scholarly journals 28 How is Postpartum Depression Currently Diagnosed and Managed? Insights from a Virtual Patient Simulation

CNS Spectrums ◽  
2019 ◽  
Vol 24 (1) ◽  
pp. 189-190
Author(s):  
Jovana Lubarda ◽  
Martin Warters ◽  
Piyali Chatterjee ◽  
Marlene P. Freeman ◽  
Roger S. McIntyre
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Postpartum Depression ◽  
Clinical Decision Making ◽  
Patient Simulation ◽  
Clinical Decision ◽  
Virtual Patient ◽  
Evidence Based ◽  
Clinical Decisions ◽  
Practice Gaps

AbstractObjectivesThe goal of this study was to determine physician performance in diagnosis and management of postpartum depression (PPD) and to provide needed education in the consequence free environment of a virtual patient simulation (VPS).Methods∙ A continuing medical education activity was delivered via an online VPS learning platform that offers a lifelike clinical care experience with complete freedom of choice in clinical decision-making and expert personalized feedback to address learner’s practice gaps∙ Physicians including psychiatrists, primary care physicians (PCPs), and obstetricians/gynecologists (ob/gyns) were presented with two cases of PPD designed to model the experience of actual practice by including use of electronic health records∙ Following virtual interactions with patients, physicians were asked to make decisions regarding assessments, diagnoses, and pharmacologic therapies. The clinical decisions were analyzed using a sophisticated decision engine, and clinical guidance (CG) based on current evidence-based recommendations was provided in response to learners’ clinical decisions∙ Impact of the education was measured by comparing participant decisions pre- and post-CG using a 2-tailed, paired t-test; P <.05 was considered statistically significant∙ The activity launched on Medscape Education on April 26, 2018, and data were collected through to June 17,2018.Results∙ From pre- to post-CG in the simulation, physicians were more likely to make evidence-based clinical decisions related to:∙ Ordering appropriate baseline tests including tools/scales to screen for PPD: in case 1, psychiatrists (n=624) improved from 34% to 42% on average (P<.05); PCPs (n=197) improved from 38% to 48% on average (P<.05); and, ob/gyns (n=216) improved from 30% to 38% on average (P<.05)∙ Diagnosing moderate-to-severe PPD: in case 2, psychiatrists (n=531) improved from 46% to 62% (P<.05); PCPs (n=154) improved from 43% to 55% (P<.05); and, ob/gyns (n=137) improved from 55% to 73% (P<.05)∙ Ordering appropriate treatments for moderate-to-severe PPD such as selective serotonin-reuptake inhibitors: in case 2, psychiatrists (n=531) improved from 47% CG to 75% (P<.05); PCPs (n=154) improved from 55% to 74% (P<.05); and, ob/gyns (n=137) improved from 51% to 78% (P<.05)∙ Interestingly, a small percentage of physicians (average of 5%) chose investigational agents for PPD which were in clinical trials pre-CG, and this increased to an average of 9% post-CGConclusionsPhysicians who participated in VPS-based education significantly improved their clinical decision-making in PPD, particularly in selection of validated screening tools/scales, diagnosis, and pharmacologic treatments based on severity. Given that VPS immerses physicians in an authentic, practical learning experience matching the scope of clinical practice, this type of intervention can be used to determine clinical practice gaps and translate knowledge into practice.Funding Acknowledgements: The educational activity and outcomes measurement were funded through an independent educational grant from Sage Therapeutics, Inc.

Awareness of Heuristics in Clinical Decision Making

2014 ◽  
Vol 7 (1) ◽  
pp. 16-23 ◽  
Author(s):  
Luann G. Richardson
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Daily Clinical Practice ◽  
Evidence Based ◽  
Clinical Decisions ◽  
Subjective Judgment ◽  
Novices And Experts

Evidence-based principles should unquestionably play a key role in decision making. However, we must recognize that gaps in both knowledge and evidence occur in daily clinical practice. Subjective judgment can be a constructive component in making clinical decisions. The use of heuristics has been used both purposely and instinctively to help fill gaps and assist in solving complex dilemmas. A goal of this article is to encourage clinicians to assess their own decision-making skills as well as the skills of novices and experts with whom they work with.

scholarly journals Medical Simulation in Relapsed Follicular Lymphoma Improves Clinical Decision Making of Hematologists/Oncologists

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 33-34
Author(s):  
Lauren Willis ◽  
Donna Topping ◽  
Sarah Atwood ◽  
Jonathon B. Cohen
Keyword(s):  
Decision Making ◽  
Follicular Lymphoma ◽  
Treatment Option ◽  
Clinical Decision Making ◽  
Response Rates ◽  
Clinical Decision ◽  
Evidence Based ◽  
Cell Transplant ◽  
Clinical Decisions ◽  
Appropriate Treatment

