Clinical decision-making on spinal cord injury-associated pneumonia: a nationwide survey in Germany

Spinal cord injury (SCI) patients suffer from diverse gait deficits depending on the severity of their injury. Gait assessments can objectively track the progress during rehabilitation and support clinical decision making, but a comprehensive gait analysis requires far more complex setups and time-consuming protocols that are not feasible in the daily clinical routine. As using inertial sensors for mobile gait analysis has started to gain ground, this work aimed to develop a sensor-based gait analysis for the specific population of SCI patients that measures the spatio-temporal parameters of typical gait laboratories for day-to-day clinical applications. The proposed algorithm uses shank-mounted inertial sensors and personalized thresholds to detect steps and gait events according to the individual gait profiles. The method was validated in nine SCI patients and 17 healthy controls walking on an instrumented treadmill while wearing reflective markers for motion capture used as a gold standard. The sensor-based algorithm (i) performed similarly well for the two cohorts and (ii) is robust enough to cover the diverse gait deficits of SCI patients, from slow (0.3 m/s) to preferred walking speeds.

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Correlational Dueling Bandits with Application to Clinical Treatment in Large Decision Spaces

Proceedings of the Twenty-Sixth International Joint Conference on Artificial Intelligence ◽

10.24963/ijcai.2017/389 ◽

2017 ◽

Cited By ~ 2

Author(s):

Yanan Sui ◽

Joel W. Burdick

Keyword(s):

Decision Making ◽

Spinal Cord ◽

Clinical Decision Making ◽

Clinical Decision ◽

Sequential Decision Making ◽

Sequential Decision ◽

Decision Space ◽

Cord Injury ◽

Effectiveness And Efficiency ◽

Comparative Feedback

We consider sequential decision making under uncertainty, the optimization over large decision space with noisy comparative feedback. This problem can be formulated as a K-armed Dueling Bandits problem where K is the total number of decisions. When K is very large, existing dueling bandits algorithms suffer huge cumulative regret before converging on the optimal arm. This paper studies the dueling bandits problem with a large number of dependent arms. Our problem is motivated by a clinical decision making process in large decision space. We propose an efficient algorithm CorrDuel for the problem which makes decisions to simultaneously deliver effective therapy and explore the decision space. Many sequential decision making problems with large and structured decision space could be facilitated by our algorithm. After evaluated the fast convergence of CorrDuel in analysis and simulation experiments, we applied it on a live clinical trial of therapeutic spinal cord stimulation. It is the first applied algorithm towards spinal cord injury treatments and experimental results show the effectiveness and efficiency of our algorithm.

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A day in the life: a qualitative study of clinical decision-making and uptake of neurorehabilitation technology

Journal of NeuroEngineering and Rehabilitation ◽

10.1186/s12984-021-00911-6 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Courtney Celian ◽

Veronica Swanson ◽

Maahi Shah ◽

Caitlin Newman ◽

Bridget Fowler-King ◽

...

