scholarly journals Toward Novel Tools for Autism Identification: Fusing Computational and Clinical Expertise

2021 ◽  
Author(s):  
Laura L. Corona ◽  
Liliana Wagner ◽  
Joshua Wade ◽  
Amy S. Weitlauf ◽  
Jeffrey Hine ◽  
...  
Keyword(s):  
Clinical Expertise

What Does Evidence-Based Practice Mean to You? A Follow-Up Study Examining School-Based Speech-Language Pathologists' Perspectives on Evidence-Based Practice

2020 ◽  
Vol 29 (2) ◽  
pp. 688-704
Author(s):  
Katrina Fulcher-Rood ◽  
Anny Castilla-Earls ◽  
Jeff Higginbotham
Keyword(s):  
Clinical Practice ◽  
Research Evidence ◽  
Evidence Based Practice ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Speech Language Pathologists ◽  
School Based ◽  
Research Findings ◽  
Ebp Implementation

Purpose The current investigation is a follow-up from a previous study examining child language diagnostic decision making in school-based speech-language pathologists (SLPs). The purpose of this study was to examine the SLPs' perspectives regarding the use of evidence-based practice (EBP) in their clinical work. Method Semistructured phone interviews were conducted with 25 school-based SLPs who previously participated in an earlier study by Fulcher-Rood et al. 2018). SLPs were asked questions regarding their definition of EBP, the value of research evidence, contexts in which they implement scientific literature in clinical practice, and the barriers to implementing EBP. Results SLPs' definitions of EBP differed from current definitions, in that SLPs only included the use of research findings. SLPs seem to discuss EBP as it relates to treatment and not assessment. Reported barriers to EBP implementation were insufficient time, limited funding, and restrictions from their employment setting. SLPs found it difficult to translate research findings to clinical practice. SLPs implemented external research evidence when they did not have enough clinical expertise regarding a specific client or when they needed scientific evidence to support a strategy they used. Conclusions SLPs appear to use EBP for specific reasons and not for every clinical decision they make. In addition, SLPs rely on EBP for treatment decisions and not for assessment decisions. Educational systems potentially present other challenges that need to be considered for EBP implementation. Considerations for implementation science and the research-to-practice gap are discussed.

Life Experience or Clinical Expertise: Exploring Instructor Content Knowledge in Cross-Cultural Courses

2013 ◽  
Author(s):  
Sheena M. Turner ◽  
Sylvie Taylor ◽  
Theodore R. Burnes ◽  
Gregor V. Sarkisian ◽  
Amanda L. Archer ◽  
...  
Keyword(s):  
Content Knowledge ◽  
Life Experience ◽  
Cross Cultural ◽  
Clinical Expertise

Solution-Focused Brief Therapy with Clients Managing Trauma

2018 ◽  
Keyword(s):  
Brief Therapy ◽  
Treatment Approach ◽  
Traumatic Experiences ◽  
Clinical Expertise ◽  
Therapeutic Approaches ◽  
Comprehensive Overview ◽  
Strength Based ◽  
Solution Focused Brief Therapy ◽  
Unique Approach ◽  
Solution Focused

This book is a comprehensive overview of how solution-focused brief therapy (SFBT) can be used as a treatment approach for working with clients managing various forms of trauma. This book includes an overview of SFBT with its basic tenets and a description of the current research supporting SFBT as an evidence-based practice. This is followed by a comparison of how SFBT clinicians may approach trauma cases differently than clinicians from other therapeutic approaches. The bulk of the book includes various chapters contributed by skilled SFBT clinicians, with differing clinical expertise, illustrating SFBT as it is applied to different traumatic experiences/clinical cases. This book is the first solution-focused book to comprehensively discuss how traumatized clients can be helped to develop a unique preferred future and move toward healing and health. The distinguishing feature of this book lies not only in its unique approach to trauma but also in the outstanding contributors from various specialties in the field of trauma and SFBT: These contributors will share their knowledge and describe their strength-based, resiliency focus of applying SFBT in different traumatic circumstances.

scholarly journals Predicting COVID-19 mortality with electronic medical records

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Hossein Estiri ◽  
Zachary H. Strasser ◽  
Jeffy G. Klann ◽  
Pourandokht Naseri ◽  
Kavishwar B. Wagholikar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Medical Information ◽  
Age Groups ◽  
Prognostic Models ◽  
Smoking History ◽  
Risk Scores ◽  
Gradient Boosting ◽  
Chronic Obstructive ◽  
Clinical Expertise ◽  
History Of

