conscious level, air way, respiratory status and circulation assessment were identified as major criteria in decision-making. 5-tier Triage protocol showed the most comprehensiveness characteristics to prioritizing intoxicated patients.DiscussionResources necessary for evidence-based performance to support nursing decisions in triaging intoxicated patients needs fundamentally to be developed. It`s necessary to develop National Triage Scale to approach intoxicated patients effectively.
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Cioffi, J. "Triage decision making: Educational strategies." Accident and Emergency Nursing 7, no. 2 (April 1999): 106–11. http://dx.doi.org/10.1016/s0965-2302(99)80031-9.

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Mirhaghi, A., M. Sajjadi, and A. Golafshani. "(A279) Evidence-Based Decision-Making in Triage." Prehospital and Disaster Medicine 26, S1 (May 2011): s77. http://dx.doi.org/10.1017/s1049023x11002639.

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Background and AimsDecision-making is the major component in triaging emergency department patients. Influencing factors on decision-making have been identified but it`s not clear how much of the decision is based upon scientific criteria. The objective of this study was to determine frequency of using reliable and valid guidelines by nurses in emergency departments.MethodsIt was a descriptive survey study. The questionnaire was composed of demographic data, evidence-based triage questions (15) and triage decision-making questions (10). The questionnaire reliability was 0.87 using the test-retest method. Content validity was considered based upon Canadian Triage and Acuity Scale.Results70 nurses from 10 emergency departments participated. 40 % of nurses` responses to evidence-based questions was correct. The percentage of inter-rater agreement between nurses was moderate (0.56) related to decision-making questions. No valid and reliable guideline was utilized in emergency departments.ConclusionNurses` decision-making was poorly based on evidence-based criteria. Low level of nurses` knowledge about triage may be derived from lack of official and specialized triage training courses. Academic triage courses establishment and development of national triage scale are recommended.
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Levy, Mitchell M. "Triage decision making for the elderly." Critical Care Medicine 40, no. 1 (January 2012): 323–24. http://dx.doi.org/10.1097/ccm.0b013e31823b96fe.

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Kilner, Tim, and F. John Hall. "Triage Decisions of United Kingdom Police Firearms Officers Using a Multiple-Casualty Scenario Paper Exercise." Prehospital and Disaster Medicine 20, no. 1 (February 2005): 40–46. http://dx.doi.org/10.1017/s1049023x00002132.

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AbstractIntroduction:British police officers authorized to carry firearms may need to make judgments about the severity of injury of individuals or the relative priority of clinical need of a group of injured patients in tactical and non-tactical situations. Most of these officers receive little or no medical training beyond basic first aid to enable them to make these clinical decisions. Therefore, the aim of this study is to determine the accuracy of triage decision-making of firearms-trained police officers with and without printed decision-support materials.Methods:Eighty-two police firearms officers attending a tactical medicine course (FASTAid) were recruited to the study. Data were collected using a paper-based triage exercise that contained brief, clinical details of 20 adults and 10 children. Subjects were asked to assign a clinical priority of immediate or priority 1 (P1); urgent or priority 2 (P2); delayed or priority 3 (P3); or dead, to each casualty. Then, they were provided with decision-making materials, but were not given any instruction as to how these materials should be used. Subjects then completed a second triage exercise, identical to the first, except this time using the decision-support materials.Data were analyzed using mixed between-within subjects analysis of variance. This allowed comparisons to be made between the scores for Exercise 1 (no decision-support material) and Exercise 2 (with decision-support material). It also allowed any differences between those students with previous triage training and those without previous training to be explored.Results:The use of triage decision-making materials resulted in a significant increase in correct responses (p <0.001). Improvement in accuracy appears to result mainly from a reduction in the extent of under-triage. There were significant differences (p <0.05) between those who had received previous triage training and those who had not, with those having received triage training doing slightly better.Conclusion:It appears that significant improvements in the accuracy of triage decision-making by police firearms officers can be achieved with the use of appropriate triage decision-support materials. Training may offer additional improvements in accuracy, but this improvement is likely to be small when decision-support materials are provided. With basic clinical skills and appropriate decision-support materials, it is likely that the police officer can make accurate triage decisions in a multiple-casualty scenario or make judgments of the severity of injury of a given individual in both tactical and non-tactical situations.
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Cioffi, J. "Decision making by emergency nurses in triage assessments." Accident and Emergency Nursing 6, no. 4 (October 1998): 184–91. http://dx.doi.org/10.1016/s0965-2302(98)90077-7.

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Whelan, Lori, William Justice, Jeffrey M. Goodloe, Jeff D. Dixon, and Stephen H. Thomas. "Trauma Ultrasound in Civilian Tactical Medicine." Emergency Medicine International 2012 (2012): 1–6. http://dx.doi.org/10.1155/2012/781570.

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The term “tactical medicine” can be defined in more than one way, but in the nonmilitary setting the term tactical emergency medical services (TEMS) is often used to denote medical support operations for law enforcement. In supporting operations involving groups such as special weapons and tactics (SWAT) teams, TEMS entail executing triage, diagnosis, stabilization, and evacuation decision-making in challenging settings. Ultrasound, now well entrenched as a part of trauma evaluation in the hospital setting, has been investigated in the prehospital arena and may have utility in TEMS. This paper addresses potential use of US in the tactical environment, with emphasis on the lessons of recent years’ literature. Possible uses of US are discussed, in terms of both specific clinical applications and also with respect to informing triage and related decision making.
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McLeod, S., J. McCarron, T. Ahmed, S. Scott, H. Ovens, N. Mittmann, and B. Borgundvaag. "LO70: Interrater agreement and time it takes to assign a Canadian Triage and Acuity Scale score pre and post implementation of eCTAS." CJEM 20, S1 (May 2018): S31—S32. http://dx.doi.org/10.1017/cem.2018.132.