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

New Technologies ◽

Clinical Decision ◽

Relative Advantage ◽

Personal Attributes ◽

Design Work ◽

Cognitive Limitations ◽

Knowledge And Beliefs ◽

Cord Injury

Abstract Background Neurorehabilitation engineering faces numerous challenges to translating new technologies, but it is unclear which of these challenges are most limiting. Our aim is to improve understanding of rehabilitation therapists’ real-time decision-making processes on the use of rehabilitation technology (RT) in clinical treatment. Methods We used a phenomenological qualitative approach, in which three OTs and two PTs employed at a major, technology-encouraging rehabilitation hospital wrote vignettes from a written prompt describing their RT use decisions during treatment sessions with nine patients (4 with stroke, 2 traumatic brain injury, 1 spinal cord injury, 1 with multiple sclerosis). We then coded the vignettes using deductive qualitative analysis from 17 constructs derived from the RT literature and the Consolidated Framework for Implementation Research (CFIR). Data were synthesized using summative content analysis. Results Of the constructs recorded, the five most prominent are from CFIR determinants of: (i) relative advantage, (ii) personal attributes of the patients, (iii) clinician knowledge and beliefs of the device/intervention, (iv) complexity of the devices including time and setup, and (v) organizational readiness to implement. Therapists characterized candidate RT as having a relative disadvantage compared to conventional treatment due to lack of relevance to functional training. RT design also often failed to consider the multi-faceted personal attributes of the patients, including diagnoses, goals, and physical and cognitive limitations. Clinicians’ comfort with RT was increased by their previous training but was decreased by the perceived complexity of RT. Finally, therapists have limited time to gather, setup, and use RT. Conclusions Despite decades of design work aimed at creating clinically useful RT, many lack compatibility with clinical translation needs in inpatient neurologic rehabilitation. New RT continue to impede the immediacy, versatility, and functionality of hands-on therapy mediated treatment with simple everyday objects.

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A nationwide survey of UK cardiac surgeons' view on clinical decision making during the coronavirus disease 2019 (COVID-19) pandemic

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2020.05.016 ◽

2020 ◽

Vol 160 (4) ◽

pp. 968-973 ◽

Cited By ~ 11

Author(s):

Umberto Benedetto ◽

Andrew Goodwin ◽

Simon Kendall ◽

Rakesh Uppal ◽

Enoch Akowuah

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Nationwide Survey ◽

Clinical Decision ◽

Cardiac Surgeons

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Return to Play after Cervical Spine Injuries: A Consensus of Opinion

Global Spine Journal ◽

10.1055/s-0036-1582394 ◽

2016 ◽

Vol 6 (8) ◽

pp. 792-797 ◽

Cited By ~ 5

Author(s):

John C. France ◽

Michael Karsy ◽

James S. Harrop ◽

Andrew T. Dailey

Keyword(s):

Decision Making ◽

Cervical Spine ◽

Clinical Decision Making ◽

Clinical Symptoms ◽

Clinical Decision ◽

Return To Play ◽

Spine Injury ◽

Cervical Cord ◽

Clinical Scenarios ◽

Cord Injury

Study Design Survey. Objective Sports-related spinal cord injury (SCI) represents a growing proportion of total SCIs but lacks evidence or guidelines to guide clinical decision-making on return to play (RTP). Our objective is to offer the treating physician a consensus analysis of expert opinion regarding RTP that can be incorporated with the unique factors of a case for clinical decision-making. Methods Ten common clinical scenarios involving neurapraxia and stenosis, atlantoaxial injury, subaxial injury, and general cervical spine injury were presented to 25 spine surgeons from level 1 trauma centers for whom spine trauma is a significant component of their practice. We evaluated responses to questions about patient RTP, level of contact, imaging required for a clinical decision, and time to return for each scenario. The chi-square test was used for statistical analysis, with p < 0.05 considered significant. Results Evaluation of the surgeons’ responses to these cases showed significant consensus regarding return to high-contact sports in cases of cervical cord neurapraxia without symptoms or stenosis, surgically repaired herniated disks, and nonoperatively healed C1 ring or C2 hangman's fractures. Greater variability was found in recommendations for patients showing persistent clinical symptomatology. Conclusion This survey suggests a consensus among surgeons for allowing patients with relatively normal imaging and resolution of symptoms to return to high-contact activities; however, patients with cervical stenosis or clinical symptoms continue to be a challenge for management. This survey may serve as a basis for future clinical trials and consensus guidelines.

