scholarly journals 1077 TELP In Urology: Hindrance or A Help During Covid-19 Pandemic? A Closed Loop Audit

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
L Henderson ◽  
E Birse ◽  
S Nalagatla ◽  
S Reid
Keyword(s):  
Closed Loop ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Management Plan ◽  
Health Board ◽  
Emergency Admissions ◽  
Patient Capacity ◽  
Patient Deterioration ◽  
Patient Groups ◽  
Treatment Escalation

Abstract Aim TELP (Treatment Escalation/Limitation Plan) form is a novel clinical decision-making tool introduced during the COVID-19 pandemic in our health board to provide a standardised patient management plan in case of patient deterioration. A closed loop audit of its compliance in Urology patients was performed. Method Patient medical records were analysed over two periods (Cycle 1: 5/10/20 - 11/10/20 and Cycle 2: 23/11/20 – 29/11/20) for all Urology patients in our institution. Cycle 1 audit findings were presented at the Departmental Education Meeting. During Cycle 1, an anonymous questionnaire was sent to all Urology Medical and Nursing staff to gather their opinion on TELP. Results In total 100 patients were analysed. 66 were male and 34 females. Age ranged from 15 to 91 years. TELP form completion rate improved from 48% (Cycle 1) to 68% (Cycle 2), however, correct completion remained poor at 11.1% and 16.7% in Cycle 1 and Cycle 2 respectively. Commonly, there was no reporting of ‘discussion with patient or family’ or ‘patient capacity’. Majority of patients with a completed TELP had one to four underlying co-morbidities and were emergency admissions (65%). The questionnaire reported barriers to compliance including, time for completion, document size, and the feeling it was inappropriate for certain patient groups. Most felt it did not represent patients’ wishes (73%) or improved discussion regarding escalation status (50%). Conclusions TELP forms have sub-optimal correct completion rates and may not always represent patient’s wishes. Inherent barriers to its use need to be addressed, given limited resources during the COVID pandemic.

scholarly journals Serum N-Glycomic Biomarkers Predict Treatment Escalation in Inflammatory Bowel Disease

2021 ◽  
Author(s):  
Archana Shubhakar ◽  
Bas C Jansen ◽  
Alex T. Adams ◽  
Karli R. Reiding ◽  
Nicholas T. Ventham ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
High Performance ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Predictive Capacity ◽  
Cox Proportional Hazard Models ◽  
Independent Replication ◽  
Inflammatory Bowel ◽  
Treatment Escalation

Abstract A blood-based prognostic biomarker to guide clinical decision-making at diagnosis of inflammatory bowel disease (IBD) would be immensely helpful. We investigated a composite serum N-glycomic biomarker to predict future disease course in 244 newly diagnosed IBD patients. Forty-seven individual glycan peaks were analysed using ultra-high performance liquid chromatography identifying 105 glycoforms from which 24 derived glycan traits were calculated. Multivariable logistic regression was performed to determine associations of derived glycan traits with disease. Cox proportional hazard models were used to predict treatment escalation from first-line treatment to biologics or surgery (hazard ratio (HR) 25.9, p = 1.1×10− 12; 95% confidence interval (CI), 8.52–78.78). Application to an independent replication cohort of 54 IBD patients yielded a HR of 5.1 (p = 1.1×10− 5; 95% CI, 2.54–10.1). These data demonstrate the predictive capacity of serum N-glycan biomarkers and represent a step towards personalized medicine in IBD.

The junior doctor's virtual consulting room

2007 ◽  
Vol 13 (1_suppl) ◽  
pp. 65-67 ◽  
Author(s):  
Eleanor Wood ◽  
Alexandra Rankin ◽  
Pasquale Berlingieri ◽  
Owen Epstein
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Management Plan ◽  
Direct Access ◽  
Knowledge Use ◽  
Patient Journey ◽  
Web Based ◽  
Final Destination ◽  
Specialist Knowledge

We assessed the usability of the Virtual Consulting Room (VCR), a Web-based guidance application providing direct access to specialist knowledge. The VCR guides the user through the patient journey from first presentation to final destination. Four pre-registration house officers (PRHOs) were informed of the availability of the VCR which was accessible from all ward computers at the Royal Free Hospital. During a six-week study, 52 patients were assessed by four PRHOs. The VCR was accessed for all 52 patients. A questionnaire was completed in 49 cases (94%). In 43 of the 49 cases (88%), the PRHOs reported that the VCR supported clinical decision-making, and in 46 cases (94%) it improved their knowledge. Use of the VCR altered the PRHOs investigations in 24 cases (49%), changed the management plan in 18 cases (37%) and the decision to refer in 10 cases (20%). The present study showed that the VCR was easy to use, educational, supported clinical decision-making and affected patient management.

