Clinical Utility of Serological Markers and Thiopurine Drug Monitoring in IBD: An Evidence-Based Review

2011 ◽  
pp. 177-194
Author(s):  
Raja Tamaz ◽  
Ernest G. Seidman
Keyword(s):  
Drug Monitoring ◽  
Clinical Utility ◽  
Evidence Based ◽  
Serological Markers

Developing Criteria for Evidence-Based Assessment: An Introduction to Assessments That Work

2018 ◽  
pp. 3-16 ◽  
Keyword(s):  
Treatment Planning ◽  
Clinical Utility ◽  
Scientific Evidence ◽  
Treatment Monitoring ◽  
Treatment Evaluation ◽  
Assessment Instruments ◽  
Evidence Based ◽  
Case Conceptualization ◽  
Starting Point ◽  
Professional Psychologists

For many professional psychologists, assessment is viewed as a unique and defining feature of their expertise. Criteria for evaluating the scientific evidence supporting clinical instruments are presented in this chapter, including criteria for norms, reliability, validity, and clinical utility. These criteria are used by chapter authors in this volume in their condition-specific reviews of assessment instruments used for (a) diagnosis, (b) case conceptualization and treatment planning, and (c) treatment monitoring and treatment evaluation. Selecting and using scientifically sound instruments is a necessary starting point for evidence-based practice, but a remaining challenge is for professionals to integrate the resulting assessment data in a manner that is itself evidence-based.

Obsessive-compulsive and related disorders in DSM-5, ICD-11, and RDoC: Conceptual questions and practical solutions

2017 ◽  
Author(s):  
Dan J. Stein
Keyword(s):  
Anxiety Disorder ◽  
Mental Disorder ◽  
Clinical Utility ◽  
Work Groups ◽  
Integrative Approach ◽  
Evidence Based ◽  
Diagnostic Validity ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Dsm 5

Key nosological questions facing the DSM-5 and ICD-11 work groups on obsessive-compulsive and related disorders (OCRDs) included whether putative OCRDs should be classified together, and whether obsessive-compulsive disorder (OCD) should retain its classification as an anxiety disorder. Given that some of the putative OCRDs were new to the official nosologies, the work groups also had to grapple with the perennial questions of how to decide whether any condition is a mental disorder, and how to draw boundaries between disorder and normality. This chapter reviews some of the conceptual questions that emerged and some of the practical solutions that were suggested. The emphasis on both diagnostic validity and clinical utility is consistent with an integrative approach which holds that nosology should be both evidence-based and values-based.

DSM-5.1: Perspectives on continuous improvement in diagnostic frameworks

2017 ◽  
Author(s):  
Paul S. Appelbaum
Keyword(s):  
Twentieth Century ◽  
Continuous Improvement ◽  
American Psychiatric Association ◽  
Clinical Utility ◽  
Review Process ◽  
Evidence Based ◽  
Efficient Approach ◽  
Diagnostic Categories ◽  
New Knowledge ◽  
Iterative Improvement

Since the mid-twentieth century, the DSM has guided psychiatrists in categorizing disorders. Revisions have taken years, with work groups considering changes to the entire manual. A more timely and efficient approach to updating the DSM would involve continuous improvement of particular diagnostic categories, when and if supported by advances in the field. The aim is to avoid the delays in the incorporation of new knowledge that are inherent in updating at intervals of a decade or more. The American Psychiatric Association has therefore established a structure by which evidence-based proposals for changes to the DSM can be considered and adopted on an ongoing basis. This chapter describes how proposals will be considered and the standards to be applied to proposed modifications. Challenges include calibrating optimal rigor of the review process, pruning diagnoses that lack validity or clinical utility, and subjecting the process itself to iterative improvement.

scholarly journals Clinical utility of pembrolizumab in the management of advanced solid tumors: an evidence-based review on the emerging new data

2019 ◽  
Vol Volume 11 ◽  
pp. 4297-4312 ◽  
Author(s):  
Pauline du Rusquec ◽  
Ombline de Calbiac ◽  
Marie Robert ◽  
Mario Campone ◽  
Jean Sebastien Frenel
Keyword(s):  
Solid Tumors ◽  
Clinical Utility ◽  
Evidence Based ◽  
Advanced Solid Tumors

scholarly journals Cumulative antibiogram and multidrug-resistant organisms in a regional equine referral hospital

2020 ◽  
Vol 33 (1) ◽  
pp. 149-155
Author(s):  
Ka Y. Yuen ◽  
Justine S. Gibson ◽  
Sophia Hinrichsen ◽  
Carlos E. Medina-Torres ◽  
Francois-Rene Bertin ◽  
...  
Keyword(s):  
Clinical Utility ◽  
Multidrug Resistant ◽  
Referral Hospital ◽  
Advisory Group ◽  
Evidence Based ◽  
Local Resistance ◽  
Development Of Resistance ◽  
Technical Advisory Group ◽  
Resistance Patterns ◽  
Culture Positive

Prudent use of antimicrobials is paramount to slow the development of resistance and for successful treatment. The use of cumulative antibiograms will allow evidence-based antimicrobial selection with consideration of local resistance patterns. We generated a “first-isolate-per-patient” cumulative antibiogram for a regional equine referral hospital. Bacterial organisms cultured from horses between 2011 and 2018, sample origin, antimicrobial susceptibilities, and multidrug-resistant (MDR) status were tabulated. Of 1,176 samples, 50% were culture positive. Overall, 93 of 374 (25%) were MDR. Of the MDR isolates, 11 (12%) were susceptible to high-importance antimicrobials only (as defined by the Australian Strategic and Technical Advisory Group on antimicrobial resistance). β-hemolytic streptococci were uniformly susceptible to penicillin (76 of 76); 17 of 20 (85%) non–β-hemolytic Streptococcus spp. were susceptible to penicillin. Despite veterinary-specific challenges in constructing an antibiogram, our study provides an exemplar of the clinical utility of regional-, farm-, or hospital-specific cumulative antibiograms for evidence-based empirical antimicrobial selection by veterinarians prior to susceptibility result availability.