AbstractThis study aims to predict death after COVID-19 using only the past medical information routinely collected in electronic health records (EHRs) and to understand the differences in risk factors across age groups. Combining computational methods and clinical expertise, we curated clusters that represent 46 clinical conditions as potential risk factors for death after a COVID-19 infection. We trained age-stratified generalized linear models (GLMs) with component-wise gradient boosting to predict the probability of death based on what we know from the patients before they contracted the virus. Despite only relying on previously documented demographics and comorbidities, our models demonstrated similar performance to other prognostic models that require an assortment of symptoms, laboratory values, and images at the time of diagnosis or during the course of the illness. In general, we found age as the most important predictor of mortality in COVID-19 patients. A history of pneumonia, which is rarely asked in typical epidemiology studies, was one of the most important risk factors for predicting COVID-19 mortality. A history of diabetes with complications and cancer (breast and prostate) were notable risk factors for patients between the ages of 45 and 65 years. In patients aged 65–85 years, diseases that affect the pulmonary system, including interstitial lung disease, chronic obstructive pulmonary disease, lung cancer, and a smoking history, were important for predicting mortality. The ability to compute precise individual-level risk scores exclusively based on the EHR is crucial for effectively allocating and distributing resources, such as prioritizing vaccination among the general population.

scholarly journals How will artificial intelligence and bioinformatics change our understanding of IgA in the next decade?

2021 ◽  
Author(s):  
Roman David Bülow ◽  
Daniel Dimitrov ◽  
Peter Boor ◽  
Julio Saez-Rodriguez
Keyword(s):  
Artificial Intelligence ◽  
Multidisciplinary Approach ◽  
Immunoglobulin A ◽  
Improve Patient Care ◽  
Integrated Analysis ◽  
Clinical Expertise ◽  
End Stage ◽  
The Complement System ◽  
Improve Patient ◽  
Generation Sequencing

AbstractIgA nephropathy (IgAN) is the most common glomerulonephritis. It is characterized by the deposition of immune complexes containing immunoglobulin A (IgA) in the kidney’s glomeruli, triggering an inflammatory process. In many patients, the disease has a progressive course, eventually leading to end-stage kidney disease. The current understanding of IgAN’s pathophysiology is incomplete, with the involvement of several potential players, including the mucosal immune system, the complement system, and the microbiome. Dissecting this complex pathophysiology requires an integrated analysis across molecular, cellular, and organ scales. Such data can be obtained by employing emerging technologies, including single-cell sequencing, next-generation sequencing, proteomics, and complex imaging approaches. These techniques generate complex “big data,” requiring advanced computational methods for their analyses and interpretation. Here, we introduce such methods, focusing on the broad areas of bioinformatics and artificial intelligence and discuss how they can advance our understanding of IgAN and ultimately improve patient care. The close integration of advanced experimental and computational technologies with medical and clinical expertise is essential to improve our understanding of human diseases. We argue that IgAN is a paradigmatic disease to demonstrate the value of such a multidisciplinary approach.

Strategies Australian Hospitals Utilize to Incorporate Patient Feedback in the Delivery and Measurement of Person-Centered Care: A Scoping Review

2021 ◽  
pp. 105477382110330
Author(s):  
Joy Davis ◽  
Sue Sinni ◽  
Stephen Maloney ◽  
Lorraine Walker
Keyword(s):  
Scoping Review ◽  
Clinical Expertise ◽  
Educational Strategies ◽  
Hospital Governance ◽  
Societal Values ◽  
Patient Feedback ◽  
Person Centered Care ◽  
Acute Hospitals ◽  
Centered Care ◽  
Strategy Design

Patients are central to healthcare clinicians and organizations but often subsidiary to clinical expertise, knowledge, workplace processes, and culture. Shifting societal values, technology, and regulations have remoulded the patient-clinician relationship, augmenting the patient’s voice within the healthcare construct. Scaffolding this restructure is the global imperative to deliver person-centered care (PCC). The aim of the scoping review was to explore and map the intersection between patient feedback and strategies to improve the provision of PCC within acute hospitals in Australia. Database searches yielded 493 articles, with 16 studies meeting inclusion criteria. Integration of patient feedback varied from strategy design, through to multi-staged input throughout the initiative and beyond. Initiatives actioning patient feedback fell broadly into four categories: clinical practice, educational strategies, governance, and measurement. How clinicians can invite feedback and support patients to engage equally remains unclear, requiring further exploration of strategies to propel clinician-patient partnerships, scaffolded by hospital governance structures.

scholarly journals The art and science of drug titration

2020 ◽  
Vol 11 ◽  
pp. 204209862095891
Author(s):  
Aisling R. Caffrey ◽  
Eric P. Borrelli
Keyword(s):  
Real World ◽  
Therapeutic Index ◽  
Clinical Expertise ◽  
Coordination Of Care ◽  
Patient Centered ◽  
Narrow Therapeutic Index ◽  
Drug Dosing ◽  
Scientific Principles ◽  
Suboptimal Adherence ◽  
Personalized Approach