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Introduction: In addition to its clinical utility, the Canadian Triage and Acuity Scale (CTAS) has become an administrative metric used by governments to estimate patient care requirements, ED funding and workload models. The Electronic Canadian Triage and Acuity Scale (eCTAS) initiative aims to improve patient safety and quality of care by establishing an electronic triage decision support tool that standardizes the application of national triage guidelines (CTAS) across Ontario. The objective of this study was to evaluate the implementation of eCTAS in a variety of ED settings. Methods: This was a prospective, observational study conducted in 7 hospital EDs, selected to represent a mix of triage processes (electronic vs. manual), documentation practices (electronic vs. paper), hospital types (rural, community and teaching) and patient volumes (annual ED census ranged from 38,000 to 136,000). An expert CTAS auditor observed on-duty triage nurses in the ED and assigned independent CTAS in real time. Research assistants not involved in the triage process independently recorded the triage time. Interrater agreement was estimated using unweighted and quadratic-weighted kappa statistics with 95% confidence intervals (CIs). Results: 1200 (738 pre-eCTAS, 462 post-implementation) individual patient CTAS assessments were audited over 33 (21 pre-eCTAS, 11 post-implementation) seven-hour triage shifts. Exact modal agreement was achieved for 554 (75.0%) patients pre-eCTAS, compared to 429 (93.0%) patients triaged with eCTAS. Using the auditors CTAS score as the reference standard, eCTAS significantly reduced the number of patients over-triaged (12.1% vs. 3.2%; 8.9, 95% CI: 5.7, 11.7) and under-triaged (12.9% vs. 3.9%; 9.0, 95% CI: 5.9, 12.0). Interrater agreement was higher with eCTAS (unweighted kappa 0.90 vs 0.63; quadratic-weighted kappa 0.79 vs. 0.94). Research assistants captured triage time for 4403 patients pre-eCTAS and 1849 post implementation of eCTAS. Median triage time was 304 seconds pre-eCTAS and 329 seconds with eCTAS ( 25 seconds, 95% CI: 18, 32 seconds). Conclusion: A standardized, electronic approach to performing CTAS assessments improves both clinical decision making and administrative data accuracy without substantially increasing triage time.
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Miladinia, Mojtaba, Farhad Abolnezhadian, Joachim G. Voss, Kourosh Zarea, Naser Hatamzadeh, and Mandana Ghanavati. "Final triage methods to decide on home-isolation versus hospitalization in COVID-19 pandemic: a challenge for clinicians." Journal of Emergency Practice and Trauma 8, no. 2 (September 23, 2020): 90–94. http://dx.doi.org/10.34172/jept.2020.37.

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Objective: Final patient triage determines which patients can be home-isolated and which patients require hospitalization on the basis to predict the patient’s prognosis most accurately. Final triage is an important link in the clinical management chain of the coronavirus disease 2019 (COVID-19) pandemic, and a comprehensive review of various patient triage methods is very important to guide decision making and triage efficiency. Decision by clinicians about hospitalization or home-discharge is one of the main challenges in places with limited hospital facilities compared to the high volume of COVID-19 patients. This review was designed to guide clinicians on how to address this challenge. Methods: In this mini review we searched scientific databases to obtain the final triage methods of COVID-19 patients and the important criteria in each method. In order to conducted searches a period from December 2019 to July 2020 was considered. All searches were done in electronic databases and search engines. Results: Findings revealed four current methods for final triage (decision-making regarding home-isolation or hospitalization of COVID-19 patients). These methods included 1) demographic and background information, 2) clinical information, 3) laboratory indicators and 4) initial chest CT-scan. Each of the aforementioned methods encompassed significant criteria according to which decisions on the patient’s prognosis and final triage were made. Finally, by evaluating each final triage method, we found that each method had some limitations. Conclusion: An effective and quick final triage requires simultaneous complementary use of all four methods to compensate for each other’s weaknesses and add to each other’s strengths. It is therefore suggested to assure that clinicians are trained in all four COVID-19 patient’s triage methods and their useful criteria in order to achieve evidence-based performance for better triage (decision between home-isolation versus hospitalization).
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Mulla, MD, MSc, Ali, Blair L. Bigham, MD, MSc, DTMH, Andrea Frolic, MA, PhD, and Michael D. Christian, MD, MSc, FRCPC. "Canadian emergency medicine and critical care physician perspectives on pandemic triage in COVID-19." Journal of Emergency Management 18, no. 7 (December 8, 2020): 31–35. http://dx.doi.org/10.5055/jem.2020.0484.

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Introduction: Local and regional policies to guide the allocation of scarce critical care resources have been developed, but the views of prospective users are not understood. We sought to investigate the perspectives of Canadian acute care physicians toward triaging scarce critical care resources in the COVID-19 pandemic.Methods: We rapidly deployed a brief survey to Canadian emergency and critical care physicians in April 2020 to investigate current attitudes toward triaging scarce critical care resources and identify subsequent areas for improvement. Descriptive and between-group analyses along with thematic coding were used.Results: The survey was completed by 261 acute care physicians. Feelings of anxiety related to the pandemic were common (65 percent), as well as fears of psychological distress if required to triage scarce resources (77 percent). Only 49 percent of respondents felt confident in making resource allocation decisions. Both critical care and emergency physicians favored multidisciplinary teams over single physicians to allocate scarce critical care resources. Critical care physicians were supportive of decision making by teams not involved in patient care (3.4/5 versus 2.9/5 p = 0.04), whereas emergency physicians preferred to maintain their involvement in such decisions (3.4/5 versus 4.0/5 p = 0.007). Free text responses identified five themes for subsequent action including the need for further guidance on existing triage policies, ethical support in decision making, medicolegal protection, additional tools for therapeutic communications, and healthcare provider psychological support.Conclusion: There is an urgent need for collaboration between policymakers and frontline physicians to develop critical care resource triage policies that wholly consider the diversity of provider perspectives across practice environments.
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Dissertations / Theses on the topic "Triage (Medicine) Decision making"

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Forde, Colin Ainsworth. "Emergency Medicine Triage as the Intersection of Storytelling, Decision-Making, and Dramaturgy." Scholar Commons, 2014. https://scholarcommons.usf.edu/etd/5354.

