Decisionmaking in practice: The dynamics of muddling through.

An alternative to conventional models that treat decisions as open-loop independent choices is presented. The alterative model is based on observations of work situations such as healthcare, where decisionmaking is more typically a closed-loop, dynamic, problem-solving process. The article suggests five important distinctions between the processes assumed by conventional models and the reality of decisionmaking in practice.

Colorectal cancer: a summary of the evidence for screening and prevention.

Colorectal cancer causes significant morbidity and mortality in the United States. The incidence of colorectal cancer can be reduced with increasing efforts directed at mass screening of average-risk adults 50 years and older. Currently, fecal occult blood test and flexible sigmoidoscopy have the highest levels of evidence to support their use for colorectal cancer screening.

Treatment of skin malignancies.

Malignant melanomas in situ can usually be treated in consultation with a specialist (C). Larger lesions may require referral. Based on best available evidence, surgical excision is the first-line treatment for most nonmelanoma skin cancers, with cure rates as high as 98% with proper margins.

Diagnosing skin malignancy: assessment of predictive clinical criteria and risk factors.

Expect to encounter 6 to 7 cases of basal cell cancer, 1 to 2 cases of squamous cell cancer, and approximately 1 case of melanoma every year. There is good evidence for using the American Cancer Society's ABCDE criteria as a clinical diagnostic test to rule out malignant melanoma). The revised 7-point checklist has high sensitivity and is therefore useful for ruling out a diagnosis of malignant melanoma.