Selection of diagnostic tests for clinical decision making and translation to a problem oriented medical record

2008 ◽  
Vol 393 (1) ◽  
pp. 37-43 ◽  
Author(s):  
Giuseppe Realdi ◽  
Lorenzo Previato ◽  
Nicola Vitturi
Keyword(s):  
Decision Making ◽  
Medical Record ◽  
Diagnostic Tests ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Selection Of

scholarly journals Treatment selection of early stage non-small cell lung cancer: the role of the patient in clinical decision making

BMC Cancer ◽  
2018 ◽  
Vol 18 (1) ◽  
Author(s):  
S. Mokhles ◽  
J. J. M. E. Nuyttens ◽  
M. de Mol ◽  
J. G. J. V. Aerts ◽  
A. P. W. M. Maat ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Decision Making ◽  
Small Cell Lung Cancer ◽  
Clinical Decision Making ◽  
Early Stage ◽  
Clinical Decision ◽  
Small Cell ◽  
Small Cell Lung ◽  
Selection Of

scholarly journals HER2 Testing and Clinical Decision Making in Gastroesophageal Adenocarcinoma: Guideline From the College of American Pathologists, American Society for Clinical Pathology, and American Society of Clinical Oncology

2016 ◽  
Vol 140 (12) ◽  
pp. 1345-1363 ◽  
Author(s):  
Angela N. Bartley ◽  
Mary Kay Washington ◽  
Christina B. Ventura ◽  
Nofisat Ismaila ◽  
Carol Colasacco ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Pathology ◽  
Clinical Decision ◽  
Evidence Based ◽  
Her2 Testing ◽  
Gastroesophageal Adenocarcinoma ◽  
American Society ◽  
Evidence Based Guideline ◽  
Selection Of

Context.— ERBB2 (erb-b2 receptor tyrosine kinase 2 or HER2) is currently the only biomarker established for selection of a specific therapy for patients with advanced gastroesophageal adenocarcinoma (GEA). However, there are no comprehensive guidelines for the assessment of HER2 in patients with GEA. Objectives.— To establish an evidence-based guideline for HER2 testing in patients with GEA, to formalize the algorithms for methods to improve the accuracy of HER2 testing while addressing which patients and tumor specimens are appropriate, and to provide guidance on clinical decision making. Design.— The College of American Pathologists, American Society for Clinical Pathology, and American Society of Clinical Oncology convened an expert panel to conduct a systematic review of the literature to develop an evidence-based guideline with recommendations for optimal HER2 testing in patients with GEA. Results.— The panel is proposing 11 recommendations with strong agreement from the open-comment participants. Recommendations.— The panel recommends that tumor specimen(s) from all patients with advanced GEA, who are candidates for HER2-targeted therapy, should be assessed for HER2 status before the initiation of HER2-targeted therapy. Clinicians should offer combination chemotherapy and a HER2-targeted agent as initial therapy for all patients with HER2-positive advanced GEA. For pathologists, guidance is provided for morphologic selection of neoplastic tissue, testing algorithms, scoring methods, interpretation and reporting of results, and laboratory quality assurance. Conclusions.— This guideline provides specific recommendations for assessment of HER2 in patients with advanced GEA while addressing pertinent technical issues and clinical implications of the results.

scholarly journals Scar Resurfacing

2020 ◽  
pp. 311-316
Author(s):  
Fiona M. Wood
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Healing Process ◽  
Clinical Decision ◽  
Skin Surface ◽  
History Of ◽  
Secondary Healing ◽  
The Impact ◽  
Selection Of

AbstractScar resurfacing is focused on the improvement in the quality of a scar by disruption of the skin surface and reducing the bulk of the scar by control of the secondary healing process. The prerequisite is knowledge of the wound healing and scarring process such that the intervention can be designed to reduce the risk of increasing the scarring.The clinical examination and assessment of the scar will guide the selection of the technique addressing the specific aspects of the scar, such as the pigment restoration and volume reduction, with the aim of blending the scar with the surrounding uninjured skin.Understanding the natural history of the scar, the impact it has on the patient, and the techniques available for improvement provides the clinical decision-making matrix to drive an improved scar outcome. Resurfacing is one opportunity for scar modulation which needs to be taken into context relative to the range of conservative and surgical therapeutic opportunities explored within the chapters of the book.

scholarly journals Medical Simulation in High-Risk AML Improves Clinical Decision Making of Hematologists/Oncologists

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4985-4985
Author(s):  
Lauren Willis ◽  
Richard M. Stone ◽  
Geoffrey L. Uy
Keyword(s):  
Decision Making ◽  
Diagnostic Tests ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Learning Objectives ◽  
Evidence Based ◽  
Clinical Decisions ◽  
Community Based ◽  
Clinical Guidance ◽  
Appropriate Treatment