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This dissertation presents a comprehensive qualitative study of the decision-making aspects of emergency department (ED) triage at a large urban Trauma I hospital in the Southeast. Specifically, this study addresses the following research questions: (1) What do triage nurses perceive as the primary role of the triage process? (2) How do triage nurses interpret patient performances? These questions are explored through illuminating the intricacies of triage decision-making by the use of semi-structured interviews and observations. The findings of this study indicate: (1) a better understanding of the triage decision- making process yielding more practical insights related to the informal, emergent, and often improvisational ways patients are received, categorized, and treated was needed, and (2) providing a clearer understanding of the processes involved in sorting patients may provide much-needed insight regarding clinical concerns and/or issues regarding patient categorization, adverse clinical events, and excessive patient wait times. These findings are of particular importance due to the widespread overuse of EDs for nonemergent care. Essentially, EDs are designed for patients to visit due to an alteration in their physical and/or mental state. Once a patient enters the ED, a medical professional is tasked with the responsibility of interpreting the physical and/or mental state of the patient, which is generally achieved by interpreting the patient story - the precipitating event that brought them into the ED. What this study contributes to the literature is a deeper understanding of the communicative processes that ED triage nurses leverage to make sense of patient stories.
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Lundberg, Camilla, and Karin Winge. "Prehospital bedömning : En forskningsöversikt." Thesis, Högskolan i Borås, Institutionen för Vårdvetenskap, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-18828.

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Patienter utsätts för onödiga transporter och efterföljande väntetid på akutmottagningen, vilket i sin tur leder till ett onödigt vårdlidande. Det är inte längre en självklar åtgärd för ambulanssjukvården att transportera alla patienter till akutmottagningen för fortsatt vård. Detta innebär att kravet har ökat på ambulanssjukvården och den prehospitala bedömningen. Mot bakgrund av dessa förutsättningar som idag gäller för ambulanssjukvård, är frågan om forskningen kan vägleda till hur den prehospitala bedömningen ska kunna underlättas.Syftet med studien är att beskriva prehospital bedömning i ambulanssjukvård och genom en forskningsöversikt har kvalitativ och kvantitativ forskning analyserats.I resultatet framkommer det att prehospital bedömning består av två huvudinnehåll, dels en vårdvetenskaplig där den prehospitala bedömningen ses som en kontinuerlig process och dels en medicinsk där den prehospitala bedömningen inriktas på att utifrån fastställda kriterier ringa in patientens vårdbehov. I den vårdvetenskapliga forskningen framkommer att vårdrelationen är en central del i den prehospitala bedömningen liksom att vinna patientens förtroende. I den medicinska forskningen framkommer att prehospital bedömning och triagering med hjälp av protokoll kan vara ett sätt att minska patientens vårdlidande. Protokoll kan ge en vägledning till alternativa vårdnivåer men måste kombineras med ett vårdvetenskapligt patientperspektiv och ett öppet förhållningssätt för att möta patienters individuella nyanser. Genom att möjliggöra patientstyrning till alternativa vårdnivåer, kan akutmottagningar avlastas och leda till att fler patienter kan vårdas hemma, dock i ringa omfattning.

Program: Fristående kurs

Uppsatsnivå: C

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Göransson, Katarina. "Registered nurse-led emergency department triage : organisation, allocation of acuity ratings and triage decision making." Doctoral thesis, Örebro University, Department of Health Sciences, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-732.

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Successful triage is the basis for sound emergency department (ED) care, whereas unsuccessful triage could result in adverse outcomes. ED triage is a rather unexplored area in the Swedish health care system. This thesis contributes to our understanding of this complex nursing task. The main focus of this study has been on the organisation, performance, and decision making in Swedish ED triage. Specific aims were to describe the Swedish ED triage context, describe and compare registered nurses’ (RNs) allocation of acuity ratings, use of thinking strategies and the way they structure the ED triage process.

In this descriptive, comparative, and correlative research project quantitative and qualitative data were collected using telephone interviews, patient scenarios and think aloud method. Both convenience and purposeful sampling were used when identifying the participating 69 nurse managers and 423 RNs from various types of hospital-based EDs throughout the country.

The results showed national variation, both in the way triage was organised and in the way it was conducted. From an organisational perspective, the variation emerged in several areas: the use of various triageurs, designated triage nurses, and triage scales. Variation was also noted in the accuracy and concordance of allocated acuity ratings. Statistical methods provided limited explanations for these variations, suggesting that RNs’ clinical experience might have some affect on the RNs’ triage accuracy. The project identified several thinking strategies used by the RNs, indicating that the RNs, amongst other things, searched for additional information, generated hypotheses about the fictitious patients and provided explanations for the interventions chosen. The RNs formed relationships between their interventions and the fictitious patients’ symptoms. The RNs structured the triage process in several ways, beginning the process by searching for information, generating hypotheses, or allocating acuity ratings. Comparison of RNs’ use of thinking strategies and the structure of the triage process based on triage accuracy revealed only slight differences.

The findings in this dissertation indicate that the way a patient is triaged, and by whom, depends upon the particular organisation of the ED. Moreover, the large variation in RNs triage accuracy and the inter-rater agreement and concordance of the allocated acuity ratings suggest that the acuity rating allocated to a patient may vary considerably, depending on who does the allocation. That neither clinical experience nor the RNs’ decision-making processes alone can explain the variations in the RNs triage accuracy indicates that accuracy might be influenced by individual and contextual factors. Future studies investigating triage accuracy are recommended to be carried out in natural settings.

In conclusion, Swedish ED triage is permeated by diversity, both in its organisation and in its performance. The reasons for these variations are not well understood.

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Göransson, Katarina. "Registered nurse-led emergency department triage : organisation, allocation of acuity ratings and triage decision making /." Örebro : Hälsovetenskapliga institutionen, Örebro universitet, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-732.

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Spence, James Michael. "A Comparison of Major Factors that Affect Hospital Formulary Decision-Making by Three Groups of Prescribers." Thesis, University of North Texas, 2018. https://digital.library.unt.edu/ark:/67531/metadc1157518/.

