scholarly journals Anaesthesiologists’ clinical judgment accuracy regarding preoperative full stomach: Diagnostic study in urgent surgical adult patients

2021 ◽  
Vol 40 (3) ◽  
pp. 100836
Author(s):  
Louis Delamarre ◽  
Mohamed Srairi ◽  
Lionel Bouvet ◽  
Jean-Marie Conil ◽  
Olivier Fourcade ◽  
...  
Keyword(s):  
Clinical Judgment ◽  
Adult Patients ◽  
Diagnostic Study ◽  
Full Stomach ◽  
Judgment Accuracy

scholarly journals Inflammatory Biomarkers and Clinical Judgment in the Emergency Diagnosis of Urgent Abdominal Pain

2019 ◽  
Vol 65 (2) ◽  
pp. 302-312 ◽  
Author(s):  
Tobias Breidthardt ◽  
Nora Brunner-Schaub ◽  
Catharina Balmelli ◽  
Juan Jose Sancho Insenser ◽  
Katrin Burri-Winkler ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Early Diagnosis ◽  
Interleukin 6 ◽  
Clinical Judgment ◽  
Full Range ◽  
Correct Identification ◽  
Diagnostic Study ◽  
Laboratory Assessment ◽  
Emergency Diagnosis ◽  
Incremental Value

Abstract BACKGROUND The early diagnosis of urgent abdominal pain (UAP) is challenging. Most causes of UAP are associated with extensive inflammation. Therefore, we hypothesized that quantifying inflammation using interleukin-6 and/or procalcitonin would provide incremental value in the emergency diagnosis of UAP. METHODS This was an investigator-initiated prospective, multicenter diagnostic study enrolling patients presenting to the emergency department (ED) with acute abdominal pain. Clinical judgment of the treating physician regarding the presence of UAP was quantified using a visual analog scale after initial clinical and physician-directed laboratory assessment, and again after imaging. Two independent specialists adjudicated the final diagnosis and the classification as UAP (life-threatening, needing urgent surgery and/or hospitalization for acute medical reasons) using all information including histology and follow-up. Interleukin-6 and procalcitonin were measured blinded in a central laboratory. RESULTS UAP was adjudicated in 376 of 1038 (36%) patients. Diagnostic accuracy for UAP was higher for interleukin-6 [area under the ROC curve (AUC), 0.80; 95% CI, 0.77–0.82] vs procalcitonin (AUC, 0.65; 95% CI, 0.62–0.68) and clinical judgment (AUC, 0.69; 95% CI, 0.65–0.72; both P < 0.001). Combined assessment of interleukin-6 and clinical judgment increased the AUC at presentation to 0.83 (95% CI, 0.80–0.85) and after imaging to 0.87 (95% CI, 0.84–0.89) and improved the correct identification of patients with and without UAP (net improvement in mean predicted probability: presentation, +19%; after imaging, +15%; P < 0.001). Decision curve analysis documented incremental value across the full range of pretest probabilities. A clinical judgment/interleukin-6 algorithm ruled out UAP with a sensitivity of 97% and ruled in UAP with a specificity of 93%. CONCLUSIONS Interleukin-6 significantly improves the early diagnosis of UAP in the ED.

Clinical Judgment Accuracy

2007 ◽  
Vol 37 (3) ◽  
pp. 400-409 ◽  
Author(s):  
Charles R. Ridley ◽  
Mary Shaw-Ridley
Keyword(s):  
Clinical Experience ◽  
Clinical Judgment ◽  
Traditional Education ◽  
The Self ◽  
Judgment Accuracy ◽  
Psychological Practice ◽  
Self Reflection ◽  
Therapeutic Outcomes ◽  
Accurate Judgment ◽  
Professional Psychologists

Clinical judgment is foundational to psychological practice. Accurate judgment forms the basis for establishing reasonable goals and selecting appropriate treatments, which in turn are essential in achieving positive therapeutic outcomes. Therefore, Spengler and colleagues' meta-analytic finding—clinical judgment accuracy improves marginally with traditional education, training, and clinical experience—is disconcerting and should serve as a wake-up call. Now is the time to move with urgency. The authors urge the development of a comprehensive, standardized, and scientifically based metatheory to inform clinical judgment. A metatheory should describe the content of clinical judgment, the process of clinical judgment, and the self-reflection of clinicians. Without employment of such a metatheory and concomitant improvement in clinicians' judgment, professional psychologists are on soft footing in extolling their claim as scientist—practitioners and ethical professionals.

