The Number of Cores at First Biopsy May Suggest the Need for a Confirmatory Biopsy in Patients Eligible for Active Surveillance—Implication for Clinical Decision Making in the Real-life Setting

Urology ◽  
2014 ◽  
Vol 84 (3) ◽  
pp. 634-641 ◽  
Author(s):  
Luca Villa ◽  
Andrea Salonia ◽  
Umberto Capitanio ◽  
Vincenzo Scattoni ◽  
Firas Abdollah ◽  
...  
Keyword(s):  
Decision Making ◽  
Active Surveillance ◽  
Clinical Decision Making ◽  
Real Life ◽  
Clinical Decision ◽  
The Real ◽  
Real Life Setting

Context: a key dimension in midwifery decision making and practice for safe labour care

2020 ◽  
Vol 14 (3) ◽  
pp. 1-14
Author(s):  
Elizabeth Chodzaza ◽  
Elaine Haycock-Stuart ◽  
Aisha Holloway ◽  
Ursula Kafulafula
Keyword(s):  
Decision Making ◽  
Maternity Care ◽  
Clinical Decision Making ◽  
Medical Profession ◽  
Contextual Factors ◽  
Real Life ◽  
Clinical Decision ◽  
Structured Interviews ◽  
Theoretical Understanding ◽  
The Real

Background/Aims Research into midwifery decision making to date is limited and, where it exists, theoretical understanding has focused on the cognitive aspects of the process. Understanding the real-life context in which midwives work and how this influences their decision making during labour is important for safer maternity care. This study aimed to explore the contextual factors that influence the decision making of midwives at secondary and tertiary level health facilities during the first stage of labour in the real context of practice. Methods Using a focused ethnographic methodology, data from nine midwives working in two hospital labour ward settings were collected from October 2013 to May 2014. A total of 27 participant observations of midwives supporting women in the first stage of labour, 26 semi-structured interviews with midwives, and a documentary analysis of maternal labour records were conducted. All data were analysed using theme and category formation. Results Four major themes that influenced midwifery decision making for the safe care of women in labour were found: dominance of the medical profession over maternity care, shortage of midwifery staff, limited material resources, and midwifery strategies for maternal and child safety. Conclusions Understanding and improving clinical decision making requires consideration of contextual factors. For safe maternal care during the first stage of labour, midwives need to be supported to manage contextual factors for favourable outcomes for the mother and neonate.

scholarly journals P418 Does capsule endoscopy impact clinical management in established Crohn’s Disease?

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S423-S424
Author(s):  
A Elosua Gonzalez ◽  
M Rullan Iriarte ◽  
S Rubio Iturria ◽  
S Oquiñena Legaz ◽  
C Rodríguez Gutiérrez ◽  
...  
Keyword(s):  
Decision Making ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Capsule Endoscopy ◽  
Clinical Management ◽  
Clinical Decision Making ◽  
Real Life ◽  
Clinical Decision ◽  
Mucosal Inflammation ◽  
Therapeutic Impact

Abstract Background Capsule endoscopy (SBCE) has developed a relevant role in different indications in patients with established Crohn’s Disease (CD). However, evaluation of its impact in clinical management in CD specific modification strategies has been scarce. The purpose of our study was to question therapeutic impact of SBCE in an 11-year real-life cohort of established CD patients. Methods Retrospective single center study including all consecutive patients with CD submitted to SBCE from January 2008 to December 2019. Small bowel patency was evaluated with patency capsule in selected patients. A conclusive procedure was defined as the one that allowed clinical decision-making. Mucosal inflammation was graded as mild (few aphtoid ulcers), moderate (multiple aphtoid ulcers/isolated deep ulcers) or severe (multiple deep ulcers/stenosis). Therapeutic impact was defined as a change in CD related treatment including escalation, de-escalation, dose adjustment or referral to surgery recommended based on SBCE results within the next 3 months after the SBCE. Patients were assigned to four groups regarding CE indication: staging, flare, post-op and remission (fig 1). Results From the 432 CE performed, 378 (87.5%) were conclusive and allowed clinical decision-making. SBCE results guided changes in 51.3% of patients: 199 (46.1%) with escalation and 23 (5.3%) with de-escalation of treatment. Active disease was present in 310 (71.8%) patients; 131 (30.3%) presented mild, 126 (29.2%) moderate and 53 (12.3%) severe activity. Disease activity demonstrated by SBCE correlated with therapeutic changes. With mild activity 24.1% increased therapy, whereas 77.8% and 84.9% increased therapy with moderate or severe disease, respectively (p<0.001). De-escalation was conducted in 12.8% patients with mucosal healing and 6.1% with mild disease but not in moderate or severe activity (p<0.001). Treatment before and after SBCE is shown in the table. Conclusion SBCE is a safe and useful tool when approaching established CD patients guiding therapeutic management in a real-life setting. Its positive impact does not limit to treatment escalation but also helps to de-escalate in patients who can benefit from it.

