Circular functional analysis of OCT data for precise identification of structural phenotypes in the eye

AbstractProgressive optic neuropathies such as glaucoma are major causes of blindness globally. Multiple sources of subjectivity and analytical challenges are often encountered by clinicians in the process of early diagnosis and clinical management of these diseases. In glaucoma, the structural damage is often characterized by neuroretinal rim (NRR) thinning of the optic nerve head, and other clinical parameters. Baseline structural heterogeneity in the eyes can play a key role in the progression of optic neuropathies, and present challenges to clinical decision-making. We generated a dataset of Optical Coherence Tomography (OCT) based high-resolution circular measurements on NRR phenotypes, along with other clinical covariates, of 3973 healthy eyes as part of an established clinical cohort of Asian Indian participants. We introduced CIFU, a new computational pipeline for CIrcular FUnctional data modeling and analysis. We demonstrated CIFU by unsupervised circular functional clustering of the OCT NRR data, followed by meta-clustering to characterize the clusters using clinical covariates, and presented a circular visualization of the results. Upon stratification by age, we identified a healthy NRR phenotype cluster in the age group 40–49 years with predictive potential for glaucoma. Our dataset also addresses the disparity of representation of this particular population in normative OCT databases.

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Circular functional analysis of OCT data for precise identification of structural phenotypes in the eye

10.1101/2021.02.07.21251275 ◽

2021 ◽

Author(s):

Md. Hasnat Ali ◽

Brian Wainwright ◽

Alexander Petersen ◽

Ganesh B. Jonnadula ◽

Meghana Aruru ◽

...

Keyword(s):

High Resolution ◽

Asian Indian ◽

Structural Damage ◽

Clinical Decision Making ◽

Clinical Decision ◽

Structural Heterogeneity ◽

Circular Data ◽

Multiple Sources ◽

Modeling And Analysis ◽

Clinical Covariates

AbstractProgressive optic neuropathies such as glaucoma are major causes of blindness globally. Multiple sources of subjectivity and analytical challenges are often encountered by the clinicians in the process of early diagnosis and clinical management of these diseases. In glaucoma, the structural damage is often characterized by neuroretinal rim (NRR) thinning of the optic nerve head, and other clinical parameters. Optical coherence tomography (OCT) is a popular and quantitative eye imaging platform for precise and reproducible measurement of such parameters in the clinic.Baseline structural heterogeneity in the eyes can play a key role in the progression of optic neuropathies, and thus present challenges to clinical decision-making. To address this, large and diverse normative OCT databases with mathematically precise description of phenotypes can help with early detection and characterization of the different phenotypes that are encountered in the clinic. In this study, we generated a new large dataset of OCT generated high-resolution circular data on NRR phenotypes, along with other clinical covariates, of nearly 4,000 healthy eyes as part of a well-established clinical cohort (LVPEI-GLEAMS) of Asian Indian participants.In this study, we (1) generated high-resolution circular OCT measurements of NRR thickness in a given eye, (2) introduced CIFU, a new computational pipeline for CIrcular FUnctional data modeling and analysis that is demonstrated using the OCT dataset, and (3) addressed the disparity of representation of the Asian Indian population in normative OCT databases. We demonstrated CIFU by unsupervised circular functional clustering of the OCT NRR data, meta-clustering to characterize the clustering output using clinical covariates, and presenting a circular visualization of the results. Upon stratification by age, we identified a healthy NRR phenotype cluster in the age group 40-49 years with predictive potential for glaucoma.

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Supporting the Development of Clinical Reasoning of Preprofessional Novices in Dysphagia Management

Seminars in Speech and Language ◽

10.1055/s-0039-1688814 ◽

2019 ◽

Vol 40 (03) ◽

pp. 151-161 ◽

Cited By ~ 1

Author(s):

Sebastian Doeltgen ◽

Stacie Attrill ◽

Joanne Murray

Keyword(s):