Experience and Clinical Judgment Accuracy: A Final Meta-Analysis

2007 ◽  
Author(s):  
Paul M. Spengler ◽  
Michael J. White ◽  
Stefania Aegisdottir
Keyword(s):  
Clinical Judgment ◽  
Meta Analysis ◽  
Judgment Accuracy

scholarly journals 0755 Pitolisant (Wakix) is an Effective Anti-Cataplexy Agent in Narcolepsy Type 1

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A287-A287
Author(s):  
G J Meskill
Keyword(s):  
Clinical Judgment ◽  
Small Sample Size ◽  
Treatment Options ◽  
Standard Of Care ◽  
The United States ◽  
Substantial Improvement ◽  
Small Sample ◽  
Adult Patients

Abstract Introduction Harmony Biosciences initiated the Pitolisant Expanded Access Clinical Evaluation (PEACE) program to allow treatment with pitolisant in adult patients with narcolepsy while pitolisant was an investigational medication in the United States. Starting in March 2019, Comprehensive Sleep Medicine Associates (CSMA) offered enrollment to patients who met the inclusion/exclusion criteria and who were deemed appropriate based on clinical judgment. All patients who enrolled were taking at least one standard-of-care agent for narcolepsy at enrollment. Many of the enrolled patients had refractory/challenging cases of narcolepsy. On August 14, 2019, Wakix received FDA approval for the treatment of excessive daytime sleepiness in adult patients with narcolepsy, which contrasts with the European label that states that Wakix is indicated for the treatment of narcolepsy in adults with or without cataplexy. Methods CSMA enrolled 21 patients in the PEACE program. The charts for all 10 narcolepsy type 1 (NT1) patients were reviewed. The 2 patients who did not have follow up after starting pitolisant were excluded. Results Of the 8 NT1 patients who had at least one follow up visit after initiating pitolisant, 6 reported substantial improvement or complete resolution of cataplexy compared to baseline. For example, one patient’s wife stated, “I forgot my husband was funny because he would avoid telling jokes until he started pitolisant.” Another stated, “I have not had an episode of cataplexy since starting pitolisant.” 5 of these patients were taking an anti-cataplectic agent at the time of starting pitolisant (sodium oxybate 3, venlafaxine 2). Conclusion While a relatively small sample size, these results demonstrate that in a “real world” uncontrolled population of refractory/challenging NT1 patients, pitolisant is an effective anti-cataplectic agent. As there are relatively few treatment options for NT1, clinicians should consider use of pitolisant for patients with cataplexy, and further consideration for adding an indication for pitolisant to treat cataplexy is warranted. Support Harmony Biosciences (PEACE trial)

scholarly journals Bohler Angle and the Crucial Angle of Gissane in Paediatric Population

2019 ◽  
Vol 12 ◽  
pp. 117954411983522
Author(s):  
Bruno Pombo ◽  
Ana Cristina Ferreira ◽  
Luís Costa
Keyword(s):  
Young Children ◽  
Age Groups ◽  
Paediatric Population ◽  
Mean Difference ◽  
Adult Patients ◽  
Control Group ◽  
Diagnostic Study ◽  
Age Group ◽  
Level Of Evidence ◽  
Calcaneus Fractures

Bohler angle and the crucial angle of Gissane are used on the evaluation of calcaneus fractures. However, few authors have described the variation of the angles when the calcaneus is growing. In this study, Bohler angle and the crucial angle of Gissane in paediatric population were measured using lateral foot radiographs of 429 patients, from 0 to 16 years of age. The control group was composed of 70 adult patients. The sample had a mean Bohler angle of 35.4° ± 5.9° and a mean crucial angle of Gissane of 110.5° ± 7.4°. The greater mean difference was identified for Bohler angle (8°) in the age group of 5 to 8 years (39.6° ± 5.7°) and for the crucial angle of Gissane (5°-6°) in the age group of 0 to 4 years (115.8° ± 7.3) ( P < .05). The influence of the ossification centres on the geometry of the calcaneus across age groups makes Bohler angle and the crucial angle of Gissane higher in young children. The increase in Bohler angle points out the relative development of the posterior facet in young children and the importance of the reconstruction of the posterior facet height in the intra-articular calcaneus fractures. Level of Evidence: Diagnostic study; Level III.

