Interpreting the Wide Range of NT-proBNP Concentrations in Clinical Decision Making

2018 ◽  
Vol 71 (11) ◽  
pp. 1201-1203 ◽  
Author(s):  
Peter A. McCullough ◽  
Aaron Y. Kluger
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Wide Range

scholarly journals Awareness, Knowledge, and Utility of RCT Data vs RWE: Results From a Survey of US Cardiologists: Real-world Evidence in Clinical Decision Making

2020 ◽  
Vol 14 ◽  
pp. 117954682095341 ◽  
Author(s):  
Todd C Villines ◽  
Mark J Cziraky ◽  
Alpesh N Amin
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Real World ◽  
Randomized Clinical Trials ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The Body ◽  
Representative Sampling ◽  
Real World Evidence ◽  
Wide Range

Real-world evidence (RWE) provides a potential rich source of additional information to the body of data available from randomized clinical trials (RCTs), but there is a need to understand the strengths and limitations of RWE before it can be applied to clinical practice. To gain insight into current thinking in clinical decision making and utility of different data sources, a representative sampling of US cardiologists selected from the current, active Fellows of the American College of Cardiology (ACC) were surveyed to evaluate their perceptions of findings from RCTs and RWE studies and their application in clinical practice. The survey was conducted online via the ACC web portal between 12 July and 11 August 2017. Of the 548 active ACC Fellows invited as panel members, 173 completed the survey (32% response), most of whom were board certified in general cardiology (n = 119, 69%) or interventional cardiology (n = 40, 23%). The survey results indicated a wide range of familiarity with and utilization of RWE amongst cardiologists. Most cardiologists were familiar with RWE and considered RWE in clinical practice at least some of the time. However, a significant minority of survey respondents had rarely or never applied RWE learnings in their clinical practice, and many did not feel confident in the results of RWE other than registry data. These survey findings suggest that additional education on how to assess and interpret RWE could help physicians to integrate data and learnings from RCTs and RWE to best guide clinical decision making.

scholarly journals Use of Acute Psychiatric Hospitalisation: A Study of the Factors Influencing Decisions to Arrange Acute Admission to Inpatient Mental Health Facilities

2021 ◽  
Vol 12 ◽  
Author(s):  
Rajan Nathan ◽  
Mark Gabbay ◽  
Sean Boyle ◽  
Phil Elliott ◽  
Clarissa Giebel ◽  
...  
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Contextual Factors ◽  
Clinical Decision ◽  
Personal Factors ◽  
Liaison Psychiatry ◽  
Acute Admission ◽  
Factors Influencing ◽  
Wide Range

Background: Human decision-making involves a complex interplay of intra- and inter-personal factors. The decisions clinicians make in practise are subject to a wide range of influences. Admission to a psychiatric hospital is a major clinical intervention, but the decision-making processes involved in admissions remain unclear.Aims: To delineate the range of factors influencing clinicians' decisions to arrange acute psychiatric admissions.Methods: We undertook six focus groups with teams centrally involved in decisions to admit patients to hospital (crisis resolution home treatment, liaison psychiatry, approved mental health practitioners and consultant psychiatrists). The data were analysed using qualitative thematic analysis.Results: Our analysis of the data show a complex range of factors influencing decision-making that were categorised as those related to: (i) clinical and risk factors; (ii) fear/threat factors; (iii) interpersonal dynamics; (iv) contextual factors.Conclusions: Decisions to arrange acute admission to hospital are not just based on an appraisal of clinical and risk-related information. Emotional, interpersonal and contextual factors are also critical in decision-making. Delineating the breadth of factors that bear on clinical decision-making can inform approaches to (i) clinical decision-making research, (ii) the training and supervision of clinicians, and (iii) service delivery models.

scholarly journals Operationalization of the learned non-use phenomenon - A Delphi study

2020 ◽  
Author(s):  
Theresa Hirsch ◽  
Maria Barthel ◽  
Pauline Aarts ◽  
Yi-An Chen ◽  
Susanna Freivogel ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Delphi Study ◽  
Clinical Decision Making ◽  
Negative Reinforcement ◽  
Brain Lesion ◽  
Clinical Decision ◽  
Diagnostic Process ◽  
Sources Of Information ◽  
Wide Range