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The exponential growth in medical pharmaceuticals and related clinical trials have created a need to better understand the decision-making factors in the processes for developing hospital medication formularies. The purpose of the study was to identify, rank, and compare major factors impacting hospital formulary decision-making among three prescriber groups serving on a hospital's pharmacy and therapeutics (P&T) committee. Prescribers were selected from the University of Texas, MD Anderson Cancer Center which is a large, multi-facility, academic oncology hospital. Specifically, the prescriber groups studied were comprised of physicians, midlevel providers, and pharmacists. A self-administered online survey was disseminated to participants. Seven major hospital formulary decision-making factors were identified in the scientific literature. Study participants were asked to respond to questions about each of the hospital formulary decision-making factors and to rank the various formulary decision-making factors from the factor deemed most important to the factor deemed least important. There are five major conclusions drawn from the study including three similarities and two significant differences among the prescriber groups and factors. Similarities include: (1) the factor "pharmacy staff's evaluation of medical evidence including formulary recommendations" was ranked highest for all three prescriber groups; (2) "evaluation of medications by expert physicians" was ranked second for physicians and midlevel providers while pharmacists ranked it third; and (3) the factor, "financial impact of the treatment to the patient" was fifth in terms of hospital formulary decision-making statement and ranking by all three prescriber groups. Two significant differences include: (1) for the hospital-formulary decision making statement, "I consider the number of patients affected by adding, removing, or modifying a drug on the formulary when making hospital medication formulary decisions," midlevel providers considered this factor of significantly greater importance than did physicians; and (2) for the ranked hospital formulary decision-making factor, "financial impact of treatment to the institution," pharmacists ranked this factor significantly higher than did physicians. This study contributes to a greater understanding of the three prescriber groups serving on a P&T committee. Also, the study contributes to the body of literature regarding decision-making processes in medicine and specifically factors impacting hospital formulary decision-making. Furthermore, this study has the potential to impact the operational guidelines for the P&T committee at the University of Texas, MD Anderson Cancer Center as well as other hospitals.
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Gollan, Srisuda Siera. "A Mixed Methods Examination of Pre-Hospital Trauma Triage Decision Making." Thesis, Augusta University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10634622.

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The objective of pre-hospital trauma care is ensuring that the most severely injured persons are transported to the facility best suited to meet their complex needs (Fitzharris, Stevenson, Middleton, & Sinclair, 2011; Hoff, Tinkoff, Lucke, & Lehr, 1992; Leach et al., 2008; Sasser et al., 2012). To support pre-hospital decision making regarding trauma triage destination determinations, the Guidelines for Field Triage of Injured Patients decision scheme (FTDS) was developed as an algorithmic decision tool (Sasser et al., 2012).

The purpose of this study was to examine pre-hospital trauma triage transport decision making by EMS providers from multiple perspectives. This study used a concurrent mixed methods triangulation design (QUAL+QUANT). Mixed methods included: (1) Grounded theory methodology to describe a model of decision making used by EMS providers to make trauma triage determinations and (2) quantitative analysis of secondary data to determine how the FTDS criteria are utilized by EMS providers. The FTDS criteria were also examined relative to trauma outcomes: level of trauma team activation (TTA), patient disposition when leaving the emergency department (ED), and the injury severity score (ISS).

A model of Interpreting Trauma into Action was elucidated to describe the processes used by EMS providers. Pre-hospital providers based their trauma transport decisions on the perceived patient level of injury severity. The FTDS criteria were not explicitly used in this study region, but were interwoven into practice through employer policies and other training. The convergence of these findings indicated congruence between the model and trauma outcomes. The quantitative data indicated relationships (p<.05) between 12 of the 29 FTDS criteria and trauma outcomes. Both sources of evidence supported the relationships between the model of Interpreting Trauma into Action, the FTDS criteria, and specific trauma outcomes.

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Juhlin, Marie, and Ingela Liljeqvist. "Triage prehospitalt : Faktorer som har betydelse för sjuksköterskans bedömning." Thesis, Högskolan Kristianstad, Sektionen för Hälsa och Samhälle, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:hkr:diva-8378.

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Bakgrund: Grundläggande för välfungerande sjukvård är möjligheten att efter bedömning av patienten vårdbehov kunna prioritera och hänvisa till lämplig vårdnivå på ett snabbt och säkert sätt. Det är viktigt att det sker på gemensamma grunder oavsett hur den initiala kontakten sker. När patienten anländer till sjukhus via ambulans, är han/hon redan bedömd via triage av en specialistutbildad sjuksköterska. Syfte: Syftet med studien är att belysa vilka faktorer som är av betydelse för sjuksköterskans triagebedömning prehospitalt. Metod: Uppsatsen genomfördes som en kvalitativ litteraturstudie. Resultat: Resultatet av litteratursökningen presenterar vilka faktorer som påverkar sjuksköterskan i beslutprocessen vid triagering. Triageutbildning, yrkeserfarenhet, personliga resurser och den psykosociala arbetsmiljön redovisas av de valda artiklarna. Diskussion: Triageutbildning, yrkeserfarenhet och psykosociala arbetsmiljön har betydelse vid triagebedömning. Diskussionen belyser behovet av kvalitetssäkring och att fler studier utförs inom prehospital verksamhet. Konklusion:  Många faktorer är av betydelse för sjuksköterskans triagebedömning, både triageutbildning, yrkeserfarenhet och psykosociala arbetsmiljön. Ett gemensamt kvalitetsdokument är också en förutsättning för ett bra triagearbete. Diskussionen belyser behovet av kvalitetssäkring och att fler studier utförs inom prehospital verksamhet.
Background: The foundation of a well functioning healthcare service is correct patient assessment and onward referral to the appropriate level of care. It is important that this transfer is conducted safely and effectively and that care considerations are the same no matter how the initial contact is made. Optimally the patient is evaluated by a triage trained specialist nurse before arrival at the hospital. Aim: The aim of this study is to highlight factors which are relevant to the nurse´s triage assessment pre-hospital. Method: Literature study. Results: This literature study discusses a number of factors which are important to the nurse in the process of triage evaluation e.g. triage training, work experience, and the psycho-social workplace environment. Discussion: Special training in triage procedures, the nurse's work experience and the psycho-social workplace environment have an affect on the triage evaluation process. The discussion emphasises the need for quality control and suggests the need for more studies in regard to pre-hospital medical care. Conclusion: Many factors are relevant to the nurse's triage assessment, both triage training, work experience and psychosocial work environment. A common quality documents is also a prerequisite for a good triage work. The discussion highlights the need for quality assurance and that more studies be performed in the prehospital operations.
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Kiatpongsan, Sorapop. "Decision Making for Medical Innovations." Thesis, Harvard University, 2014. http://dissertations.umi.com/gsas.harvard:11386.

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Fry, Margaret. "Triage Nursing Practice in Australian Emergency Departments 2002-2004: An Ethnography." University of Sydney, 2004. http://hdl.handle.net/2123/701.