425 Investigating the Utility of Routine Carbon Dioxide Measurements During Polysomnography in the Evaluation of Obese Adult Patients

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A168-A168
Author(s):  
Valentin Nuzhny ◽  
Ruckshanda Majid ◽  
Komal Imtiaz ◽  
Reeba Mathew
Keyword(s):  
Carbon Dioxide ◽  
Diagnostic Yield ◽  
Adult Patients ◽  
P Value ◽  
Morbidly Obese ◽  
Diagnostic Study ◽  
Obese Adult ◽  
Mean Values ◽  
Obstructive Sleep ◽  
Co2 Monitoring

Abstract Introduction With the increasing prevalence of obesity, the diagnosis of obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS) have also increased. Adding routine transcutaneous carbon dioxide (TcCO2) or end-tidal carbon dioxide sensors (EtCO2) may add beneficial information to the polysomnogram (PSG) and expand the diagnostic and treatment capabilities in this population. Our study looks at the use of this parameter in obese adults on whom CO2monitoring has been used. Methods We performed a retrospective chart review of obese adult patients (body mass index [BMI] &gt;30) undergoing a PSG. We documented the EtCO2 values at baseline (supine awake) and during sleep. Correlations between the EtCO2 readings and BMI were reviewed. We excluded patients that had poor EtCO2 waveforms and patients with known preexisting hypoventilation syndromes, such a COPD. Results Fifty patients were identified between January and November 2020 at the Memorial Hermann Sleep Center. 54% were female and 46% were male with an average age of 55.3 years (range 26–73) and an average BMI for the cohort of 40.1 (SD +/-9.5). The average AHI on the diagnostic study (CMS criteria) was 30.9 events/hour (SD +/- 43) and the average oxygen desaturation nadir was 79%. Sixteen patients (32%) met diagnostic criteria for OHS based on the baseline awake EtCO2 which would have otherwise been missed without CO2 monitoring. When comparing the mean values of the ETCO2 between Group 1 whose BMI was less than 40 kg/m2 (39.9 mmHg) to Group 2 whose BMI was greater than 40 kg/m2 (45.9 mm Hg), the difference was statistically significant with a p-value is 0.001. Conclusion OHS is reported to have greater mortality when compared to OSA. CO2 monitoring is currently only routinely required in pediatric PSGs. Our review suggests a higher diagnostic yield of OHS in adults with the use of CO2 monitoring especially when morbidly obese. Given the alarming trend towards obesity in the US, this advocates for the routine use of CO2 monitoring in adult obese patients. Although more research is needed, we may draw a conclusion that there is meaningful data to support the use of routine ETCO2 monitoring in this adult patient population. Support (if any):

The Meta-Analysis of Clinical Judgment Project

2007 ◽  
Vol 37 (3) ◽  
pp. 350-399 ◽  
Author(s):  
Paul M. Spengler ◽  
Michael J. White ◽  
Stefanía Ægisdóttir ◽  
Alan S. Maugherman ◽  
Linda A. Anderson ◽  
...  
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Clinical Judgment ◽  
Counseling Psychology ◽  
Meta Analysis ◽  
Judgment Accuracy ◽  
Psychological Issues ◽  
Vocational Personality ◽  
Reliable Effect ◽  
D 12

Clinical and educational experience is one of the most commonly studied variables in clinical judgment research. Contrary to clinicians' perceptions, clinical judgment researchers have generally concluded that accuracy does not improve with increased education, training, or clinical experience. In this meta-analysis, the authors synthesized results from 75 clinical judgment studies where the experience of 4,607 clinicians was assessed in relation to the accuracy of their judgments about mental health (e.g., diagnosis, prognosis, treatment) and psychological issues (e.g., vocational, personality). The authors found a small but reliable effect, d = .12, showing that experience, whether educational or clinical, is positively associated with judgment accuracy. This small effect was robust across several tested moderator models, indicating experienced counselors and clinicians acquire, in general, almost a 13% increase in their decision-making accuracy, regardless of other factors. Results are discussed in light of their implications for clinical judgment research and for counseling psychology training and practice.

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