Diabetes-mellitus # Ischemia

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FA for the 82F with h/o hemi-CRVO. Notice the delayed filling of inferior veins and the lack of leak at 5m, which suggests that the abnormal vessels are collaterals and not NVD. You can also see some MAs from her diabetic dz.

discolored area noticed on residents abdomen during routine insulin regimen. No recent trauma.

Patient decision aids to help people who are facing decisions about health treatment or screening

Review question: How effective/beneficial are patient decision aids for adults making decisions regarding health treatment or screening?

Key messages:

• Patient decision aids are pamphlets or videos used in person or online. They clearly identify the healthcare decision to be made, provide information on options (benefits and harms), and help people clarify what is most important to them. Decision aids are designed to enhance and supplement consultation with the clinician, not replace it.
• Over 200 studies showed that patient decision aids helped adults be more involved in making health decisions by improving their knowledge and expectations of benefits and harms, and choosing an option that reflected what was most important to them.
• There were no unwanted effects for adults who used a patient decision aid.

What did we find? We found 209 studies that involved 107,698 adults. The patient decision aids focused on 71 different decisions. The common decisions were about: surgery, screening (e.g. prostate cancer, colon cancer, prenatal), genetic testing, and long‐term medication treatments (e.g. insulin injections for diabetes, or statins for high cholesterol).

We are moderately confident that adults given patient decision aids were more likely to choose an option that reflected what features of the options were most important to them. Our confidence in the evidence is only moderate because the studies that provided results for our review represent only a small set of the studies evaluating patient decision aids. We are confident that when adults used patient decision aids, they had large increases in their knowledge, expectations of benefits and harms, and participation in making the decision. We are also confident that they felt better informed and were more clear about what mattered most to them. We are confident that patient decision aids did not cause any unwanted effects such as regret about the decision.

What are the limitations of the evidence? Further research could strengthen the confidence in the evidence for choosing options that reflect which features of the options are most important to people.