Clinical Reasoning ◽

Clinical Decision Making ◽

Management Practice ◽

Clinical Decision ◽

Assessment Process ◽

Evidence Based ◽

Sources Of Information ◽

Multiple Sources ◽

Implicit Processing ◽

Reasoning Skills

AbstractProficient clinical reasoning is a critical skill in high-quality, evidence-based management of swallowing impairment (dysphagia). Clinical reasoning in this area of practice is a cognitively complex process, as it requires synthesis of multiple sources of information that are generated during a thorough, evidence-based assessment process and which are moderated by the patient's individual situations, including their social and demographic circumstances, comorbidities, or other health concerns. A growing body of health and medical literature demonstrates that clinical reasoning skills develop with increasing exposure to clinical cases and that the approaches to clinical reasoning differ between novices and experts. It appears that it is not the amount of knowledge held, but the way it is used, that distinguishes a novice from an experienced clinician. In this article, we review the roles of explicit and implicit processing as well as illness scripts in clinical decision making across the continuum of medical expertise and discuss how they relate to the clinical management of swallowing impairment. We also reflect on how this literature may inform educational curricula that support SLP students in developing preclinical reasoning skills that facilitate their transition to early clinical practice. Specifically, we discuss the role of case-based curricula to assist students to develop a meta-cognitive awareness of the different approaches to clinical reasoning, their own capabilities and preferences, and how and when to apply these in dysphagia management practice.

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Integrating research and evidence-based guidance into prescribing practice

Journal of Prescribing Practice ◽

10.12968/jprp.2021.3.3.120 ◽

2021 ◽

Vol 3 (3) ◽

pp. 120-123

Author(s):

Adam Bedson

Keyword(s):

Decision Making ◽

Critical Appraisal ◽

Clinical Decision Making ◽

Primary Source ◽

Clinical Decision ◽

Evidence Base ◽

Evidence Based ◽

Multiple Sources ◽

Prescribing Practice ◽

Critical Appraisal Skills

The College of Paramedics and the Royal Pharmaceutical Society are clear that they require advanced paramedics, as non-medical prescribers, to review and critically appraise the evidence base underpinning their prescribing practice. Evidence-based clinical guidance such as that published by the National Institute for Health and Care Excellence (NICE) is recommended as the primary source of evidence on which paramedics should base their prescribing decisions. NICE guidance reflects the best available evidence on which to base clinical decision-making. However, paramedics still need to critically appraise the evidence underpinning their prescribing, applying expertise and decision-making skills to inform their clinical reasoning. This is achieved by synthesising information from multiple sources to make appropriate, evidence-based judgments and diagnoses. This first article in the prescribing paramedic pharmacology series considers the importance of evidence-based paramedic prescribing, alongside a range of tools that can be used to develop and apply critical appraisal skills to support prescribing decision-making. These include critical appraisal check lists and research reporting tools

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Integrating research and evidence-based guidance into prescribing practice

Journal of Paramedic Practice ◽

10.12968/jpar.2021.13.1.10 ◽

2021 ◽

Vol 13 (1) ◽

pp. 10-13

Author(s):

Adam Bedson

Keyword(s):

Decision Making ◽

Critical Appraisal ◽

Clinical Decision Making ◽

Primary Source ◽

Clinical Decision ◽

Evidence Base ◽

Evidence Based ◽

Multiple Sources ◽

Prescribing Practice ◽

Critical Appraisal Skills

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Data ambiguity and clinical decision making: A qualitative case study of the use of predictive information technologies in a personalized cancer clinical trial

Health Informatics Journal ◽

10.1177/1460458219827355 ◽

2019 ◽

Vol 25 (3) ◽

pp. 500-510 ◽

Cited By ~ 1

Author(s):

Nadav Even Chorev

Keyword(s):

Clinical Trial ◽

Information Technologies ◽

Clinical Decision Making ◽

Qualitative Case Study ◽

Clinical Decision ◽

Clinical Decisions ◽

Multiple Sources ◽

Advanced Cancer Patients ◽

High Resolution Data

Personalized medicine aims to tailor the treatment to the specific characteristics of the individual patient. In the process, physicians engage with multiple sources of data and information to decide on a personalized treatment. This article draws on a qualitative case study of a clinical trial testing a method for matching treatments for advanced cancer patients. Specialists in the trial used data and information processed by a specifically developed drug-efficacy predictive algorithm and other information artifacts to make personalized clinical decisions. While using high-resolution data in the trial was expected to provide a more accurate basis for action, sociomaterial engagements of oncologists with data and its representation by artifacts paradoxically hindered personalized clinical decisions. I contend that the engagement between human discretion, ambiguous data, and malleable artifacts in this non-standardized trial produced moments of contradiction within entanglement. Sociomaterial approaches should acknowledge such conflicts in further analyses of medical practice transitions.