Abstract Background: Our understanding of the biology of acute myeloid leukemia (AML) has increased dramatically with the use of next-generation sequencing. The identification of recurrently mutated genes in AML has allowed for better risk stratification and provided novel therapeutic targets. The European Leukemia Network (ELN) 2017 prognostic system divides patients into favorable, intermediate, and adverse groups based on genetic abnormalities.[Döhner 2017] Patients with features including MDS related changes, complex karyotype and adverse molecular features including mutations in FLT3 are at high risk (HR AML) for treatment failure and relapse. Aim: This study was conducted to determine if an online, simulation-based continuing medical education (CME)-certified intervention could improve clinical decision making of hematologists/oncologists (hem/oncs) regarding treatment selection for patients with HR AML. Description of Intervention: A CME-certified virtual patient simulation (VPS) was made available via a website dedicated to continuous professional development. The VPS consisted of 2 cases of HR AML presented in a platform that allows hem/oncs to assess the patients and make clinical decisions supported by an extensive database of diagnostic and treatment possibilities, matching the scope and depth of actual practice. *CASE 1* 63-year-old male with AML-MRC, mutations detected: RUNX1, TET2, SRSF2; no mutations detected in NPM1, CEBPA, IDH1, IDH2, KIT, KRAS, NRAS, ASXL1, ASXL2, BCR-ABL1, WT1. *CASE 2* 57-year-old female with FLT3-ITD mutated AML who is a candidate for intensive induction therapy. Methods: Clinical decisions were analyzed using a sophisticated decision engine, and tailored clinical guidance (CG) employing up-to-date evidence-base and faculty recommendations was provided after each decision. Decisions were collected post-CG and compared with each user's baseline (pre-CG) decisions using McNemar's test to determine p-values (P < .05 indicates significance). Data were collected between October 8, 2020 and July 22, 2021. Results: At the time of assessment, 186 hem/oncs who made clinical decisions were included in the analysis (112 case 1, 74 case 2). From pre- to post-CG in the VPS, hem/oncs were significantly more likely to make evidence-based practice decisions across all learning objectives, see the Table. *CASE 1* For the case of AML-MRC, the VPS led to a higher percentage of community-based hem/oncs ordering necessary diagnostic tests and ordering an appropriate treatment. After clinical guidance, slightly more academic-based hem/oncs identified the correct diagnosis for the patient. *CASE 2* For the patient with FLT3-ITD mutated AML, the VPS led to a higher percentage of community-based hem/oncs ordering and correctly interpreting diagnostic tests in order to make an accurate diagnosis. After clinical guidance, a higher percentage of academic-based hem/oncs ordered an appropriate treatment for the patient based on the FLT3-ITD mutation and their fitness assessment. Treatment rationales were collected and can be presented. Conclusions: This study demonstrates that VPS that immerses and engages hem/oncs in an authentic learning experience improved evidence-based clinical decisions related to the management of HR AML. Clinical guidance in the VPS improved hem/oncs clinical decision making for all learning objectives and the improvements were statistically significant. For almost all learning objectives, the activity had a significant and larger impact on improving clinical decision making of community-based hem/oncs compared to hem/oncs from other practice settings. This study indicates that unique educational methodologies and platforms, which are available on-demand, can be effective tools for promoting guideline-based therapy selection and clinical decision making. Additional education is recommended about the role for FLT3 inhibitors and the optimal treatment for AML-MRC. Acknowledgement: This CME activity was supported by an independent educational grant from Jazz Pharmaceuticals. References: 1. Döhner H, Estey E, Grimwade D, et al. Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel. 2017. 129(4):424-447. 2. MedSims Activity: https://www.medscape.org/viewarticle/936156 Figure 1 Figure 1. Disclosures Stone: AbbVie Inc, Actinium Pharmaceuticals Inc, Aprea Therapeutics, BerGenBio ASA, ElevateBio, Foghorn Therapeutics, GEMoaB, GlaxoSmithKline, Innate Pharma, Syndax Pharmaceuticals Inc, Syros Pharmaceuticals Inc, Takeda Oncology: Other: Advisory Committee; Agios Pharmaceuticals Inc, Novartis;: Research Funding; ACI Clinical, Syntrix Pharmaceuticals, Takeda Oncology: Other: Data Safety & Monitoring. Uy: GlaxoSmithKline: Consultancy; AbbVie: Consultancy; Agios: Consultancy; Macrogenics: Research Funding; Astellas: Honoraria, Speakers Bureau; Novartis: Consultancy; Genentech: Consultancy; Jazz: Consultancy.

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