AbstractThe discrepancy between residual functional capacity and reduced use of the contralesional hand, frequently observed after a brain lesion, has been termed Learned Non-Use (LNU) and is thought to depend on the interaction of neuronal mechanisms during recovery and learning-dependent mechanisms such as negative reinforcement. Despite the generally accepted existence of the LNU phenomenon among clinicians and researchers, no unequivocal and transdisciplinary definition exists to date. Furthermore, although therapeutic approaches are implemented in clinical practice to explicitly target LNU, no standardized diagnostic routine is described in the current literature.Based on a structured group communication following the Delphi method among clinical and scientific experts in the field of LNU, knowledge from both, the work with patient populations and with animal models, was synthesized and integrated to reach consensus regarding a transdisciplinary definition of the LNU phenomenon. Furthermore, the mode and strategy of the diagnostic process, as well as the sources of information and outcome parameters relevant for the clinical decision making, were described with a wide range showing the current lack of a consistent universal diagnostic approach. Building on these results, the need for the development of a structured diagnostic procedure and its implementation into clinical practice is emphasized. Moreover, it exists a striking gap between the prevailing hypotheses regarding the mechanisms underlying the LNU phenomenon and the actual evidence. Therefore, basic research is needed to bridge between bedside and bench and eventually improve clinical decision making and further development of interventional strategies beyond the field of stroke rehabilitation.

Gaps Between Alarm Capabilities and Decision-making Needs: An Observational Study of Detecting Patient Decompensation

2018 ◽  
Vol 7 (1) ◽  
pp. 112-116 ◽  
Author(s):  
Chelsea R. Horwood ◽  
Michael F. Rayo ◽  
Morgan Fitzgerald ◽  
E. Asher Balkin ◽  
Susan D. Moffatt-Bruce
Keyword(s):  
Decision Making ◽  
Early Warning ◽  
Clinical Decision Making ◽  
Vital Signs ◽  
Clinical Decision ◽  
Unintended Consequences ◽  
Warning Signs ◽  
Medical Setting ◽  
Mental Picture ◽  
Wide Range

Decompensation is a change in the overall ability to maintain physiological function in the presence of a stressor or disease. In the medical setting, clinicians utilize a wide range of technological tools to aid in their clinical decision making and to identify early warning signals for decompensation. However, many of these technologies have underperformed and are not aligned with the actual role of practitioners, resulting in unintended consequences and adverse events. The primary aim of this study is to explore how different nurses interpret early warning signs in order to anticipate decompensation. The secondary aim is to assess which technologies nurses rely on when anticipating decompensation, and if those technologies are adequately aiding them in their clinical decision making. Two researchers performed semi-structured ethnographic interviews that were recorded and transcribed during the summer of 2017. In total, 43 nurses were interviewed from different medical and surgical floors within the same hospital. Participants were asked questions focused on how they use and respond to alarms and how they anticipate patient decompensation. Constant Comparative Analysis was used to reveal patterns of responses between participants. Based on the qualitative analysis 6 major themes emerged:  1. Anticipating patient decompensation requires creating a complete mental “picture of the patient” by the nurses  2. Nurse-to-nurse communication and expertise is essential to understanding the patient’s history  3. Warning signs for decompensation were largely determined by a patient’s baseline  4. Change over time, or trends, is informative for anticipating decompensation. Numbers (regarding vital signs and labs) alone are not  5. Consistent care of patients improved nurse’s confidence in decision making  6. Anticipating decompensation requires “staying ahead of the machines Our research suggests that there is a gap between the information practitioners need to accurately anticipate patient decompensation, and the information current alarm technologies provide. Alarms are the primary tool provided to nurses to aid them in detecting hazardous events, however, current alarms are not well-suited in supporting signals that anticipate patient decompensation before it happens.

Cognitive assessment

2012 ◽  
pp. 85-94
Author(s):  
Graham E. Powell
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Ecological Validity ◽  
Classical Test Theory ◽  
Real Life ◽  
Clinical Decision ◽  
Test Theory ◽  
Test Results ◽  
Wide Range ◽  
Assessment Procedures

Psychometric methods based on classical test theory have permitted the development of reliable and valid tests assessing a wide range of intellectual and cognitive functions. Test results assist in formulation and diagnosis, guide rehabilitation and management, provide baseline measures to detect change, and generally assist clinical decision-making regarding such issues as capacity. Tests and assessment procedures are being further developed so as to improve their ecological validity, enabling better prediction of real-life behaviour and functioning.

scholarly journals Vagueness in Medicine: On Disciplinary Indistinctness, Fuzzy Phenomena, Vague Concepts, Uncertain Knowledge, and Fact-Value-Interaction

