scholarly journals A Standardized Framework for Fluorescence-Guided Margin Assessment for Head and Neck Cancer Using a Tumor Acidosis Sensitive Optical Imaging Agent

2021 ◽  
Author(s):  
Pieter Jan Steinkamp ◽  
Floris Jan Voskuil ◽  
Bert van der Vegt ◽  
Jan Johannes Doff ◽  
Kees-Pieter Schepman ◽  
...  
Keyword(s):  
Decision Making ◽  
Head And Neck ◽  
Real Time ◽  
Clinical Decision Making ◽  
Resection Margin ◽  
Clinical Decision ◽  
Fluorescent Imaging ◽  
Imaging Agent ◽  
Margin Assessment ◽  
Surgical Specimen

Abstract Purpose Intra-operative management of the surgical margin in patients diagnosed with head and neck squamous cell carcinoma (HNSCC) remains challenging as surgeons still have to rely on visual and tactile information. Fluorescence-guided surgery using tumor-specific imaging agents can assist in clinical decision-making. However, a standardized imaging methodology is lacking. In this study, we determined whether a standardized, specimen-driven, fluorescence imaging framework using ONM-100 could assist in clinical decision-making during surgery. Procedures Thirteen patients with histologically proven HNSCC were included in this clinical study and received ONM-100 24 ± 8 h before surgery. Fluorescence images of the excised surgical specimen and of the surgical cavity were analyzed. A fluorescent lesion with a tumor-to-background ratio (TBR) > 1.5 was considered fluorescence-positive and correlated to standard of care (SOC) histopathology. Results All six tumor-positive surgical margins were detected immediately after excision using fluorescence-guided intra-operative imaging. Postoperative analysis showed a median TBR (±IQR) of the fluorescent lesions on the resection margin of 3.36 ± 1.62. Three fluorescence-positive lesions in the surgical cavity were biopsied and showed occult carcinoma and severe dysplasia, and a false-positive fluorescence lesion. Conclusion Our specimen-driven fluorescence framework using a novel, pH-activatable, fluorescent imaging agent could assist in reliable and real-time adequate clinical decision-making showing that a fluorescent lesion on the surgical specimen with a TBR of 1.5 is correlated to a tumor-positive resection margin. The binary mechanism of ONM-100 allows for a sharp tumor delineation in all patients, giving the surgeon a clinical tool for real-time margin assessment, with a high sensitivity.

scholarly journals Utility and Acceptability of Influenza Surveillance amongst Emergency Providers

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Andrea F. Dugas ◽  
Howard Burkom ◽  
Anna L. DuVal ◽  
Richard Rothman
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Real Time ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Surveillance Data ◽  
Influenza Surveillance ◽  
Additional Information ◽  
Provider Surveys

We provided emergency department providers with a real-time laboratory-based influenza surveillance tool, and evaluated the utility and acceptability of the surveillance information using provider surveys. The majority of emergency department providers found the surveillance data useful and indicated the additional information impacted their clinical decision making regarding influenza testing and treatment.

scholarly journals Deliberações clínicas na atuação em pacientes com câncer de cabeça e pescoço: atualidades e desafios na disfagia

2020 ◽  
Vol 31 (4) ◽  
pp. 693-697
Author(s):  
Guilherme Maia Zica ◽  
Andressa Silva de Freitas
Keyword(s):  
Decision Making ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Clinical Decision Making ◽  
Clinical Decision

Starmer H, Edwards J. Clinical Decision Making with Head and Neck Cancer Patients with Dysphagia. Semin Speech Lang. 2019 Jun;40(3):213-226.

Extracts from The Cochrane Library: Nasal saline irrigations for the symptoms of chronic rhinosinusitis

2007 ◽  
Vol 137 (4) ◽  
pp. 532-534 ◽  
Author(s):  
Martin J. Burton ◽  
Lee D. Eisenberg ◽  
Richard M. Rosenfeld
Keyword(s):  
Decision Making ◽  
Head And Neck ◽  
Chronic Rhinosinusitis ◽  
Systematic Reviews ◽  
Clinical Decision Making ◽  
Cochrane Review ◽  
Clinical Decision ◽  
Neck Surgery ◽  
Cochrane Library ◽  
The Cochrane Library

The “Cochrane Corner” is a quarterly section in the journal that highlights systematic reviews relevant to otolaryngology–head and neck surgery, with invited commentary to highlight implications for clinical decision-making. This installment features a Cochrane Review entitled “Nasal saline irrigations for the symptoms of chronic rhinosinusitis,” which shows that saline irrigations are well-tolerated and could be included as a treatment adjunct for the symptoms of chronic rhinosinusitis.

