scholarly journals Over one third of patients with symptomatic femoroacetabular impingement display femoral or acetabular version abnormalities

2021 ◽  
Author(s):  
Zaki Arshad ◽  
Henry David Maughan ◽  
Karadi Hari Sunil Kumar ◽  
Matthew Pettit ◽  
Arvind Arora ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Clinical Decision ◽  
Original Research ◽  
Distribution Analysis ◽  
Inclusion Criteria ◽  
Acetabular Version ◽  
Level Of Evidence ◽  
Femoral Version ◽  
Normal Mean ◽  
The Relationship

Abstract Purpose The aim of this study was investigate the relationship between version and torsional abnormalities of the acetabulum, femur and tibia in patients with symptomatic FAI. Methods A systematic review was performed according to PRISMA guidelines using the EMBASE, MEDLINE, PubMed and Cochrane databases. Original research articles evaluating the described version and torsional parameters in FAI were included. The MINORS criteria were used to appraise study quality and risk of bias. Mean version and torsion values were displayed using forest plots and the estimated proportion of hips displaying abnormalities in version/torsion were calculated. Results A total of 1206 articles were identified from the initial search, with 43 articles, involving 8861 hips, meeting the inclusion criteria. All studies evaluating femoral or acetabular version in FAI reported ‘normal’ mean version values (10–25 °). However, distribution analysis revealed that an estimated 31% and 51% of patients with FAI displayed abnormal central acetabular and femoral version, respectively. Conclusion Up to 51% of patients presenting with symptomatic FAI show an abnormal femoral version, whilst up to 31% demonstrate abnormal acetabular version. This high percentage of version abnormalities highlights the importance of evaluating these parameters routinely during assessment of patients with FAI, to guide clinical decision-making. Level of evidence IV.

scholarly journals 1300 Version Abnormalities of the Femur and Acetabulum in Patients with Femoroacetabular Impingement: A Systematic Review

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
Z Arshad ◽  
H D Maughan ◽  
M H Pettit ◽  
K H S Kumar ◽  
A Arora ◽  
...  
Keyword(s):  
Systematic Review ◽  
Femoroacetabular Impingement ◽  
Clinical Decision Making ◽  
Slipped Capital Femoral Epiphysis ◽  
Clinical Decision ◽  
Open Science ◽  
Distribution Analysis ◽  
Inclusion Criteria ◽  
Acetabular Version ◽  
Femoral Version

Abstract Aim This systematic review aims to understand the relationship between version abnormalities of the femur and acetabulum in patients with primary and secondary femoroacetabular impingement (FAI). Method A systematic review was conducted according to PRISMA guidelines. A computer-based search was performed using the EMBASE, MEDLINE, PubMed and Cochrane databases for articles relating to version and torsional abnormalities in FAI, Legg-Calve-Perthes disease (LCPD) and slipped capital femoral epiphysis (SCFE). The study was registered in the Open Science Framework. Two authors independently performed title/abstract and full text screening according to predetermined inclusion criteria. Results A total of 1206 articles were identified 55 articles, involving 10, 091 hips, met the inclusion criteria. All studies evaluating femoral/acetabular version in FAI reported ‘normal’ mean version values (10o to 25o). However, distribution analysis revealed that an estimated 31.4% and 51.3% of patients with FAI displayed abnormal acetabular and femoral version, respectively. Abnormal femoral version was reported in an estimated 74.5% of hips with LCPD, and abnormal acetabular version in an estimated 20%. Acetabular version was significantly lower in hips with SCFE compared to controls (Z=-3.26, P < 0.01). Conclusions Patients presenting with hip pain attributed to FAI are likely to display an abnormality in femoral or acetabular version. This highlights the importance of evaluating these parameters during assessment of these patients, in order to guide clinical decision making.

4971Blood viscosity and its relevance to the diagnosis and management of pulmonary hypertension: a new elephant in the cathlab

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Kempny ◽  
K Dimopoulos ◽  
A E Fraisse ◽  
G P Diller ◽  
L C Price ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Cardiac Catheterization ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Pulmonary Vasculature ◽  
Pulmonary Vascular Disease ◽  
Significant Difference ◽  
The Difference ◽  
Clinically Significant ◽  
The Relationship