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This ethnographic study provides insight and understanding, which is needed to educate and support the Triage Nursing role in Australian Emergency Departments (EDs). The triage role has emerged to address issues in providing efficient emergency care. However, Triage Nurses and educators have found the role challenging and not well understood. Method: Sampling was done first by developing a profile of 900 nurses who undertake the triage role in 50 NSW EDs through survey techniques. Purposive sampling was then done with data collected from participant observation in four metropolitan EDs (Level 4 and 6), observations and interviews with 10 Triage Nurses and the maintenance of a record of secondary data sources. Analysis used standard content and thematic analysis techniques. Findings: An ED culture is reflected in a standard geography of care and embedded beliefs and rituals that sustain a cadence of care. Triage Nurses to accomplish their role and maintain this rhythm of care used three processes: gatekeeping, timekeeping and decision-making. When patient overcrowding occurred the three processes enabled Triage Nurses to implement a range of practices to restore the cadence of care to which they were culturally oriented. Conclusion: The findings provide a framework that offers new ways of considering triage nursing practice, educational programs, policy development and future research.
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Srinivasaiah, Narasimhaiah. "Decision making in surgery and cancer care." Thesis, University of Hull, 2011. http://hydra.hull.ac.uk/resources/hull:4798.

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Decision making in surgery and cancer care is an interesting, challenging, and yet little explored area of surgical sciences research. This research addresses that paucity. In performing this research, health outcomes research (HOR) literature was comprehensively reviewed. Health outcome measures including quality of life and health-related quality of Life were described, in addition to their measurements. Subsequently health outcome measures in relation to oncoplastic and aesthetic breast surgery were described, and health outcome measures in a number of benign breast and colorectal pathologies were studied. Decision making in surgery and cancer care was explored using a mixed methodology of quantitative and qualitative studies. To derive a more comprehensive view, different specialties were explored: breast, colorectal, and head and neck surgery. To address socio-cultural factors the qualitative focus group discussions were undertaken in England, Wales, and India. Quantitative studies included literature reviews, prospective studies, retrospective studies, and questionnaire surveys. Qualitative studies were based on focus group discussions. The results showed that raw quantitative data is only one of the factors influencing the decision making process. A number of other factors play an important role in the decision making process. These include: health outcome measures (quality of life, health-related quality of life), clinician factors (knowledge, skill, expertise, judgment), patient factors (socio-economic, education, cultural), nursing factors, translational research, and resource infrastructure. Important themes and outcomes emerged from the qualitative studies. The focus group discussions showed that decision making in surgery and cancer care varies not only between the developing and the developed world, but also within different regions in the western world. In England, a small minority of patients was driving the decision making process, compared with Wales, where joint decision making is the norm. However, in India decision making is predominantly led by the clinicians and the patient�s family members. As modern health care moves towards a patient centered care approach, evidence based patient choice and patient decision making clearly has a greater role to play, and the cultural and practical issues demonstrated in this thesis must be considered.
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Books on the topic "Triage (Medicine) Decision making"

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Translational research and clinical practice: Basic tools for medical decision making and self-learning. New York: Oxford University Press, 2011.

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1946-, Boucher Rick, ed. The gift of participation: A guide to making informed decisions about volunteering for a clinical trial. Bar Harbor, ME: Jerian Publishing, 2007.

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Meta-analysis, decision analysis, and cost-effectiveness analysis: Methods for quantitative synthesis in medicine. New York: Oxford University Press, 1994.

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Life on the line: Ethics, aging, ending patients' lives, and allocating vital resources. Grand Rapids, Mich: W.B. Eerdmans Pub. Co., 1992.

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Helbock, Mike. Sick, not sick: A guide to rapid patient assessment. 2nd ed. Boston: Jones and Bartlett, 2010.

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Vamvakas, Eleftherios C. Decision making in transfusion medicine. Bethesda, Md: AABB Press, 2011.

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Vamvakas, Eleftherios C. Decision making in transfusion medicine. Bethesda, Md: AABB Press, 2011.

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Joseph, Lau, and Goldstein Ronald H, eds. Decision making in pulmonary medicine. Philadelphia: B.C. Decker, 1991.

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Raz, Manda, and Pourya Pouryahya, eds. Decision Making in Emergency Medicine. Singapore: Springer Singapore, 2021. http://dx.doi.org/10.1007/978-981-16-0143-9.

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1951-, Stewart Derek, ed. Clinical trials explained: A guide to clinical trials in the NHS for healthcare professionals. Malden, Mass: Blackwell Pub., 2006.

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Book chapters on the topic "Triage (Medicine) Decision making"

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Snape, Michelle. "Triage Cueing Error." In Decision Making in Emergency Medicine, 363–69. Singapore: Springer Singapore, 2021. http://dx.doi.org/10.1007/978-981-16-0143-9_57.

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Goodnough, L. T. "The Process of Clinical Decision-Making in Transfusion Medicine: Incorporating Guidelines and Algorithms into Transfusion Practices." In Trigger Factors in Transfusion Medicine, 35–45. Boston, MA: Springer US, 1996. http://dx.doi.org/10.1007/978-1-4613-1287-1_5.

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Upchurch Sweeney, C. Renn, J. Rick Turner, J. Rick Turner, Chad Barrett, Ana Victoria Soto, William Whang, Carolyn Korbel, et al. "Decision Making." In Encyclopedia of Behavioral Medicine, 544. New York, NY: Springer New York, 2013. http://dx.doi.org/10.1007/978-1-4419-1005-9_1013.

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Xu, Yunling, Nelson Lu, and Ying Yang. "Design and Analysis of Multiregional Clinical Trials in Evaluation of Medical Devices: A Two-Component Bayesian Approach for Targeted Decision Making." In Statistical Applications from Clinical Trials and Personalized Medicine to Finance and Business Analytics, 137–47. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-42568-9_12.

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Ridderikhoff, J. "Clinical decision-making." In Methods in Medicine, 83–117. Dordrecht: Springer Netherlands, 1989. http://dx.doi.org/10.1007/978-94-009-1097-3_4.

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Sadegh-Zadeh, Kazem. "Medical Decision-Making." In Philosophy and Medicine, 699–703. Dordrecht: Springer Netherlands, 2015. http://dx.doi.org/10.1007/978-94-017-9579-1_19.

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Whang, William. "Medical Decision-Making." In Encyclopedia of Behavioral Medicine, 1355–56. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-39903-0_1295.

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Sollins, Howard. "Surrogate Decision Making." In Encyclopedia of Behavioral Medicine, 2207–8. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-39903-0_1520.

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Khanfer, Riyad, John Ryan, Howard Aizenstein, Seema Mutti, David Busse, Ilona S. Yim, J. Rick Turner, et al. "Medical Decision-Making." In Encyclopedia of Behavioral Medicine, 1209–10. New York, NY: Springer New York, 2013. http://dx.doi.org/10.1007/978-1-4419-1005-9_1295.