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Profil Mortalitas Stroke Associated Pneumonia Tahun 2016-2017

Jurnal Ilmu dan Teknologi Kesehatan ◽

10.32668/jitek.v6i2.172 ◽

2019 ◽

Vol 6 (2) ◽

pp. 104-112

Author(s):

Anna Mardiana Ritonga ◽

Syahrizal Syarif ◽

Lyna Soertidewi

Keyword(s):

Clinical Decision Making ◽

Laboratory Data ◽

Clinical Decision ◽

Bivariate Analysis ◽

Apache Ii Score ◽

Age Group ◽

Stroke Patients ◽

Medical Record Data ◽

Record Data ◽

Male Patients

Stroke associated pneumonia (SAP) is the most common complication after stroke and has a high mortality rate. SAP mortality profile among Neuro ICU patients has not been fully investigated. Knowledge of mortality profiles can help clinical decision making for patient management. The purpose of this study was to determine the mortality profile of SAP who were treated in the Neuro ICU National Brain Centre (NBC) Hospital. This was a retrospective cohort study of the patients were hospitalized in the Neuro ICU NBC Hospital, who were diagnosed with SAP during 2016-2017. Clinical and laboratory data and the patient's status during treatment are obtained from medical record data. A total of 197 stroke patients who were treated at the Neuro ICU NBC Hospital during 2016-2017, there were 130 (65.98%) patients diagnosed with SAP, with mortality during treatment of 77.7%. The highest SAP mortality was found in male patients (75%), in the age group ≥ 60 years (55.4%), GCS at admission ≤ 8 (88.3%), accompanied by hypertension (66.7%) and leukocytosis (74.8%). In bivariate analysis, the variables that were statistically significant (p <0.05) were hypertension, GCS, LoS, APACHE II score, and PMR.

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Children's English Consonant Acquisition in the United States: A Review

American Journal of Speech-Language Pathology ◽

10.1044/2020_ajslp-19-00168 ◽

2020 ◽

Vol 29 (4) ◽

pp. 2155-2169 ◽

Cited By ~ 1

Author(s):

Kathryn Crowe ◽

Sharynne McLeod

Keyword(s):

United States ◽

Decision Making ◽

Clinical Decision Making ◽

Clinical Decision ◽

The United States ◽

Typically Developing ◽

Multiple Sources ◽

Speech Language Pathologists ◽

Cross Sectional ◽

Developmental Norms

Purpose Speech-language pathologists' clinical decision making and consideration of eligibility for services rely on quality evidence, including information about consonant acquisition (developmental norms). The purpose of this review article is to describe the typical age and pattern of acquisition of English consonants by children in the United States. Method Data were identified from published journal articles and assessments reporting English consonant acquisition by typically developing children living in the United States. Sources were identified through searching 11 electronic databases, review articles, the Buros database, and contacting experts. Data describing studies, participants, methodology, and age of consonant acquisition were extracted. Results Fifteen studies (six articles and nine assessments) were included, reporting consonant acquisition of 18,907 children acquiring English in the United States. These cross-sectional studies primarily used single-word elicitation. Most consonants were acquired by 5;0 (years;months). The consonants /b, n, m, p, h, w, d/ were acquired by 2;0–2;11; /ɡ, k, f, t, ŋ, j/ were acquired by 3;0–3;11; /v, ʤ, s, ʧ, l, ʃ, z/ were acquired by 4;0–4;11; /ɹ, ð, ʒ/ were acquired by 5;0–5;11; and /θ/ was acquired by 6;0–6;11 (ordered by mean age of acquisition, 90% criterion). Variation was evident across studies resulting from different assessments, criteria, and cohorts of children. Conclusions These findings echo the cross-linguistic findings of McLeod and Crowe (2018) across 27 languages that children had acquired most consonants by 5;0. On average, all plosives, nasals, and glides were acquired by 3;11; all affricates were acquired by 4;11; all liquids were acquired by 5;11; and all fricatives were acquired by 6;11 (90% criterion). As speech-language pathologists apply this information to clinical decision making and eligibility decisions, synthesis of knowledge from multiple sources is recommended.

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Latent prostate cancer among Japanese males: a bibliometric study of autopsy reports from 1980–2016

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyaa161 ◽

2020 ◽

Vol 51 (1) ◽

pp. 156-159

Author(s):

Yuta Takeshima ◽

Motofumi Suzuki ◽

Jimpei Miyakawa ◽

Ibuki Tsuru ◽

Yuta Yamada ◽

...