Dashboard to Support the Decision-Making within a Chronic Disease

2012 ◽  
pp. 160-171 ◽  
Author(s):  
Leonor Teixeira ◽  
Vasco Saavedra ◽  
João Pedro Simões
Keyword(s):  
Decision Making ◽  
Chronic Disease ◽  
Real Time ◽  
Clinical Decision Making ◽  
Healthcare Providers ◽  
Clinical Decision ◽  
Heterogeneous Data ◽  
Information And Communications Technologies ◽  
The Right ◽  
Real Time Information

This chapter describes a monitoring system based on alerts and Key Performance Indicators (KPIs), applied in clinical context, within a chronic disease (haemophilia). This kind of disease follows the patient through his/her life, and its treatment requires an almost permanent exchange of data/information with healthcare professional (HCPs), with the information and communications technologies (ICTs) a key contribution in this process. However, most applications based on those ICTs do not allow the analysis of heterogeneous data in real-time, requiring the availability of clinicians to check the data and analyze the information to support the clinical decision process. Since time is a scarce resource in the context of healthcare providers, and information a crucial resource in the decision support process, real-time monitoring systems can help finding the right balance between those two resources, presenting the key information in an appropriate format, through alerts and KPIs. The system described in this chapter, named hemo@care_dashboard, aims to support clinical decision-making of healthcare professionals of a specific chronic disease, providing real-time information in a push-logic through alerts and KPIs, displayed on a dashboard.

Real-time clinical application of next-generation sequencing (NGS): Results from a multicenter program.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 11016-11016 ◽  
Author(s):  
Aaron Richard Hansen ◽  
Andrew M. K. Brown ◽  
Philippe L. Bedard ◽  
Sebastien J. Hotte ◽  
Eric Winquist ◽  
...  
Keyword(s):  
Decision Making ◽  
Real Time ◽  
Clinical Decision Making ◽  
Illumina Miseq ◽  
Clinical Decision ◽  
Metastatic Lesion ◽  
Second Phase ◽  
Targeted Ngs ◽  
Approved Drugs ◽  
The Impact

11016 Background: NGS techniques enable the identification of actionable mutations in clinical tumor samples. The objective of this study is to assess feasibility and explore the impact of real-time targeted NGS on therapeutic decision-making. Methods: Patients (pts) with advanced solid tumors underwent a biopsy of a metastatic lesion. The first phase was performed with Sequenom MassARRAY somatic genotyping and Pacific Biosciences RS-targeted NGS. The second phase broadened genomic coverage in both Sequenom and Illumina MiSeq. All pts had a molecular profiling (mp) report issued after identified actionable mutations were verified by Sanger sequencing in a CLIA-lab and reviewed by an expert panel. “Actionability” was defined as having prognostic, predictive or diagnostic implications on patient management. Details of clinical outcomes and subsequent matched therapy, if applicable, were captured. Referring physicians were surveyed on the impact of mutation results on their treatment recommendations. Results: These are summarized in the Table. Conclusions: Broader mp platforms resulted in more identified actionable mutations which required a longer time for verification prior to reporting, but may yield a greater impact on clinical decision-making. However, the matching of pts to drugs based on their molecular profiles depends highly on drug access. For mp to be clinically relevant, it must be coupled with access to approved drugs or to investigational agents on clinical trials. Clinical trial information: NCT01345513. [Table: see text]

Clinical Practices in Head and Neck Cancer: A Speech-Language Pathologist Practice Pattern Survey

2021 ◽  
pp. 000348942110010
Author(s):  
Ashley M. Logan ◽  
Mario A. Landera
Keyword(s):  
Decision Making ◽  
Head And Neck Cancer ◽  
Best Practices ◽  
Head And Neck ◽  
Neck Cancer ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Years Of Experience ◽  
Group Consensus ◽  
Clinical Practices

Objective: Clinical practices of speech-language pathologists (SLP) treating head and neck cancer (HNC) patients range widely despite literature trending toward best practices. This survey study was designed to identify current patterns and assess for gaps in clinical implementation of research evidence. Method: A web-based survey was distributed to SLPs via listserv and social media outlets. Descriptive statistics and group calculations were completed to identify trends and associations in responses. Results: Of 152 received surveys, the majority of respondents were hospital-based (86%) and had greater than 5 years of experience (65%). There was group consensus for the use of prophylactic exercise programs (95%), recommendations for SLP intervention during HNC treatment (75%), and use of maintenance programs post-treatment (97%). Conversely, no group consensus was observed for use of pre-treatment swallow evaluations, frequency of service provision, and content of therapy sessions. Variation in clinical decision making was noted in use of prophylactic feeding tubes and number of patients taking nothing by mouth during treatment. No associations were found between years of experience and decision-making practices, nor were any associations found between practice setting and clinical decision making. Conclusion: Despite the growing body of literature outlining evidence-based treatment practices for HNC patients, clinical practice patterns among SLPs continue to vary widely resulting in inconsistent patient care across practice settings. As compared to prior similar data, increased alignment with best practices was observed relative to early referrals, implementation of prophylactic intervention programs, and intervention with the SLP during the period of HNC treatment.

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