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Sollins, Howard. "Surrogate Decision Making." In Encyclopedia of Behavioral Medicine, 1938–39. New York, NY: Springer New York, 2013. http://dx.doi.org/10.1007/978-1-4419-1005-9_1520.

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Conference papers on the topic "Triage (Medicine) Decision making"

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Farmer, Katherine A., Susan P. McGrath, and George T. Blike. "An Experimental Architecture for Observation of Triage Related Decision Making." In 2007 29th Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE, 2007. http://dx.doi.org/10.1109/iembs.2007.4352655.

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Goel, N. N., S. Rodriguez, K. Vidal, M. Smirnoff, L. D. Richardson, J. E. Nelson, and K. S. Mathews. "Triage Decision-Making by ICU and Emergency Medicine Physicians: A Mixed Methods Analysis." In American Thoracic Society 2019 International Conference, May 17-22, 2019 - Dallas, TX. American Thoracic Society, 2019. http://dx.doi.org/10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a5574.

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Luo, Yansong, Chunrong Liu, and Kong Fan Qiang. "Extraction of Key Factors to Determining the Acceptability of Diet Therapy Based on Syndrome Differentiation of Traditional Chinese Medicine." In 13th International Conference on Applied Human Factors and Ergonomics (AHFE 2022). AHFE International, 2022. http://dx.doi.org/10.54941/ahfe1002033.

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Purpose: Extract key factors to determining the acceptability of diet therapy based on syndrome differentiation of Traditional Chinese Medicine for middle-aged and elderly people and propose some suggestions to improve their acceptance of it. Method: Thirteen main influencing factors are selected from literature survey and interviews. Semi-structured interview are conducted with Decision-Making Trial and Evaluation Laboratory questionnaires to evaluate factors’ interrelationship. Results: The understandability and the memorability of medicinal food’s knowledge, the type of medicinal food and the popularity of medicinal food’s knowledge are key influencing factors. Suggestions: Pre-research of people’s taste preferences is important and necessary; the identity of propagandist and the source of propaganda content should be transparent and the organization of publicity activities should be normalized; concise and multi-sensory propagation mode should be adopted; “Medicinal Virtue Association” can be used to reduce the difficulty of memorizing knowledge.
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Molinet, Benjamin, Santiago Marro, Elena Cabrio, Serena Villata, and Tobias Mayer. "ACTA 2.0: A Modular Architecture for Multi-Layer Argumentative Analysis of Clinical Trials." In Thirty-First International Joint Conference on Artificial Intelligence {IJCAI-22}. California: International Joint Conferences on Artificial Intelligence Organization, 2022. http://dx.doi.org/10.24963/ijcai.2022/859.

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Evidence-based medicine aims at making decisions about the care of individual patients based on the explicit use of the best available evidence in the patient clinical history and the medical literature results. Argumentation represents a natural way of addressing this task by (i) identifying evidence and claims in text, and (ii) reasoning upon the extracted arguments and their relations to make a decision. ACTA 2.0 is an automated tool which relies on Argument Mining methods to analyse the abstracts of clinical trials to extract argument components and relations to support evidence-based clinical decision making. ACTA 2.0 allows also for the identification of PICO (Patient, Intervention, Comparison, Outcome) elements, and the analysis of the effects of an intervention on the outcomes of the study. A REST API is also provided to exploit the tool’s functionalities.
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Shen, LiMing, Tao Sheng, and Xaiodong Luo. "Abstract 34: Improve decision making in clinical trials through machine learning and EHR." In Abstracts: AACR Special Conference on Advancing Precision Medicine Drug Development: Incorporation of Real-World Data and Other Novel Strategies; January 9-12, 2020; San Diego, CA. American Association for Cancer Research, 2020. http://dx.doi.org/10.1158/1557-3265.advprecmed20-34.

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Mayer, Tobias, Elena Cabrio, and Serena Villata. "ACTA A Tool for Argumentative Clinical Trial Analysis." In Twenty-Eighth International Joint Conference on Artificial Intelligence {IJCAI-19}. California: International Joint Conferences on Artificial Intelligence Organization, 2019. http://dx.doi.org/10.24963/ijcai.2019/953.

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Argumentative analysis of textual documents of various nature (e.g., persuasive essays, online discussion blogs, scientific articles) allows to detect the main argumentative components (i.e., premises and claims) present in the text and to predict whether these components are connected to each other by argumentative relations (e.g., support and attack), leading to the identification of (possibly complex) argumentative structures. Given the importance of argument-based decision making in medicine, in this demo paper we introduce ACTA, a tool for automating the argumentative analysis of clinical trials. The tool is designed to support doctors and clinicians in identifying the document(s) of interest about a certain disease, and in analyzing the main argumentative content and PICO elements.
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Brown, Thomas D., Paul D. Tittel, Philip J. Gold, Charles W. Drescher, John M. Pagel, J. D. Beatty, Patra Grevstad, et al. "Abstract 997: Impact of a personalized medicine research program (PMRP), using targeted tumor profiling and a cloud based clinical trials matching platform, on clinical decision-making." In Proceedings: AACR Annual Meeting 2017; April 1-5, 2017; Washington, DC. American Association for Cancer Research, 2017. http://dx.doi.org/10.1158/1538-7445.am2017-997.

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"DECISION SUPPORT ON THE MOVE - Mobile Decision Making for Triage Management." In 8th International Conference on Enterprise Information Systems. SciTePress - Science and and Technology Publications, 2006. http://dx.doi.org/10.5220/0002441902960299.

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Georgopoulos, Voula C., and Chrysostomos D. Stylios. "Fuzzy cognitive maps for decision making in triage of non-critical elderly patients." In 2017 International Conference on Intelligent Informatics and Biomedical Sciences (ICIIBMS). IEEE, 2017. http://dx.doi.org/10.1109/iciibms.2017.8279752.

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Putra, Kuswantoro, Baiq Rukmana, and Ahsan Ahsan. "The Nursing Work Environment and Triage Decision Making Among Nurses in General Hospitals." In Proceedings of the 6th Batusangkar International Conference, BIC 2021, 11 - 12 October, 2021, Batusangkar-West Sumatra, Indonesia. EAI, 2022. http://dx.doi.org/10.4108/eai.11-10-2021.2319516.