A “one-size-fits-all” approach has been the standard for drug dosing, in particular for agents with a wide therapeutic index. The scientific principles of drug titration, most commonly used for medications with a narrow therapeutic index, are to give the patient adequate and effective treatment, at the lowest dose possible, with the aim of minimizing unnecessary medication use and side effects. The art of drug titration involves the interplay of scientific drug titration principles with the clinical expertise of the healthcare provider, and an individualized, patient-centered partnership between the provider and the patient to review the delicate balance of perceived benefits and risks from both perspectives. Drug titration may occur as up-, down-, or cross-titration depending on whether the goal is to reach or maintain a therapeutic outcome, decrease the risk of adverse effects, or prevent withdrawal/discontinuation syndromes or recurrence of disease. Drug titration introduces additional complexities surrounding the conduct of clinical trials and real-world studies, confounding our understanding of the true effect of medications. In clinical practice, wide variations in titration schedules may exist due to a lack of evidence and consensus on titration approaches that achieve an optimal benefit-harm profile. Further, drug titration may be challenging for patients to follow, resulting in suboptimal adherence and may require increased healthcare-related visits and coordination of care amongst providers. Despite the challenges associated with drug titration, it is a personalized approach to drug dosing that blends science with art, and with supportive real-world outcomes-based evidence, can be effective for optimizing pharmacotherapeutic outcomes and improving drug safety.

scholarly journals POS0385 DURING DEVELOPMENT OF RHEUMATOID ARTHRITIS, INTERMETATARSAL BURSITIS MAY OCCUR BEFORE CLINICAL JOINT SWELLING: A LARGE MRI STUDY IN PATIENTS WITH CLINICALLY SUSPECT ARTHRALGIA

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 422.2-423
Author(s):  
B. van Dijk ◽  
F. Wouters ◽  
E. van Mulligen ◽  
M. Reijnierse ◽  
A. van der Helm - van Mil
Keyword(s):  
Rheumatoid Arthritis ◽  
Cox Regression ◽  
Clinical Expertise ◽  
Synovial Lining ◽  
Recent Onset ◽  
Clinical Arthritis ◽  
Joint Examination ◽  
Using Data ◽  
Mri Study ◽  
Subclinical Synovitis

Background:Inflammation of the synovial lining is a hallmark of rheumatoid arthritis (RA). A synovial lining is not only present at synovial joints and tendon sheaths but also at bursae. Inflammation of the synovium-lined intermetatarsal bursae in the forefoot, intermetatarsal bursitis (IMB), was recently identified with MRI. It is specific for early RA and present in the majority of RA patients at diagnosis. During development of RA, MRI-detectable subclinical synovitis and tenosynovitis often occur before clinical arthritis presents. Whether IMB is also present in a pre-arthritis stage is unknown.Objectives:To assess the occurrence of IMB in patients with clinically suspect arthralgia (CSA) and its association with progression to clinical arthritis in a large MRI-study.Methods:We studied 524 consecutive patients presenting with CSA. CSA was defined as recent-onset arthralgia of small joints that is likely to progress to RA based on the clinical expertise of the rheumatologist. Participants underwent unilateral contrast-enhanced 1.5T MRI of the forefoot, metacarpophalangeal (MCP) joints and wrist at baseline. Thereafter patients were followed for detection of clinical arthritis, as identified at physical joint examination by the rheumatologist. Baseline MRIs were evaluated for IMB at all 4 intermetatarsal spaces. Also synovitis, tenosynovitis and osteitis were assessed in line with the RA MRI scoring system (summed as RAMRIS-inflammation). Both IMB and RAMRIS-inflammation were dichotomised into positive/negative using data from age-matched symptom-free controls as a reference. Cox regression analysed the association of IMB with progression to clinical arthritis; multivariable analyses were used to adjust for RAMRIS-inflammation which is known to associate with progression to clinical arthritis. Analyses were repeated stratified for ACPA-status, since ACPA-positive and ACPA-negative RA are considered separate entities with differences in pathophysiology.Results:The baseline MRIs showed ≥1 IMB in 35% of CSA-patients. Patients with IMB were more likely to also have synovitis (OR 2.5 (95%CI 1.2–4.9)) and tenosynovitis (8.9 (3.4–22.9)) on forefoot MRI, but not osteitis (0.9 (0.5–1.8)). Patients were followed for median 25 months (IQR 19–27). IMB-positive patients developed clinical arthritis more often than IMB-negative patients (HR 3.0 (1.9-4.8)). This association was independent of RAMRIS-inflammation (adjusted HR 2.2 (1.4–3.6)). In stratified analyses, IMB was more frequent in ACPA-positive than in ACPA-negative CSA (68% vs. 30%, p<0.001). Moreover IMB predicted clinical arthritis development in ACPA-positive CSA (HR 2.5 (1.1–5.7)) but not in ACPA-negative CSA patients (1.0 (0.5–2.2)).Conclusion:One-third of CSA patients have IMB. IMB is frequently present in conjunction with subclinical synovitis and tenosynovitis. It precedes the development of clinical arthritis, and in particular the development of ACPA-positive RA. These results reinforce the notion that not only intra- but also juxta-articular synovial inflammation is involved in the development of RA.Disclosure of Interests:None declared

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