American journal of respiratory and critical care medicine
-
Am. J. Respir. Crit. Care Med. · Aug 2014
ReviewA Universal Decision Support System: Addressing the Decision Making Needs of Patients, Families, and Clinicians in the Setting of Critical Illness.
In the setting of a complex critical illness, preference-sensitive decision making-choosing between two or more reasonable treatment options-can be difficult for patients, families, and clinicians alike. A common challenge to making high-quality decisions in this setting is a lack of critical information access and sharing among participants. Decision aids-brochures, web applications, and videos-are a major focus of current research because mounting evidence suggests they can improve decision-making quality and enhance collaborative shared decision making. ⋯ The format and content of the system could be adapted to decisional participants' unique characteristics, abilities, and needs. Universal decision support can better standardize a decisional approach and also allow a unique degree of personalization within a framework of shared decision making. We also discuss potential criticisms of this approach as well as strategies that can overcome them in a critical illness setting.
-
Am. J. Respir. Crit. Care Med. · Aug 2014
ReviewGetting personal: Perspectives on individualized treatment duration in M/XDR-TB.
Tuberculosis (TB) differs from most other bacterial infectious diseases by a very long duration of combination antibiotic therapy required to achieve relapse-free cure. Although the standard recommended "short-course" treatment length for TB is 6 months, the World Health Organization recommends a duration of 20 months for the treatment of patients with multidrug-resistant and extensively drug-resistant TB (M/XDR-TB). Apart from the long duration of anti-TB therapy, treatment of M/XDR-TB is very expensive and often associated with adverse drug events. ⋯ Personalization of the duration of treatment for TB, especially for patients with M/XDR-TB, would be highly desired. Until recently there has been little interest in the identification of biosignatures that could eventually lead to individual recommendations for the duration of anti-TB therapy. This pulmonary perspective reviews the knowledge on clinical and radiological scores, host- and pathogen disease-related profiles, molecules, and signatures that are currently explored as biomarkers to personalize the duration of therapy in TB.