scholarly journals Desenvolvimento e Avaliação de uma Plataforma Colaborativa Digital para Educação e Tomada de Decisão Médica Baseada em Evidências

2019 ◽  
Vol 43 (1 suppl 1) ◽  
pp. 513-524
Author(s):  
Álisson Oliveira dos Santos ◽  
Alexandre Sztajnberg ◽  
Tales Mota Machado ◽  
Daniel Magalhães Nobre ◽  
Adriano Neves de Paula e Souza ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Clinical Decision Making ◽  
Real Life ◽  
Evaluation Process ◽  
Clinical Decision ◽  
Medical Decision ◽  
Alternative Form ◽  
Evidence Based ◽  
Life Problems

ABSTRACT The medical education for clinical decision-making has undergone changes in recent years. Previously supported by printed material, problem solving in clinical practice has recently been aided by digital tools known as summaries platforms. Doctors and medical students have been using such tools from questions found in practice scenarios. These platforms have the advantage of high-quality, evidence-based and always up-to-date content. Its popularization was mainly due to the rise of the internet use and, more recently, of mobile devices such as tablets and smartphones, facilitating their use in clinical practice. Despite this platform is widely available, the most of them actually present several access barriers as costs, foreign language and not be able to Brazilian epidemiology. A free national platform of evidence-based medical summaries was proposed, using the crowdsourcing concept to resolve those barriers. Furthermore, concepts of gamification and content evaluation were implemented. Also, there is the possibility of evaluation by the users, who assigns note for each content created. The platform was built with modern technological tools and made available for web and mobile application. After development, an evaluation process was conducted by researchers to attest to the valid of content, usability, and user satisfying. Consolidated questionnaires and evaluation tools by the literature were applied. The process of developing the digital platform fostered interdisciplinarity, from the involvement of medical and information technology professionals. The work also allowed the reflection on the innovative educational processes, in which the learning from real life problems and the construction of knowledge in a collaborative way are integrated. The assessment results suggest that platform can be real alternative form the evidence-based medical decision-making.

Serum & Urine Free Light Chain Analysis Compared to Conventional Paraprotein Measurements: Usefullness for Clinical Decision Making in Real Life Haematology.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2889-2889 ◽  
Author(s):  
Ella Willenbacher ◽  
Sofia Gasser ◽  
Günther Gastl ◽  
Wolfgang Willenbacher
Keyword(s):  
Decision Making ◽  
High Risk ◽  
Light Chain ◽  
Clinical Decision Making ◽  
Real Life ◽  
Clinical Decision ◽  
Novel Agents ◽  
Therapeutic Effectiveness ◽  
Chain Analysis ◽  
Standard Risk

Abstract Abstract 2889 Poster Board II-865 Introduction: Serum free light chain analysis (sFLCA) is a tool to monitor myeloma disease activity and treatment response, and stratify myeloma pts. to defined risk groups and has been incorporated into diagnostic guidelines[1]. Either the ratio of the free kappa/lambda light chains (FLCQ), the absolute value of the involved light chain (FLCi) or the difference of involved and uninvolved light chain (FLCD) may be used. While sFLCA is recommended , urine analysis (uFLCA) at the moment is not. To analyze whether results from sFLCA and uFLCA would potentially have translated into altered clinical decision making and timing of treatments compared to classical paraprotein measurements (sPPM) in a cohort of myeloma patients we analyzed all measurements routinely performed at Innsbruck University Hospital between MAR 03 and OKT 08 and correlated them to individual pts. clinical courses. Methods: 187 pts. (109 m, 78 f) out 235 pts. identified were deemed eligible. Myeloma subtypes were IgG (57.2%), IgA (21,9%), light chain only (13.9%), IgM (3.2%), oligo and nonsecretory (2.6 %, incl. 2 pts. completely asecretory), and IgD (1,0%). 4 pts. were complete immunoglobulin only secreters. According to mSMART 15% were high risk, 61% standard risk and 23,5% of unknown category. In this cohort 3202 sFLCa, 1136 uFLCa and 2583 sPPM were performed (range 2-89, median 12). This measurements were correlated with 167 treatment lines applied in this pts. (49 auto-transplants, 3 allo-transplants, 7 auto/allo procedures, 68 regimes containing novel agents and 40 conventional chemotherapeutic approaches. Patients, Assays and Treatment Lines: 187 pts. (109 m, 78 f) out 235 pts. identified were deemed eligible. Myeloma subtypes were IgG (57.2%), IgA (21,9%), light chain only (13.9%), IgM (3.2%), oligo and nonsecretory (2.6 %, incl. 2 pts. completely asecretory), and IgD (1,0%). 4 pts. were complete immunoglobulin only secreters. According to mSMART 15% were high risk, 61% standard risk and 23,5% of unknown category. In this cohort 3202 sFLCa, 1136 uFLCa and 2583 sPPM were performed (range 2-89, median 12). This measurements were correlated with 167 treatment lines applied in this pts. (49 auto-transplants, 3 allo-transplants, 7 auto/allo procedures, 68 regimes containing novel agents and 40 conventional chemotherapeutic approaches. Results: sFLCa showed a significant advantage in detecting any of the predefined clinical endpoints (Table 1) . By using sPPM only , ∼ 40% of events would have been missed during the observation period. A median of 13% of the applied therapies proven to be ineffective could have been stopped and altered earlier on using the results of sFLCa. While the use of sFLCi and sFLCD resulted in comparable rates of false pos. and neg. results (Table 2) in comparison to sPPM, sFLCQ is more sensitive to effects of immunoparesis, changes of the uninvolved FLC concentration and renal function resulting in both more false pos., as well as false neg. results. sFLCa detected relapses with a median of 3 months prior to sPPM, therapeutic effectiveness with a median of 2 therapy cycles earlier than sPPM and therapeutic failure with a median of 1 antecedent cycle of therapy. Data on uFLCa will be provided at ASH. Discussion: This analysis proves sFLCa to be a useful tool in monitoring myeloma pts. clinical courses and the therapeutic effectiveness of myeloma treatment approaches, even in the setting of “real life medicine”. For monitoring purposes sFLCi and sFLCD should be used preferably due the higher false pos./neg. potential of sFLCQ . By using sFLCa in a structured diagnostic pathway treatment effectiveness could be judged earlier on and altered if necessary. Thus this analysis shows a potentially clinically significant benefit to myeloma pts. [1] Dispenzieri et al. Leukemia advance online publication 20 November 2008; doi:10.1038/leu.2008.307 Disclosures: No relevant conflicts of interest to declare.