Background: Frontline treatment of follicular lymphoma (FL) yields high response rates, but most patients relapse. In addition, response rates and duration of response have historically declined with subsequent treatments. These factors make management of this disease challenging. Therefore, this study was conducted to determine if an online, simulation-based continuing medical education (CME) intervention could improve clinical decision making of hematologists/oncologists (hem/oncs) regarding treatment selection for relapsed/refractory (R/R) FL. 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 R/R FL presented in a platform that allows hem/oncs to assess the patients and make diagnostic and therapeutic decisions supported by an extensive database of diagnostic and treatment possibilities, matching the scope and depth of actual practice. Case 1: Patient with FL who failed 2 prior lines of therapy (R-CHOP, bendamustine/obinutuzumab), past medical history (PMH) well controlled hypertension and poorly controlled type 2 diabetes, presenting with constitutional symptoms and needs 3rd line treatment. Case 2: Patient with FL who failed 2 prior lines of therapy (bendamustine/rituximab, lenalidomide/rituximab), PMH well controlled atrial fibrillation and ulcerative colitis, patient requests intravenous therapy because he has trouble remembering to take oral medications. 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 &lt; .05 indicates significance). Data were collected between 11/20/19 and 2/19/20. Results: At the time of assessment, 154 hem/oncs who made clinical decisions were included in the analysis. From pre- to post-CG in the VPS, hem/oncs were more likely to make evidence-based practice decisions in: -Diagnosing patients with relapsed FL: 55% pre-CG and 73% post-CG (P &lt; 0.001) -Starting an appropriate treatment for a patient with R/R FL ----Case 1: Ordering idelalisib: 7% pre-CG and 33% post-CG (P &lt; 0.001) ----Case 1: Ordering lenalidomide + rituximab: 6% pre-CG and 28% post-CG (P &lt; 0.001) ----Case 1: Ordering duvelisib: 2% pre-CG and 9% post-CG (P &lt; 0.001) ----Case 2: Ordering copanlisib: 32% pre-CG and 73% post-CG (P &lt; 0.001) The top rationales for selecting an appropriate treatment option were: recommended by guidelines, convenience of administration route, better efficacy compared to other agents, and best option based on patient comorbidities. Other relevant concomitant therapies ordered were consult for chimeric antigen receptor (CAR) T-cell therapy, consult for stem cell transplant, radiation therapy, refer to a clinical trial, and Pneumocystis jirovecii pneumonia (PJP) prophylaxis (Figure 1). Conclusion: This study demonstrates that VPS that immerses and engages hem/oncs in an authentic and practical learning experience improved evidence-based clinical decisions related to the management of R/R FL. This VPS increased the percentage of heme/oncs who correctly diagnosed R/R FL and selected an appropriate treatment option. 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. Acknowledgement: This CME activity was supported by an independent educational grant from Bayer, Celgene Corporation, and Verastem Oncology. Jake Cohen contributed to data analysis for this research. Reference: https://www.medscape.org/viewarticle/915986 Figure Disclosures Cohen: Janssen, Adicet, Astra Zeneca, Genentech, Aptitude Health, Cellectar, Kite/Gilead, Loxo: Consultancy; Genentech, BMS, Novartis, LAM, BioInvent, LRF, ASH, Astra Zeneca, Seattle Genetics: Research Funding.

scholarly journals Reframing Perceptions in Restorative Dentistry: Evidence-Based Dentistry and Clinical Decision-Making

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Ayah A Al-Asmar ◽  
Ahmad S Al-Hiyasat ◽  
Motasum Abu-Awwad ◽  
Hakam N Mousa ◽  
Nesreen A Salim ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Root Canal ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Root Canal Treatment ◽  
Evidence Based ◽  
Dental Practice ◽  
Restorative Dentistry ◽  
Evidence Based Dentistry

Objectives. The worldwide interest of both dentists and patients in esthetic dentistry has affected decision-making in dental practice. The aim of this study was to investigate contemporary dental practice in restorative dentistry and the relationship between evidence-based dentistry in caries research and decision-making in clinical practice in restorative dentistry. Methods. The study was conducted through a structured questionnaire distributed randomly at the Jordanian Dental Association registered dentists in Jordan. The questionnaire aimed to clarify the degree of knowledge and practice of evidence-based dentistry in caries research the dentists hold regarding clinical decision-making in restorative dentistry. Results. The majority of the surveyed dentists (77%) treat teeth with irreversible pulpitis with root canal treatment rather than vital pulp therapy. 13.8% routinely insert a post and 23% routinely crown the tooth after root canal treatment regardless of the remaining tooth structure. Badly damaged teeth are treated with full crowns in 72% of the cases. Regarding Hollywood smile or smile makeover, the majority of dentists choose conservative approaches, and implants were the first choice to replace missing teeth for 93.8% of the surveyed dentists. Conclusion. A higher degree of implementation of evidence-based dentistry in clinical decision-making was found in Prosthetic Dentistry than in Endodontics. Yet, the gap between evidence-based data and clinical practice needs bridging. More emphasis on communicating these data to educators to integrate them into the dental curriculum is a must.