Abstract Background Pulmonary vascular resistance (PVR) is an essential parameter assessed during cardiac catheterization. It is used to confirm pulmonary vascular disease, to assess response to targeted pulmonary hypertension (PH) therapy and to determine the possibility of surgery, such as closure of intra-cardiac shunt or transplantation. While PVR is believed to mainly reflect the properties of the pulmonary vasculature, it is also related to blood viscosity (BV). Objectives We aimed to assess the relationship between measured (mPVR) and viscosity-corrected PVR (cPVR) and its impact on clinical decision-making. Methods We assessed consecutive PH patients undergoing cardiac catheterization. BV was assessed using the Hutton method. Results We included 465 patients (56.6% female, median age 63y). The difference between mPVR and cPVR was highest in patients with abnormal Hb levels (anemic patients: 5.6 [3.4–8.0] vs 7.8Wood Units (WU) [5.1–11.9], P<0.001; patients with raised Hb: 10.8 [6.9–15.4] vs. 7.6WU [4.6–10.8], P<0.001, respectively). Overall, 33.3% patients had a clinically significant (>2.0WU) difference between mPVR and cPVR, and this was more pronounced in those with anemia (52.9%) or raised Hb (77.6%). In patients in the upper quartile for this difference, mPVR and cPVR differed by 4.0WU [3.4–5.2]. Adjustment of PVR required Conclusions We report, herewith, a clinically significant difference between mPVR and cPVR in a third of contemporary patients assessed for PH. This difference is most pronounced in patients with anemia, in whom mPVR significantly underestimates PVR, whereas in most patients with raised Hb, mPVR overestimates it. Our data suggest that routine adjustment for BV is necessary.

scholarly journals Validation of parsimonious prognostic models for patients infected with COVID-19

2021 ◽  
Vol 28 (1) ◽  
pp. e100267
Author(s):  
Keerthi Harish ◽  
Ben Zhang ◽  
Peter Stella ◽  
Kevin Hauck ◽  
Marwa M Moussa ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Validation Cohort ◽  
External Validation ◽  
Clinical Decision ◽  
Prognostic Models ◽  
Clinical Prediction ◽  
Inclusion Criteria ◽  
Local Data ◽  
External Data ◽  
Operator Curve

ObjectivesPredictive studies play important roles in the development of models informing care for patients with COVID-19. Our concern is that studies producing ill-performing models may lead to inappropriate clinical decision-making. Thus, our objective is to summarise and characterise performance of prognostic models for COVID-19 on external data.MethodsWe performed a validation of parsimonious prognostic models for patients with COVID-19 from a literature search for published and preprint articles. Ten models meeting inclusion criteria were either (a) externally validated with our data against the model variables and weights or (b) rebuilt using original features if no weights were provided. Nine studies had internally or externally validated models on cohorts of between 18 and 320 inpatients with COVID-19. One model used cross-validation. Our external validation cohort consisted of 4444 patients with COVID-19 hospitalised between 1 March and 27 May 2020.ResultsMost models failed validation when applied to our institution’s data. Included studies reported an average validation area under the receiver–operator curve (AUROC) of 0.828. Models applied with reported features averaged an AUROC of 0.66 when validated on our data. Models rebuilt with the same features averaged an AUROC of 0.755 when validated on our data. In both cases, models did not validate against their studies’ reported AUROC values.DiscussionPublished and preprint prognostic models for patients infected with COVID-19 performed substantially worse when applied to external data. Further inquiry is required to elucidate mechanisms underlying performance deviations.ConclusionsClinicians should employ caution when applying models for clinical prediction without careful validation on local data.

Anemia and fatigue in cancer patients

1998 ◽  
Vol 4 (4_suppl) ◽  
pp. S5-S11
Author(s):  
Terri G Davidson
Keyword(s):  
Clinical Decision Making ◽  
Clinical Decision ◽  
Underlying Disease ◽  
Disease Treatment ◽  
Anemia Of Chronic Disease ◽  
Cancer Related Fatigue ◽  
Lack Of Exercise ◽  
Cancer Related Anemia ◽  
The Relationship ◽  
Adequate Tissue

Although strong evidence indicates that fatigue can be caused by anemia, little is known about the relationship between the extent and rate of hemoglobin loss and the development of fa tigue. Anemia, an insufficiency of red blood cells to maintain adequate tissue oxygenation, is the most common hematologic abnormality associ ated with cancer. It usually results from a de crease in red blood cell production, resulting from either direct tumor invasion of bone mar row or the anemia of chronic disease. Fatigue is a subjective sensation, often described as tired ness, exhaustion, lethargy, or malaise. The mechanism that precipitates or sustains fatigue is probably multifactorial and includes the re lease of inflammatory cytokines and the onset of the acute-phase inflammatory response. Other factors that contribute to cancer-related fatigue include the underlying disease, treatment of the disease, intercurrent systemic illnesses, sleep disorders, immobility and lack of exercise, chronic pain, and psychosocial factors. A review of cancer-related anemia and fatigue is pre sented, which focuses on the clinical decision- making process regarding the management of these syndromes when they exist concurrently.