Impact of 123 i-ioflupane spect on real-life clinical decision making - follow up of 99 patients

2017 ◽  
Vol 381 ◽  
pp. 217
Author(s):  
Z. Balazova ◽  
H. Kasparkova ◽  
A. Pospisilova ◽  
M. Balaz
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Real Life ◽  
Clinical Decision

scholarly journals Individual Reference Intervals for Personalized Interpretation of Clinical and Metabolomics Measurements

2021 ◽  
Author(s):  
Murih Pusparum ◽  
G&oumlkhan Ertaylan ◽  
Olivier Thas
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Clinical Decision Making ◽  
Real Life ◽  
Reference Interval ◽  
Clinical Decision ◽  
Upper And Lower Bounds ◽  
Life Data ◽  
Real Life Data ◽  
Data Points

The Population Reference Interval (PRI) refers to the range of outcomes that are expected in a healthy population for a clinical or a diagnostic measurement. This interval is widely used in daily clinical practice and is essential for assisting clinical decision making in diagnosis and treatment. In this study, we demonstrate that each individual indeed has a range for a given variable depending on personal biological traits. This Individual Reference Interval (IRI) can be calculated and be utilized in clinical practice, in combination with the PRI for improved decision making where multiple data points are present per variable. As calculating IRI requires several data points from the same individual to determine a personal range, here we introduce novel methodologies to obtain the correct estimates of IRI. We use Linear Quantile Mixed Models (LQMM) and Penalized Joint Quantile Models (PJQM) to estimate the IRI's upper and lower bounds. The estimates are obtained by considering both the within and between subjects' variations. We perform a simulation study designed to benchmark both methods' performance under different assumptions, resulted in PJQM giving a better empirical coverage than LQMM. Finally, both methods were evaluated on real-life data consisting of eleven clinical and metabolomics parameters from the VITO IAM Frontier study. The PJQM method also outperforms LQMM on its predictive accuracy in the real-life data setting. In conclusion, we introduce the concept of IRI and demonstrate two methodologies for calculating it to complement PRIs in clinical decision making.

scholarly journals Simulation in Nursing Education: Review of Research

2020 ◽  
Vol 8 (02) ◽  
pp. 82-86
Author(s):  
Sulochana Ghimire ◽  
Anuja Kachapati
Keyword(s):  
Decision Making ◽  
Nursing Education ◽  
Nursing Students ◽  
Clinical Decision Making ◽  
Full Range ◽  
Real Life ◽  
Clinical Decision ◽  
Practical Training ◽  
New Graduates ◽  
Nursing Curricula

INTRODUCTION Nursing education consists of the theoretical and practical training provided to nurses with the purpose to prepare them for their duties as nursing care professionals. The scope of nursing practice reflects all the role and responsibilities undertaken by the nurse to address the full range of human experiences and responses to health and illness. The instructional strategies utilized in both didactic and clinical components of nursing education courses are highly influential in determining critical thinking and clinical decision making ability as well as in developing the psychomotor skill performance of new graduates. Simulation provides nursing students with opportunities to practice their clinical and decision-making skills through various real-life situational experiences. Although endorsed in nursing curricula, its effectiveness is largely unknown.  

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