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.

scholarly journals Progress in Clinical Neurosciences: Evidence Based Care in the Neurosciences

2002 ◽  
Vol 29 (2) ◽  
pp. 115-119 ◽  
Author(s):  
Samuel Wiebe ◽  
Bart Demaerschalk
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Ease Of Use ◽  
Evidence Based ◽  
Content Accessibility ◽  
Evidence Based Care

Abstract:We examine the relevance of Evidence Based Care (EBC) to the field of clinical neurosciences, with particular emphasis on feasible methods of implementing EBC in clinical practice. By using pre-appraised EBC summaries, busy clinicians can move toward EBC without engaging in the laborious process of searching and critically appraising the literature. After reviewing the neurological content, accessibility and ease of use of current sources of EBC summaries, we find them substantially lacking in coverage of the neurosciences, and therefore of limited use to clinicians in this field. We emphasize a particular type of EBC summary, the critically appraised topic, and comment on its usefulness and limitations as a tool to assist clinical decision-making in the neurosciences. Finally, we propose that a collection of easily accessible, good quality, peer reviewed critically appraised topics, covering a breadth of relevant topics, is a reasonable way of moving toward EBC in the clinical neurosciences.

scholarly journals A sociodental approach in prosthodontic treatment decision making

2004 ◽  
Vol 12 (2) ◽  
pp. 127-132 ◽  
Author(s):  
Cláudio Rodrigues Leles ◽  
Maria do Carmo Matias Freire
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Clinical Decision Making ◽  
Treatment Decision ◽  
Clinical Decision ◽  
Decision Making Process ◽  
Evidence Based ◽  
Critical Problem ◽  
Practice Model ◽  
Treatment Decision Making

A critical problem in the decision making process for dental prosthodontic treatment is the lack of reliable clinical parameters. This review discusses the limits of traditional normative treatment and presents guidelines for clinical decision making. There is a need to incorporate a sociodental approach to help determine patient's needs. Adoption of the evidence-based clinical practice model is also needed to assure safe and effective clinical practice in prosthetic dentistry.

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 &lt; .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.

scholarly journals Qualitative study of cardiologists’ perceptions of factors influencing clinical practice decisions

Heart ◽  
2019 ◽  
Vol 105 (10) ◽  
pp. 749-754 ◽  
Author(s):  
Veena Manja ◽  
Gordon Guyatt ◽  
John You ◽  
Sandra Monteiro ◽  
Susan Jack
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Qualitative Study ◽  
Health System ◽  
Financial Incentives ◽  
Clinical Decision Making ◽  
Health Spending ◽  
Clinical Decision ◽  
Evidence Based ◽  
The Usa

BackgroundHealthcare costs are increasing in the USA and Canada and a substantial portion of health spending is devoted to services that do not improve health outcomes. Efforts to reduce waste by adopting evidence-based clinical practice guideline recommendations have had limited success. We sought insight into improving health system efficiency through understanding cardiologists’ perceptions of factors that influence clinical decision-making.MethodsIn this descriptive qualitative study, we conducted in-depth interviews with 18 American and 3 Canadian cardiologists. We used conventional content analysis including inductive and deductive approaches for data analysis and mapped findings to the ecological systems framework.ResultsPhysicians reported that major determinants of practice included interpersonal interactions with peers, patients and administrators; financial incentives and system factors. Patients’ insurance status represented an important consideration for some cardiologists. Other major influences included time constraints, fear of litigation (less prominent in Canada), a sense that their obligation was never to miss any underlying pathology, and patient demands. The need to bring income into their health system influenced American cardiologists’ practice; personal income implications influenced Canadian cardiologists’ practice. Cardiologists reported that knowledge limitations and logistical challenges limit their ability to assist patients with cost considerations. All these considerations were more influential than guidelines; some cardiologists expressed a high level of scepticism regarding guidelines.ConclusionsClinical decision-making by cardiologists is shaped by individual, interpersonal, organisational, environmental, financial and sociopolitical influences and only to a limited extent by guideline recommendations. Successful strategies to achieve efficient, evidence-based care will require addressing socioecological influences on decision-making.

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