Soliciting Patients to Help Define Treatment Thresholds

Watchko and Oski have a reputation for stimulating debate on the topic of neonatal jaundice. As scriptwriters of "Vigintiphobia: a one-act play,"1 they questioned the `standard practice' applied to the management of jaundice in otherwise healthy term infants. In the current issue of Pediatrics2 they again court controversy by turning their attention to treatment thresholds and the risk of kernicterus in jaundiced preterm infants. We are provided with a thoroughly researched historical review of the risk of kernicterus in the preterm infant from 1950 to the 1990s. The story is presented as a journey of experience from the pre-intensive care era, through the so-called `low bilirubin kernicterus era' (1965 through 1982), to the present.

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Diagnosis and treatment of community-acquired pneumonia in patients with acute cough: a quantitative study of decision thresholds in primary care

British Journal of General Practice ◽

10.3399/bjgp18x699545 ◽

2018 ◽

Vol 68 (676) ◽

pp. e765-e774 ◽

Cited By ~ 3

Author(s):

Mark H Ebell ◽

Isabella Locatelli ◽

Yolanda Mueller ◽

Nicolas Senn ◽

Kathryn Morgan

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Signs And Symptoms ◽

Clinical Decision ◽

Community Acquired Pneumonia ◽

Multivariate Model ◽

Clinical Decisions ◽

Acute Cough ◽

Treatment Thresholds ◽

Rule Out

BackgroundTest and treatment thresholds have not yet been described for decision-making regarding the likelihood of pneumonia in patients with acute cough.AimTo determine decision thresholds in the management of patients with acute cough.Design and settingSet among primary care physicians attending meetings in the US and Switzerland, using data from a prospective cohort of primary care patients.MethodClinical vignettes were used to study the clinical decisions of physicians regarding eight patients with cough that varied by six signs and symptoms. The probability of community-acquired pneumonia (CAP) was determined for each vignette based on a multivariate model. A previously published approach based on logistic regression was used to determine test and treatment thresholds.ResultsIn total, 256 physicians made 764 clinical decisions. Initial physician estimates systematically overestimated the likelihood of CAP; 75% estimating a higher probability than that predicted by the multivariate model. Given the probability of CAP from a multivariate model, 16.7% (125 of 749) changed their decision from ‘treat’ to ‘test’ or ‘test’ to ‘rule out’, whereas only 3.5% (26/749) changed their decision from ‘rule out’ to ‘test’ or ‘test’ to ‘treat’. Test and treatment thresholds were 9.5% (95% confidence interval (CI) = 8.7 to 10.5) and 43.1% (95% CI = 40.1 to 46.4) and were updated to 12.7% (95% CI = 11.7 to 13.8) and 51.3% (95% CI = 48.3 to 54.9) once the true probability of CAP was given. Test thresholds were consistent between subgroups. Treatment thresholds were higher if radiography was available, for Swiss physicians, and for non-primary care physicians.ConclusionTest and treatment thresholds for CAP in patients with acute cough were 9.5% and 43.1%, respectively. Physicians tended to overestimate the likelihood of CAP, and providing information from a clinical decision rule (CDR) changed about 1 in 6 clinical decisions.

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Seasonal dynamics, dispersion, sequential sampling plans and treatment thresholds for the citrus leafminer,Phyllocnistis citrellaStainton (Lepidoptera: Gracillariidae), in a mature lemon block in coastal New South Wales, Australia

Australian Journal of Entomology ◽

10.1111/j.1440-6055.2008.00651.x ◽

2008 ◽

Vol 47 (3) ◽

pp. 243-250 ◽

Cited By ~ 3

Author(s):

Zhong Min Liu ◽

Alan Meats ◽

G Andrew C Beattie

Keyword(s):

Seasonal Dynamics ◽

New South ◽

Sequential Sampling ◽

New South Wales ◽

Sampling Plans ◽

Citrus Leafminer ◽

South Wales ◽

Treatment Thresholds

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Treatment Thresholds and the Dual Theory of Choice Under Risk

Risk and Medical Decision Making - Studies in Risk and Uncertainty ◽

10.1007/978-1-4615-0991-2_8 ◽

2002 ◽

pp. 90-108

Author(s):

Louis Eeckhoudt

Keyword(s):

Dual Theory ◽

Treatment Thresholds

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Jaundice

ACoRN: Acute Care of at-Risk Newborns ◽

10.1093/med/9780197525227.003.0008 ◽

2021 ◽

pp. 257-288

Keyword(s):

Volume Expansion ◽

Exchange Transfusion ◽

Neurological Dysfunction ◽

Total Serum ◽

Case Scenario ◽

Test Volume ◽

Transcutaneous Bilirubin ◽

Treatment Thresholds ◽

Scoring Tool ◽

Severe Hyperbilirubinemia

The jaundice chapter illustrates how to stabilize newborns with hyperbilirubinemia—a common condition—and avoid their developing severe hyperbilirubinemia. Prevention is accomplished by transcutaneous bilirubin testing, total serum bilirubintests, and the use of nomograms to evaluate risk for hyperbilirubinemia and direct appropriate care. Specific risk factors for jaundice and hyperbilirubinemia, treatment thresholds for phototherapy treatment or exchange transfusion, and a bilirubin-induced neurological dysfunction scoring tool for assessing severity in acute bilirubin encephalopathy cases are included. Related procedures, such as the direct antiglobulin test, volume expansion, and intravenous immunoglobulin administration are described. Focal skills, such as plotting and interpreting the nomograms, are applied in the case scenario.

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Impact of site-specific weed management on herbicide savings and winter wheat yield

Plant Soil and Environment ◽

10.17221/599/2012-pse ◽

2013 ◽

Vol 59 (No. 3) ◽

pp. 101-107 ◽

Cited By ~ 12

Author(s):

P. Hamouz ◽

K. Hamouzová ◽

J. Holec ◽

L. Tyšer

Keyword(s):

Winter Wheat ◽

Weed Management ◽

Wheat Yield ◽

The Other ◽

Herbicide Application ◽

Site Specific ◽

Treatment Thresholds ◽

Patch Spraying ◽

Winter Wheat Yield ◽

Weed Infestation

An aggregated distribution pattern of weed populations provides opportunity to reduce the herbicide application if site-specific weed management is adopted. This work is focused on the practical testing of site-specific weed management in a winter wheat and the optimisation of the control thresholds. Patch spraying was applied to an experimental field in Central Bohemia. Total numbers of 512 application cells were arranged into 16 blocks, which allowed the randomisation of four treatments in four replications. Treatment 1 represented blanket spraying and the other treatments differed by the herbicide application thresholds. The weed infestation was estimated immediately before the post-emergence herbicide application. Treatment maps for every weed group were created based on the weed abundance data and relevant treatment thresholds. The herbicides were applied using a sprayer equipped with boom section control. The herbicide savings were calculated for every treatment and the differences in the grain yield between the treatments were tested using the analysis of variance. The site-specific applications provided herbicide savings ranging from 15.6% to 100% according to the herbicide and application threshold used. The differences in yield between the treatments were not statistically significant (P = 0.81). Thus, the yield was not lowered by site-specific weed management.

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