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Reports on the topic "Triage (Medicine) Decision making"

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Smith, Anita J. Psychometric Evaluation of a Triage Decision Making Inventory. Fort Belvoir, VA: Defense Technical Information Center, June 2011. http://dx.doi.org/10.21236/ada630016.

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Hogue, Aaron, Jacqueline Horan Fisher, and Sarah Dauber. Assessing Support for Medicine Decision Making for Youth with ADHD Who Receive Therapy. Patient-Centered Outcomes Research Institute (PCORI), September 2020. http://dx.doi.org/10.25302/09.2020.cer.140313704.

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MacFarlane, Andrew. 2021 medical student essay prize winner - A case of grief. Society for Academic Primary Care, July 2021. http://dx.doi.org/10.37361/medstudessay.2021.1.1.

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As a student undertaking a Longitudinal Integrated Clerkship (LIC)1 based in a GP practice in a rural community in the North of Scotland, I have been lucky to be given responsibility and my own clinic lists. Every day I conduct consultations that change my practice: the challenge of clinically applying the theory I have studied, controlling a consultation and efficiently exploring a patient's problems, empathising with and empowering them to play a part in their own care2 – and most difficult I feel – dealing with the vast amount of uncertainty that medicine, and particularly primary care, presents to both clinician and patient. I initially consulted with a lady in her 60s who attended with her husband, complaining of severe lower back pain who was very difficult to assess due to her pain level. Her husband was understandably concerned about the degree of pain she was in. After assessment and discussion with one of the GPs, we agreed some pain relief and a physio assessment in the next few days would be a practical plan. The patient had one red flag, some leg weakness and numbness, which was her ‘normal’ on account of her multiple sclerosis. At the physio assessment a few days later, the physio felt things were worse and some urgent bloods were ordered, unfortunately finding raised cancer and inflammatory markers. A CT scan of the lung found widespread cancer, a later CT of the head after some developing some acute confusion found brain metastases, and a week and a half after presenting to me, the patient sadly died in hospital. While that was all impactful enough on me, it was the follow-up appointment with the husband who attended on the last triage slot of the evening two weeks later that I found completely altered my understanding of grief and the mourning of a loved one. The husband had asked to speak to a Andrew MacFarlane Year 3 ScotGEM Medical Student 2 doctor just to talk about what had happened to his wife. The GP decided that it would be better if he came into the practice - strictly he probably should have been consulted with over the phone due to coronavirus restrictions - but he was asked what he would prefer and he opted to come in. I sat in on the consultation, I had been helping with any examinations the triage doctor needed and I recognised that this was the husband of the lady I had seen a few weeks earlier. He came in and sat down, head lowered, hands fiddling with the zip on his jacket, trying to find what to say. The GP sat, turned so that they were opposite each other with no desk between them - I was seated off to the side, an onlooker, but acknowledged by the patient with a kind nod when he entered the room. The GP asked gently, “How are you doing?” and roughly 30 seconds passed (a long time in a conversation) before the patient spoke. “I just really miss her…” he whispered with great effort, “I don’t understand how this all happened.” Over the next 45 minutes, he spoke about his wife, how much pain she had been in, the rapid deterioration he witnessed, the cancer being found, and cruelly how she had passed away after he had gone home to get some rest after being by her bedside all day in the hospital. He talked about how they had met, how much he missed her, how empty the house felt without her, and asking himself and us how he was meant to move forward with his life. He had a lot of questions for us, and for himself. Had we missed anything – had he missed anything? The GP really just listened for almost the whole consultation, speaking to him gently, reassuring him that this wasn’t his or anyone’s fault. She stated that this was an awful time for him and that what he was feeling was entirely normal and something we will all universally go through. She emphasised that while it wasn’t helpful at the moment, that things would get better over time.3 He was really glad I was there – having shared a consultation with his wife and I – he thanked me emphatically even though I felt like I hadn’t really helped at all. After some tears, frequent moments of silence and a lot of questions, he left having gotten a lot off his chest. “You just have to listen to people, be there for them as they go through things, and answer their questions as best you can” urged my GP as we discussed the case when the patient left. Almost all family caregivers contact their GP with regards to grief and this consultation really made me realise how important an aspect of my practice it will be in the future.4 It has also made me reflect on the emphasis on undergraduate teaching around ‘breaking bad news’ to patients, but nothing taught about when patients are in the process of grieving further down the line.5 The skill Andrew MacFarlane Year 3 ScotGEM Medical Student 3 required to manage a grieving patient is not one limited to general practice. Patients may grieve the loss of function from acute trauma through to chronic illness in all specialties of medicine - in addition to ‘traditional’ grief from loss of family or friends.6 There wasn’t anything ‘medical’ in the consultation, but I came away from it with a real sense of purpose as to why this career is such a privilege. We look after patients so they can spend as much quality time as they are given with their loved ones, and their loved ones are the ones we care for after they are gone. We as doctors are the constant, and we have to meet patients with compassion at their most difficult times – because it is as much a part of the job as the knowledge and the science – and it is the part of us that patients will remember long after they leave our clinic room. Word Count: 993 words References 1. ScotGEM MBChB - Subjects - University of St Andrews [Internet]. [cited 2021 Mar 27]. Available from: https://www.st-andrews.ac.uk/subjects/medicine/scotgem-mbchb/ 2. Shared decision making in realistic medicine: what works - gov.scot [Internet]. [cited 2021 Mar 27]. Available from: https://www.gov.scot/publications/works-support-promote-shared-decisionmaking-synthesis-recent-evidence/pages/1/ 3. Ghesquiere AR, Patel SR, Kaplan DB, Bruce ML. Primary care providers’ bereavement care practices: Recommendations for research directions. Int J Geriatr Psychiatry. 2014 Dec;29(12):1221–9. 4. Nielsen MK, Christensen K, Neergaard MA, Bidstrup PE, Guldin M-B. Grief symptoms and primary care use: a prospective study of family caregivers. BJGP Open [Internet]. 2020 Aug 1 [cited 2021 Mar 27];4(3). Available from: https://bjgpopen.org/content/4/3/bjgpopen20X101063 5. O’Connor M, Breen LJ. General Practitioners’ experiences of bereavement care and their educational support needs: a qualitative study. BMC Medical Education. 2014 Mar 27;14(1):59. 6. Sikstrom L, Saikaly R, Ferguson G, Mosher PJ, Bonato S, Soklaridis S. Being there: A scoping review of grief support training in medical education. PLOS ONE. 2019 Nov 27;14(11):e0224325.
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Klement, Eyal, Elizabeth Howerth, William C. Wilson, David Stallknecht, Danny Mead, Hagai Yadin, Itamar Lensky, and Nadav Galon. Exploration of the Epidemiology of a Newly Emerging Cattle-Epizootic Hemorrhagic Disease Virus in Israel. United States Department of Agriculture, January 2012. http://dx.doi.org/10.32747/2012.7697118.bard.

