Liposarcoma of the left hemithorax and implications of MDM2

2019 ◽  
Vol 18 (4) ◽  
pp. 397-399
Author(s):  
Michael Stolten ◽  
Deepak Sahasrabudhe ◽  
Louis Constine
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Adjuvant Radiation ◽  
Left Hemithorax ◽  
Case Presentation ◽  
Close Observation ◽  
Initial Biopsy ◽  
Molecular Information ◽  
Well Differentiated

AbstractBackground:Use of molecular information to guide clinical management of thoracic liposarcoma following resection.Case presentation:We present a case of a large liposarcoma of the left hemithorax. Initial biopsy consistent with lipoma however following resection pathology showed well-differentiated liposarcoma. Clinical data and molecular information including MDM2 from the tumour were employed in decision making regarding subsequent adjuvant radiation therapy versus close observation.Conclusion:Improved molecular characterisation has increased the precision of histological diagnoses and prediction of outcomes for many cancers. These may continue to help guide and strengthen clinical decision making and recommendations as they pertain to adjuvant therapy versus observation in the case of this patient.

scholarly journals False hyperthyroidism caused by interference in immunoassays

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Clara Jiménez García ◽  
Piedad Ortega Fernández ◽  
María Eugenia Torregrosa Quesada ◽  
Victoria González Bueno ◽  
María Teresa Botella Belda ◽  
...  
Keyword(s):  
Decision Making ◽  
Thyroid Hormone ◽  
Thyroid Function ◽  
Thyroid Disease ◽  
Clinical Decision Making ◽  
Clinical Symptoms ◽  
Clinical Decision ◽  
Case Presentation ◽  
Free Thyroid Hormone ◽  
Different Types

AbstractObjectivesImmunoassays used to assess thyroid function are vulnerable to different types of interference that may affect clinical decision-making.Case presentationWe report the case of a 37-year-old woman who developed iatrogenic hypothyroidism after having received radioiode therapy who visited our hospital for her annual checkup. The patient was asymptomatic, without signs suggestive of thyroid disease. However, laboratory analysis proved otherwise: thyrotropin (TSH) 7.75 mU/L, thyroxine (FT4) >7.7 ng/dL.ConclusionsThe inconsistency between her clinical symptoms and the biochemistry data raised the possibility of a methodological interference. A thorough evaluation of the main causes of interference was conducted in the laboratory to exclude the presence of interference in TSH and FT4. Finally, different interfering agents were identified, which affected free thyroid hormone and TSH determination.

Decipher test’s impact on the postoperative management of prostate cancer.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 146-146
Author(s):  
Brian P. Calio ◽  
Matt Murphy ◽  
Anne Calvaresi ◽  
James Ryan Mark ◽  
Mark Mann ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Risk Stratification ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Postoperative Management ◽  
Adjuvant Radiation ◽  
Chi Square ◽  
Cancer Aggressiveness ◽  
The Impact

146 Background: The Decipher Prostate Cancer Test provides risk stratification for prostate cancer aggressiveness and predicts the probability of metastasis after surgery. We aim to determine the impact on clinical decision-making Decipher risk designation has had at our institution since its implementation. Methods: A prospectively maintained single institution database was analyzed for patients who underwent prostate biopsy and prostatectomy between 2006-2017. Patients with pathologic T3 cancer, Gleason ≥3+4, or positive surgical margins were considered for the study. In cohort 1, patients’ Decipher scores were available prior to postoperative decision-making, in cohort 2 patients’ scores were not available. Postoperative management was then compared between cohorts to determine if presence of Decipher score influenced the rate of adjuvant and salvage radiation administered. The EMR was queried for the words “adjuvant”, “RT”, “salvage”, “SRT”, to record rates of radiation given to each patient. Chi Square and Mann Whitney test was used to compare rates between cohorts and Decipher risk categories. Results: 454 patients were included in the study with median (IQR) age of 62.0 (7.0) years. Mean time of follow-up was 2.0 years and 8.2 years in cohorts 1 and 2, respectively. In the cohort that received Decipher scores, rate of adjuvant radiation administered was significantly higher than in patients who did not receive a Decipher score (27.0% vs. 6.8%, p<0.001), and higher Decipher risk was associated with higher rate of adjuvant administration (9% vs 27.8% vs 35.4% for low, average and high risk, respectively; p<0.001). Rate of salvage radiation given was not significantly different between the cohorts (5.2% vs 4.0%; p=0.228). Conclusions: The Decipher Prostate Cancer Test provides valuable data regarding risk stratification of disease. As demonstrated here, the availability of Decipher scores has lead to a demonstrable effect in the postoperative management of prostate cancer.

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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