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Spine and Spinal Cord Injury

10.2310/em.4351 ◽

2018 ◽

Author(s):

Miguel Arribas ◽

Michael A. Cole

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Spinal Injury ◽

Penetrating Trauma ◽

Clinical Decision ◽

Cervical Injury ◽

Intravenous Contrast ◽

Contrast Enhanced Ct ◽

Organ Systems ◽

Cord Injury

Spinal injury has the potential to dramatically change a patient’s life. Prompt diagnosis, appropriate supportive medical care, early transfer to a spinal injury center and, if necessary, surgical intervention within 24 hours are essential to optimizing outcomes. Clinical decision rules aid in determining the need for imaging. When needed, non-contrast enhanced CT is the initial imaging test of choice with MRI being used in patients with neurologic findings, significant pathology on CT, and/or high suspicion for injury. CT or MRI with intravenous contrast is preferred in penetrating trauma. Radiographs are of limited utility in evaluating spinal injury in adults. Classification of spinal injury based on appearance on imaging and neurologic exam is important for surgical management decisions. Cervical injury may lead to respiratory distress requiring early intubation. Hypotension is most often a result of hemorrhage from concomitant traumatic injuries to other organ systems. Crystalloid, blood products, atropine and norepinephrine should be used as needed to avoid systolic BP< 90 mm Hg or heart rate< 60 BPM and maintain a MAP of 85-90 mm Hg. Steroid administration within the first 8 hours of significant spinal injury is controversial and the decision to administer steroids should be made through consultation with patient, family and spinal specialist. The review contains 8 figures, 2 videos, 13 tables, and 59 references. Keywords: blunt trauma, neurologic assessment, penetrating trauma, spinal anatomy, spinal cord injury, spinal injury, steroid use, vertebrae, vertebral anatomy, vertebral injury

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Optimization of the decision-making process for the selection of therapeutics to undergo clinical testing for spinal cord injury in the North American Clinical Trials Network

Journal of Neurosurgery Spine ◽

10.3171/2012.5.aospine1289 ◽

2012 ◽

Vol 17 (Suppl1) ◽

pp. 94-101 ◽

Cited By ~ 9

Author(s):

James Guest ◽

James S. Harrop ◽

Bizhan Aarabi ◽

Robert G. Grossman ◽

James W. Fawcett ◽

...

Keyword(s):

Clinical Trial ◽

Decision Making ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Clinical Trials ◽

North American ◽

Clinical Testing ◽

Data Set ◽

The North ◽

Cord Injury

The North American Clinical Trials Network (NACTN) includes 9 clinical centers funded by the US Department of Defense and the Christopher Reeve Paralysis Foundation. Its purpose is to accelerate clinical testing of promising therapeutics in spinal cord injury (SCI) through the development of a robust interactive infrastructure. This structure includes key committees that serve to provide longitudinal guidance to the Network. These committees include the Executive, Data Management, and Neurological Outcome Assessments Committees, and the Therapeutic Selection Committee (TSC), which is the subject of this manuscript. The NACTN brings unique elements to the SCI field. The Network's stability is not restricted to a single clinical trial. Network members have diverse expertise and include experts in clinical care, clinical trial design and methodology, pharmacology, preclinical and clinical research, and advanced rehabilitation techniques. Frequent systematic communication is assigned a high value, as is democratic process, fairness and efficiency of decision making, and resource allocation. This article focuses on how decision making occurs within the TSC to rank alternative therapeutics according to 2 main variables: quality of the preclinical data set, and fit with the Network's aims and capabilities. This selection process is important because if the Network's resources are committed to a therapeutic, alternatives cannot be pursued. A proposed methodology includes a multicriteria decision analysis that uses a Multi-Attribute Global Inference of Quality matrix to quantify the process. To rank therapeutics, the TSC uses a series of consensus steps designed to reduce individual and group bias and limit subjectivity. Given the difficulties encountered by industry in completing clinical trials in SCI, stable collaborative not-for-profit consortia, such as the NACTN, may be essential to clinical progress in SCI. The evolution of the NACTN also offers substantial opportunity to refine decision making and group dynamics. Making the best possible decisions concerning therapeutics selection for trial testing is a cornerstone of the Network's function.

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