Keyword(s):

Prostate Cancer ◽

Clinical Decision Making ◽

Temporal Change ◽

Clinical Decision ◽

P Value ◽

Age Group ◽

Continuous Growth ◽

Hand Search ◽

Lifetime Analysis ◽

Ageing Rate

Abstract Prostate cancer is one of the most common malignancies, but a substantial portion remains latent throughout the patients’ lifetime. Analysis of temporal change in the latent prostate cancer pool would be beneficial for clinical decision-making, but longitudinal autopsy studies are rare. We conducted a hand-search of the Annual of Pathological Autopsy Cases in Japan from 1980 to 2016 for cases of latent prostate cancer. Of 570 997 males aged 30 or older, latent prostate cancer was detected in 12 562 patients (2.2%). Proportion of detected cases correlated strongly with ‘aging rate’, the percentage of population aged 65 or older (squared Pearson’s correlation coefficient r2 = 0.972, P value <0.0001). Temporal increase in proportion was also seen in each age group as well. This continuous growth reinforces evidence from past Japanese reports on latent prostate cancer. The rapidly rising ageing rate of Japan may forecast further increase in the latent prostate cancer pool moving forward.

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Preliminary Findings on the Use of Session Questionnaires to Improve Clinician-Client Alliance With Special Consideration to Clinical Education

Perspectives on Administration and Supervision ◽

10.1044/aas25.1.50 ◽

2015 ◽

Vol 25 (1) ◽

pp. 50-60

Author(s):

Anu Subramanian

Keyword(s):

Graduate Students ◽

Clinical Education ◽

Clinical Decision Making ◽

Rating Scale ◽

Treatment Effectiveness ◽

Clinical Decision ◽

Added Value ◽

Therapeutic Outcomes ◽

Specific Feedback ◽

Stakeholder Perspective

ASHA's focus on evidence-based practice (EBP) includes the family/stakeholder perspective as an important tenet in clinical decision making. The common factors model for treatment effectiveness postulates that clinician-client alliance positively impacts therapeutic outcomes and may be the most important factor for success. One strategy to improve alliance between a client and clinician is the use of outcome questionnaires. In the current study, eight parents of toddlers who attended therapy sessions at a university clinic responded to a session outcome questionnaire that included both rating scale and descriptive questions. Six graduate students completed a survey that included a question about the utility of the questionnaire. Results indicated that the descriptive questions added value and information compared to using only the rating scale. The students were varied in their responses regarding the effectiveness of the questionnaire to increase their comfort with parents. Information gathered from the questionnaire allowed for specific feedback to graduate students to change behaviors and created opportunities for general discussions regarding effective therapy techniques. In addition, the responses generated conversations between the client and clinician focused on clients' concerns. Involving the stakeholder in identifying both effective and ineffective aspects of therapy has advantages for clinical practice and education.

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Clinical Decision-Making for Stroke and Aphasia in the Older Adult

Perspectives on Gerontology ◽

10.1044/gero14.1.4 ◽

2009 ◽

Vol 14 (1) ◽

pp. 4-11 ◽

Cited By ~ 1

Author(s):

Jacqueline Hinckley

Keyword(s):

Executive Function ◽

Cerebrovascular Disease ◽

Cognitive Abilities ◽

Clinical Decision Making ◽

Clinical Decision ◽

Cognitive Profile ◽

Focal Lesion ◽

Cognitive Profiles ◽

Supportive Communication ◽

Spaced Retrieval

Abstract A patient with aphasia that is uncomplicated by other cognitive abilities will usually show a primary impairment of language. The frequency of additional cognitive impairments associated with cerebrovascular disease, multiple (silent or diagnosed) infarcts, or dementia increases with age and can complicate a single focal lesion that produces aphasia. The typical cognitive profiles of vascular dementia or dementia due to cerebrovascular disease may differ from the cognitive profile of patients with Alzheimer's dementia. In order to complete effective treatment selection, clinicians must know the cognitive profile of the patient and choose treatments accordingly. When attention, memory, and executive function are relatively preserved, strategy-based and conversation-based interventions provide the best choices to target personally relevant communication abilities. Examples of treatments in this category include PACE and Response Elaboration Training. When patients with aphasia have co-occurring episodic memory or executive function impairments, treatments that rely less on these abilities should be selected. Examples of treatments that fit these selection criteria include spaced retrieval and errorless learning. Finally, training caregivers in the use of supportive communication strategies is helpful to patients with aphasia, with or without additional cognitive complications.

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