Introduction

2018 ◽  
Author(s):  
John R. Peteet ◽  
Mary Lynn Dell ◽  
Wai Lun Alan Fung
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Ethics Committees ◽  
Clinical Decision ◽  
Cultural Formulation ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Religious Professionals ◽  
The Relationship

Historical tensions between psychiatry and religion continue to hinder dialogue and restrict consensus on how to approach areas of overlap in clinical decision making. In Part One, contributors to this volume discuss concerns arising in the general areas of values, religious and psychiatric ethics, diagnosis and treatment, and the work of religious professionals and ethics committees. In Part Two, chapter authors consider these issues as they arise within various subspecialties of psychiatric practice, often using the Jonsen Four Topics (or Four Quadrants) Model. The theme of the relationship between religion and culture runs throughout and is addressed more directly than in the Outline for Cultural Formulation in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

scholarly journals The experiences of family members witnessing the diminishing drinking of a dying relative: An adapted meta-narrative literature review

2019 ◽  
Vol 33 (9) ◽  
pp. 1146-1157 ◽  
Author(s):  
Annie Pettifer ◽  
Katherine Froggatt ◽  
Sean Hughes
Keyword(s):  
Oral Fluid ◽  
Cancer Cachexia ◽  
Clinical Decision Making ◽  
Family Members ◽  
Clinical Decision ◽  
Future Research ◽  
Inclusion Criteria ◽  
Relevant Research ◽  
Narrative Literature ◽  
Narrative Literature Review

Background:Addressing the concerns of family members is an important aspect of palliative and end-of-life care. One aspect that commonly causes family caregivers concern is the decline of patients’ oral fluid intake in the last few days of life.Aim:To map the narratives in which family members’ experiences of witnessing the diminishing drinking of a dying relative have been researched, review the findings within each narrative and consider directions for future research.Design:An adapted meta-narrative review approach.Data Sources:The Cumulative Index of Nursing and Applied Health Literature, Medline, PsycINFO, Psycharticles and Scopus databases were searched for relevant research published between January 1982 and December 2017. Quality was assessed using the Quality Assessment and Review Instrument.Results:A total of 22 papers met the inclusion criteria. No study focused specifically on the experiences of family members when witnessing the diminishing drinking of dying relatives. However, research about diminishing drinking was identified within studies broadly focusing on cancer cachexia, clinical decision-making about hydration and/or nutrition and support in a hospice context. The research indicates that family members’ experiences of diminishing drinking vary with their views about the significance of drinking, dying well and their expectations of themselves and healthcare professionals.Conclusion:While some understanding of the topic can be inferred from research in related areas, there is a paucity of information specifically about family members’ experiences when witnessing the diminishing drinking of a dying relative.

Likelihood Ratio, Skull Roentgenograms, and Clinical Decision-Making

PEDIATRICS ◽  
1983 ◽  
Vol 71 (4) ◽  
pp. 672-673
Author(s):  
JOHN M. LEVENTHAL ◽  
ROBERT M. LEMBO
Keyword(s):  
Decision Making ◽  
Likelihood Ratio ◽  
Clinical Finding ◽  
Clinical Decision Making ◽  
Skull Fracture ◽  
Clinical Decision ◽  
Clinical Findings ◽  
Skull Fractures ◽  
Fractures In Children ◽  
The Relationship

To the Editor.— In the February 1982 issue of Pediatrics, Leonidas et al1 examined the relationship between clinical findings and skull fractures in children evaluated with skull roentgenograms to develop reliable criteria for the ordering of roentgenograms in patients with head trauma. In their analysis, the authors used the liklihood ratio (LR) to characterize quantitatively the relationship between a clinical finding and the presence of a skull fracture. As defined by the authors, the LR is that ratio between the probability of a certain clinical finding occurring in the presence of a fracture and the probability of the same clinical finding occurring in the absence of a fracture.

Data Mining and Analysis of Lung Cancer

2010 ◽  
pp. 118-144
Author(s):  
Guoxin Tang
Keyword(s):  
Lung Cancer ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The United States ◽  
Claim Data ◽  
National Database ◽  
Appropriate Treatment ◽  
The World ◽  
The Cost ◽  
The Relationship

Lung cancer is the leading cause of cancer death in the United States and the world, with more than 1.3 million deaths worldwide per year. However, because of a lack of effective tools to diagnose lung cancer, more than half of all cases are diagnosed at an advanced stage, when surgical resection is unlikely to be feasible. The purpose of this study is to examine the relationship between patient outcomes and conditions of the patients undergoing different treatments for lung cancer and to develop models to estimate the population burden, the cost of cancer, and to help physicians and patients determine appropriate treatment in clinical decision-making. We use a national database, and also claim data to investigate treatments for lung cancer.

Countertransference and ethics: A perspective on clinical dilemmas in end-of-life decisions

2003 ◽  
Vol 1 (4) ◽  
pp. 367-375 ◽  
Author(s):  
BRIAN J. KELLY ◽  
FRANCIS T. VARGHESE ◽  
DAN PELUSI
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Assisted Suicide ◽  
Clinical Decision Making ◽  
Ethical Dilemmas ◽  
Clinical Decision ◽  
Life Care ◽  
End Of Life Decisions ◽  
The Relationship ◽  
Dying Patient

Ethical dilemmas in end-of-life care, such as the request for assisted suicide, must be understood in the context of the relationship that exists between patients and the clinicians treating them. This context includes the way health professionals respond to the tasks in caring for a dying patient. This article reviews the literature exploring the factors the influence clinical decision making at the end of life. The interplay of ethics, countertransference and transference are explained in detail.

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