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In September 2006 an outbreak of 'Bluetongue like' disease struck the cattle herds in Israel. Over 100 dairy and beef cattle herds were affected. Epizootic hemorrhagic disease virus (EHDV) (an Orbivirusclosely related to bluetongue virus (BTV)), was isolated from samples collected from several herds during the outbreaks. Following are the aims of the study and summary of the results: which up until now were published in 6 articles in peer-reviewed journals. Three more articles are still under preparation: 1. To identify the origin of the virus: The virus identified was fully sequenced and compared with the sequences available in the GenBank. It appeared that while gene segment L2 was clustered with EHDV-7 isolated in Australia, most of the other segments were clustered with EHDV-6 isolates from South-Africa and Bahrain. This may suggest that the strain which affected Israel on 2006 may have been related to similar outbreaks which occurred in north-Africa at the same year and could also be a result of reassortment with an Australian strain (Wilson et al. article in preparation). Analysis of the serological results from Israel demonstrated that cows and calves were similarly positive as opposed to BTV for which seropositivity in cows was significantly higher than in calves. This finding also supports the hypothesis that the 2006 EHD outbreak in Israel was an incursive event and the virus was not present in Israel before this outbreak (Kedmi et al. Veterinary Journal, 2011) 2. To identify the vectors of this virus: In the US, Culicoides sonorensis was found as an efficient vector of EHDV as the virus was transmitted by midges fed on infected white tailed deer (WTD; Odocoileusvirginianus) to susceptible WTD (Ruder et al. Parasites and Vectors, 2012). We also examined the effect of temperature on replication of EHDV-7 in C. sonorensis and demonstrated that the time to detection of potentially competent midges decreased with increasing temperature (Ruder et al. in preparation). Although multiple attempts were made, we failed to evaluate wild-caught Culicoidesinsignisas a potential vector for EHDV-7; however, our finding that C. sonorensis is a competent vector is far more significant because this species is widespread in the U.S. As for Israeli Culicoides spp. the main species caught near farms affected during the outbreaks were C. imicolaand C. oxystoma. The vector competence studies performed in Israel were in a smaller scale than in the US due to lack of a laboratory colony of these species and due to lack of facilities to infect animals with vector borne diseases. However, we found both species to be susceptible for infection by EHDV. For C. oxystoma, 1/3 of the Culicoidesinfected were positive 11 days post feeding. 3. To identify the host and environmental factors influencing the level of exposure to EHDV, its spread and its associated morbidity: Analysis of the cattle morbidity in Israel showed that the disease resulted in an average loss of over 200 kg milk per cow in herds affected during September 2006 and 1.42% excess mortality in heavily infected herds (Kedmi et al. Journal of Dairy Science, 2010). Outbreak investigation showed that winds played a significant role in virus spread during the 2006 outbreak (Kedmi et al. Preventive Veterinary Medicine, 2010). Further studies showed that both sheep (Kedmi et al. Veterinary Microbiology, 2011) and wild ruminants did not play a significant role in virus spread in Israel (Kedmi et al. article in preparation). Clinical studies in WTD showed that this species is highly susceptibile to EHDV-7 infection and disease (Ruder et al. Journal of Wildlife Diseases, 2012). Experimental infection of Holstein cattle (cows and calves) yielded subclinical viremia (Ruder et al. in preparation). The findings of this study, which resulted in 6 articles, published in peer reviewed journals and 4 more articles which are in preparation, contributed to the dairy industry in Israel by defining the main factors associated with disease spread and assessment of disease impact. In the US, we demonstrated that sufficient conditions exist for potential virus establishment if EHDV-7 were introduced. The significant knowledge gained through this study will enable better decision making regarding prevention and control measures for EHDV and similar viruses, such as BTV.
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Evidence Synthesis and Meta-Analysis for Drug Safety. Council for International Organizations of Medical Sciences (CIOMS), 2016. http://dx.doi.org/10.56759/lela7055.

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At any point in the drug development process, systematic reviews and meta-analysis can provide important information to guide the future path of the development programme and any actions that might be needed in the post-marketing setting. This report gives the rationale for why and when a meta-analysis should be considered, all in the context of regulatory decision-making, and the tasks, data collection, and analyses that need to be carried out to inform those decisions. -- There is increasing demand by decision-makers in health care, the biopharmaceutical industry, and society at large to have access to the best available evidence on benefits and risks of medicinal products. The best strategy will take an overview of all the evidence and where it is possible and sensible, combine the evidence and summarize the results. For efficacy, the outcomes generally use the same or very similar predefined events for each of the trials to be included. Most regulatory guidance and many Cochrane Collaboration reviews have usually given more attention to assessment of benefits, while issues around combining evidence on harms have not been as well-covered. However, the (inevitably) unplanned nature of the data on safety makes the process more difficult. -- Combining evidence on adverse events (AEs), where these were not the focus of the original studies, is more challenging than combining evidence on pre-specified benefits. This focus on AEs represents the main contribution of the current CIOMS X report. The goal of the CIOMS X report is to provide principles on appropriate application of meta-analysis in assessing safety of pharmaceutical products to inform regulatory decision-making. This report is about meta-analysis in this narrow area, but the present report should also provide conceptually helpful points to consider for a wider range of applications, such as vaccines, medical devices, veterinary medicines or even products that are combinations of medicinal products and medical devices. -- Although some of the content of this report describes highly technical statistical concepts and methods (in particular Chapter 4), the ambition of the working group has been to make it comprehensible to non-statisticians for its use in clinical epidemiology and regulatory science. To that end, Chapters 3 and 4, which contain the main technical statistical aspects of the appropriate design, analysis and reporting of a meta-analysis of safety data are followed by Chapter 5 with a thought process for evaluating the findings of a meta-analysis and how to communicate these.
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