Validity and clinical utility of the DSM-5 severity specifier for bulimia nervosa: results from a multisite sample of patients who received evidence-based treatment

2016 ◽  
Vol 267 (8) ◽  
pp. 823-829 ◽  
Author(s):  
Antonios Dakanalis ◽  
Francesco Bartoli ◽  
Manuela Caslini ◽  
Cristina Crocamo ◽  
Maria Assunta Zanetti ◽  
...  
Keyword(s):  
Bulimia Nervosa ◽  
Clinical Utility ◽  
Evidence Based ◽  
Evidence Based Treatment ◽  
Dsm 5

scholarly journals Using State Transition Models To Explore How the Prevalence of Subtherapeutic Posaconazole Exposures Impacts the Clinical Utility of Therapeutic Drug Monitoring for Posaconazole Tablets and Oral Suspension

2019 ◽  
Vol 63 (12) ◽  
Author(s):  
Russell E. Lewis ◽  
Dimitrios P. Kontoyiannis ◽  
Pierluigi Viale ◽  
Eric M. Sarpong
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Clinical Utility ◽  
State Transition ◽  
Oral Suspension ◽  
Phase Iii ◽  
Therapeutic Drug ◽  
Failure Rates ◽  
Clinical Failure ◽  
Transition Models

ABSTRACT Therapeutic drug monitoring (TDM) has been recommended in guidelines for patients receiving posaconazole oral suspension, but its utility in patients receiving posaconazole tablet, which has an improved bioavailability, remains unclear. We used state transition models with first-order Monte Carlo microsimulation to re-examine the posaconazole exposure-response relationships reported in two phase III clinical trials (prophylaxis with posaconazole oral suspension, models 1 and 2) and a third multicenter observational TDM study (model 3). We simulated the impact of TDM-guided interventions to improve initial average posaconazole concentrations (Cavg) to reduce clinical failure (in models 1 and 2) and breakthrough invasive fungal disease (bIFD) in model 3. Simulations were then repeated using posaconazole tablet Cavg distributions in place of the oral suspension formulation. In all three models with posaconazole oral suspension, TDM interventions associated with maximal improvement in posaconazole Cavg reduced absolute rates of subtherapeutic exposures (Cavg < 700 ng/ml) by 25% to 49%. Predicted reductions in absolute clinical failure rates were 11% in model 1 and 6.5% in model 2 and a 12.6% reduction in bIFD in model 3. With the tablet formulation, maximally effective TDM interventions reduced subtherapeutic exposures by approximately 5% in all three models and absolute clinical failure rates by 3.9% in model 1 and 1.6% in model 2; there was a 1.6% reduction in bIFD in model 3. Our modeling suggests that routine TDM during prophylaxis with posaconazole tablets may have limited clinical utility unless populations with higher prevalence (>10%) of subtherapeutic exposures can be identified based on clinical risk factors.

scholarly journals Implementation and Clinical Utility of an Integrated Academic-Community Regional Molecular Tumor Board

2017 ◽  
pp. 1-10 ◽  
Author(s):  
Mark E. Burkard ◽  
Dustin A. Deming ◽  
Benjamin M. Parsons ◽  
Paraic A. Kenny ◽  
Marissa R. Schuh ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Precision Medicine ◽  
Clinical Utility ◽  
Journal Club ◽  
Academic Community ◽  
Tumor Board ◽  
Observational Research ◽  
Evidence Based ◽  
Precision Oncology ◽  
Molecular Tumor Board

Purpose Precision oncology develops and implements evidence-based personalized therapies that are based on specific genetic targets within each tumor. However, a major challenge that remains is the provision of a standardized, up-to-date, and evidenced-based precision medicine initiative across a geographic region. Materials and Methods We developed a statewide molecular tumor board that integrates academic and community oncology practices. The Precision Medicine Molecular Tumor Board (PMMTB) has three components: a biweekly Web-based teleconference tumor board meeting provided as a free clinical service, an observational research registry, and a monthly journal club to establish and revise evidence-based guidelines for off-label therapies. The PMMTB allows for flexible and rapid implementation of treatment, uniformity in practice, and the ability to track outcomes. Results We describe the implementation of the PMMTB and its first year of activity. Seventy-seven patient cases were presented, 48 were enrolled in a registry, and 38 had recommendations and clinical follow-up. The 38 subjects had diverse solid tumors (lung, 45%; GI, 21%; breast, 13%; other, 21%). Of these subjects, targeted therapy was recommended for 32 (84%). Clinical trials were identified for 24 subjects (63%), and nontrial targeted medicines for 16 (42%). Nine subjects (28%) received recommended therapy with a response rate of 17% (one of six) and a clinical benefit rate (partial response + stable disease) of 38% (three of eight). Although clinical trials often were identified, patients rarely enrolled. Conclusion The PMMTB provides a model for a regional molecular tumor board with clinical utility. This work highlights the need for outcome registries and improved access to clinical trials to pragmatically implement precision oncology.

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