scholarly journals Analysing Breast Cancer Multidisciplinary Patient Management: A Prospective Observational Evaluation of Team Clinical Decision-Making

2018 ◽  
Vol 43 (2) ◽  
pp. 559-566 ◽  
Author(s):  
T. A. K. Gandamihardja ◽  
T. Soukup ◽  
S. McInerney ◽  
J. S. A. Green ◽  
N. Sevdalis
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Patient Management ◽  
Clinical Decision Making ◽  
Clinical Decision

Quality specifications: self pleasure for clinical laboratories or added value for patient management?

2007 ◽  
Vol 45 (4) ◽  
Author(s):  
Mario Plebani
Keyword(s):  
Decision Making ◽  
Patient Management ◽  
Clinical Decision Making ◽  
Laboratory Data ◽  
Clinical Decision ◽  
Added Value ◽  
Internal Quality ◽  
Laboratory Services ◽  
Management Procedures ◽  
Quality Specifications

AbstractAnalytical quality specifications play a key role in assuring and continuously improving high-quality laboratory services. However, I believe, that there are two “missing links” in the effective management of quality specifications in the delivery of laboratory services. The first is the evidence that pre-analytical variation and related problems are not taken into great consideration by laboratory professionals. The second missing link is the communication of quality specifications to clinicians and other possible stakeholders. If quality specifications represent “the level of performance required to facilitate clinical decision-making”, they cannot be used only for internal quality management procedures but must be communicated to facilitate clinical reasoning, decision-making and patient management. A consensus should be achieved in the scientific community on these issues to assure better utilization of laboratory data and, ultimately, improved clinical outcomes.Clin Chem Lab Med 2007;45:462–6.

scholarly journals Nottingham Prognostic Index Plus (NPI+): a modern clinical decision making tool in breast cancer

2014 ◽  
Vol 110 (7) ◽  
pp. 1688-1697 ◽  
Author(s):  
E A Rakha ◽  
D Soria ◽  
A R Green ◽  
C Lemetre ◽  
D G Powe ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Prognostic Index ◽  
Clinical Decision ◽  
Nottingham Prognostic Index ◽  
Decision Making Tool

scholarly journals Influence of breast reconstruction on technical aspects of echocardiographic image acquisition compared with physician-assessed image quality

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Joaquin Duarte Ow ◽  
Mohamad Hemu ◽  
Anel Yakupovich ◽  
Parva Bhatt ◽  
Hannah Gaddam ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Image Quality ◽  
Cardiac Function ◽  
Breast Reconstruction ◽  
Clinical Decision Making ◽  
Image Acquisition ◽  
Clinical Decision ◽  
Echocardiographic Image ◽  
Significant Difference

Abstract Introduction Assessment of cardiac function after treatment for breast cancer relies on interval evaluation of ventricular function through echocardiography. Women who undergo mastectomy more frequently choose to undergo breast reconstruction with implant. This could impede assessment of cardiac function in those with left-sided implant. We aimed to examine whether left-sided breast reconstruction with tissue expanders (TE) affect echo image acquisition and quality, possibly affecting clinical decision-making. Methods A retrospective case-control study was conducted in 190 female breast cancer patients who had undergone breast reconstruction with TE at an urban academic center. Echocardiographic technical assessment and image quality were respectively classified as excellent/good or adequate/technically difficult by technicians; and excellent/good or adequate/poor by 2 board-certified cardiologist readers. Likelihood ratio was used to test multivariate associations between image quality and left-sided TE. Results We identified 32 women (81.3% white; mean age 48 years) with left-sided/bilateral TE, and 158 right-sided/no TE (76.6% white, mean age 57 years). In multivariable analyses, we found a statistically significant difference in technician-assessed difficulty in image acquisition between cases and controls (p = 0.01); but no differences in physician-assessed image quality between cases and controls (p = 0.09, Pearson’s r = 0.467). Conclusions Left-sided breast TE appears to affect the technical difficulty of echo image acquisition, but not physician-assessed echo image quality. This likely means that echo technicians absorb most of the impediments associated with imaging patients with breast TE such that the presence of TE has no bearing on downstream clinical decision-making associated with echo image quality.

scholarly journals Distinct fracture characteristics influence decision making and patient management in fragility fractures of the pelvis – an alternative approach for fracture evaluation

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
M Ramser ◽  
D Cadosch ◽  
W Vach ◽  
F Saxer ◽  
H Eckardt
Keyword(s):  
Decision Making ◽  
Risk Factor ◽  
Patient Management ◽  
Independent Risk Factor ◽  
Clinical Decision Making ◽  
Pelvic Ring ◽  
Fragility Fractures ◽  
Clinical Decision ◽  
Ring Fracture ◽  
Fracture Characteristics

Abstract Objective Pelvic ring fractures in the elderly with osteoporotic bone are often caused by a minor trauma. A separate classification for these fragility fractures of the pelvis (FFP) has been proposed by Rommens. However, at our institution the management algorithm is rather based on patient profile, clinical course and the ability to mobilize than on the fracture category. We aimed to identify fracture characteristics that might better reflect clinical decision making and show an association with outcome. Methods Four fracture characteristics were investigated as potential variables: 1. Extent of the dorsal pelvic ring fracture (absent, unilateral, bilateral); 2. Extent of the ventral pelvic ring fracture (absent, unilateral, bilateral); 3. Ventral comminution/dislocation; 4. Presence of a horizontal sacral fracture. These four characteristics were assessed retrospectively in a series of 548 patients with a CT scan proven FFP. The association of the fracture morphology with the decision to perform surgery, failure of conservative treatment and the length of hospital stay (LOS) was determined. Results Three of the four evaluated characteristics showed an independent and significant association with clinical decision making and patient management. In particular the extent of the dorsal fractures was identified as an independent risk factor for the decision to perform surgery with a 7.3-fold increase per category (p < 0.001). The same was observed for the presence of ventral comminution/dislocation (OR = 2.4; p = 0.002). The extent of ventral fractures (OR = 1.5; p = 0.047) was an independent risk factor for a longer LOS in conservatively treated patients. Conclusion Three evaluated morphologic aspects of FFPs showed a clear and independent relation to current clinical decision making and patient management at our institution. Importantly, the ventral fracture component has been shown to have major impact on treatment decision and outcome, which has been underestimated in the current FFP classification system. These four easily distinguishable fracture characteristics have the potential to form the basis of an alternative classification system that matches clinical reality and captures prognostic aspects.

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