Axiomathes ◽  
2021 ◽  
Author(s):  
Bjørn Hofmann
Keyword(s):  
Decision Making ◽  
Health Policy ◽  
Policy Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Modern Medicine ◽  
Borderline Cases ◽  
Wide Range ◽  
Practice Of Medicine ◽  
Uncertain Knowledge

AbstractThis article investigates five kinds of vagueness in medicine: disciplinary, ontological, conceptual, epistemic, and vagueness with respect to descriptive-prescriptive connections. First, medicine is a discipline with unclear borders, as it builds on a wide range of other disciplines and subjects. Second, medicine deals with many indistinct phenomena resulting in borderline cases. Third, medicine uses a variety of vague concepts, making it unclear which situations, conditions, and processes that fall under them. Fourth, medicine is based on and produces uncertain knowledge and evidence. Fifth, vagueness emerges in medicine as a result of a wide range of fact-value-interactions. The various kinds of vagueness in medicine can explain many of the basic challenges of modern medicine, such as overdiagnosis, underdiagnosis, and medicalization. Even more, it illustrates how complex and challenging the field of medicine is, but also how important contributions from the philosophy can be for the practice of medicine. By clarifying and, where possible, reducing or limiting vagueness, philosophy can help improving care. Reducing the various types of vagueness can improve clinical decision-making, informing individuals, and health policy making.

scholarly journals Emerging Innovations and Professional Skills Needed Within Pharmacy Curricula

2020 ◽  
Vol 7 ◽  
pp. 238212052094359 ◽  
Author(s):  
Amanda A Olsen ◽  
Lana M Minshew ◽  
Kathryn A Morbitzer ◽  
Tina P Brock ◽  
Jacqueline E McLaughlin
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Precision Medicine ◽  
Clinical Decision Making ◽  
Interprofessional Collaboration ◽  
Digital Health ◽  
Pharmacy Practice ◽  
Clinical Decision ◽  
Professional Skills ◽  
Wide Range

To ensure students are prepared for the rapidly evolving world of health care, curricula must be aligned with emerging innovations, as well as professional skills likely to influence students’ abilities to be successful. At the 2019 annual meeting of PharmAlliance institutions, we asked experts to identify innovations and professional skills necessary for the future of pharmacy practice. Experts identified a wide range of topics, including personalized and precision medicine, digital health, interprofessional collaboration, clinical decision making, and overcoming complexity and ambiguity. While these findings are useful for informing curriculum content, we must also commit to ensuring our pharmacy curricula are emerging, forward thinking, and effective at preparing students for the challenges in health care.

scholarly journals A First Step Toward the Operationalization of the Learned Non-Use Phenomenon: A Delphi Study

2021 ◽  
pp. 154596832199906
Author(s):  
Theresa Hirsch ◽  
Maria Barthel ◽  
Pauline Aarts ◽  
Yi-An Chen ◽  
Susanna Freivogel ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Delphi Study ◽  
Clinical Decision Making ◽  
Brain Lesion ◽  
Basic Research ◽  
Clinical Decision ◽  
Diagnostic Process ◽  
Sources Of Information ◽  
Wide Range

Background The negative discrepancy between residual functional capacity and reduced use of the contralesional hand, frequently observed after a brain lesion, has been termed Learned Non-Use (LNU) and is thought to depend on the interaction of neuronal mechanisms during recovery and learning-dependent mechanisms. Objective Albeit the LNU phenomenon is generally accepted to exist, currently, no transdisciplinary definition exists. Furthermore, although therapeutic approaches are implemented in clinical practice targeting LNU, no standardized diagnostic routine is described in the available literature. Our objective was to reach consensus regarding a definition as well as synthesize knowledge about the current diagnostic procedures. Methods We used a structured group communication following the Delphi method among clinical and scientific experts in the field, knowledge from both, the work with patient populations and with animal models. Results Consensus was reached regarding a transdisciplinary definition of the LNU phenomenon. Furthermore, the mode and strategy of the diagnostic process, as well as the sources of information and outcome parameters relevant for the clinical decision making, were described with a wide range showing the current lack of a consistent universal diagnostic approach. Conclusions The need for the development of a structured diagnostic procedure and its implementation into clinical practice is emphasized. Moreover, it exists a striking gap between the prevailing hypotheses regarding the mechanisms underlying the LNU phenomenon and the actual evidence. Therefore, basic research is needed to bridge between bedside and bench and eventually improve clinical decision making and further development of interventional strategies beyond the field of stroke rehabilitation.

Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

2011 ◽  
Vol 20 (4) ◽  
pp. 121-123
Author(s):  
Jeri A. Logemann
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Clinical Outcomes ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Method ◽  
Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

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