scholarly journals Slumped posture on chest X-ray—association with mortality and length of hospital stay in older hospitalised patients

2019 ◽  
Vol 48 (4) ◽  
pp. 588-591
Author(s):  
Aled Lloyd ◽  
Elin Thomas ◽  
Hasan Haboubi
Keyword(s):  
Length Of Stay ◽  
Hospital Stay ◽  
Clinical Decision Making ◽  
Length Of Hospital Stay ◽  
Clinical Decision ◽  
Health Board ◽  
X Ray ◽  
Shortest Distance ◽  
Hospitalised Patients ◽  
Chest X Ray

Abstract Introduction frail, older patients are occasionally incapable of keeping their head out of the field of view of a chest radiograph (CXR) resulting in a ‘slumpogram’. This study aims to explore a possible link between a slumped appearance on a CXR; mortality and length of hospital stay. Methods the CXRs of patients aged over 65 admitted to a Health Board with a catchment area of approximately 300,000 were investigated in a retrospective analysis of all CXRs taken during the first week of January 2015. Slumped patients were compared to age matched controls. The degree of slumping was measured by the number of ribs covered and the MA/C factor (the shortest distance between the angle of the mandible and a line drawn between the heads of both acromion divided by the length of the patient’s clavicle). Outcomes investigated included length of hospital stay and 18-month mortality. Results 806 CXRs were viewed with 53 slumped patients and 53 matched controls identified. In all patients aged over 65 there was a statistically significant correlation between the length of stay and the number of ribs covered by the patients’ head (P = 0.038). The MA/C factor was also associated with length of stay (P = 0.025). In patients over 80 there was a significant association between the number of ribs covered and death (P = 0.015). Conclusion a slumped CXR may be associated with longer hospitalisation or death. The results of this small study require further revalidation but if true could help inform clinical decision making.

Multidisciplinary cancer care

2016 ◽  
pp. 196-208
Author(s):  
David N. Church ◽  
Rachel Kerr ◽  
David J. Kerr
Keyword(s):  
Decision Making ◽  
Patient Outcomes ◽  
Multidisciplinary Team ◽  
Cancer Care ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Healthcare Systems ◽  
Management Plan ◽  
Therapeutic Options ◽  
Western World

Over the last two decades, multidisciplinary team (MDT) working has become an integral part of cancer care in many healthcare systems in the Western world. MDT meetings were established as part of an effort to reduce the fragmented provision of cancer care, and to ensure that each patient receives a management plan based on expert consensus following consideration of all appropriate therapeutic options. Although limited, the available evidence indicates that MDT working is associated with improved patient outcomes, though the associated costs are significant. MDTs are likely to evolve over the coming years through the development of specific software tools to aid clinical decision-making, and through the incorporation of tumour genomics and the personalization of therapy this enables.

Error trawling and fringe decision competence: Ethical hazards in monitoring and address patient decision capacity in clinical practice

2018 ◽  
Vol 13 (3) ◽  
pp. 126-136 ◽  
Author(s):  
Thomas Hartvigsson ◽  
Christian Munthe ◽  
Gun Forsander
Keyword(s):  
Decision Making ◽  
Health Professionals ◽  
Clinical Decision Making ◽  
Treatment Plan ◽  
Clinical Decision ◽  
Video Study ◽  
Patient Capacity ◽  
Patient Decision ◽  
Decision Making Capacity ◽  
Patients With Diabetes

This article addresses how health professionals should monitor and safeguard their patients’ ability to participate in making clinical decisions and making subsequent decisions regarding the implementation of their treatment plan. Patient participation in clinical decision-making is essential, e.g. in self-care, where patients are responsible for most ongoing care. We argue that one common, fact-oriented patient education strategy may in practice easily tend to take a destructive form that we call error trawling. Illustrating with empirical findings from a video study of consultations between clinicians and adolescent patients with diabetes, we argue on independent grounds that this strategy not only risks to overlook significant weaknesses in patient decision competence, but also to undermine patient capacity for decision-making and implementing care. In effect, this strategy for clinically monitoring and addressing the problem of fragile decision-making capacity brings hazards in need of address. We close by suggesting complementary and alternative strategies, and comment on how these may call for broadened competency among clinical health professionals.

Implementation of malignant bowel obstruction multidisciplinary case conferences (MCCs) to improve clinical decision making in malignant bowel obstruction (MBO) in gynecologic oncology.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18322-e18322
Author(s):  
Gita Bhat ◽  
Ainhoa Madariaga ◽  
Luisa Bonilla ◽  
Yeh Chen Lee ◽  
Neesha C. Dhani ◽  
...  
Keyword(s):  
Decision Making ◽  
Interventional Radiology ◽  
Bowel Obstruction ◽  
Clinical Management ◽  
Clinical Decision Making ◽  
Gynecologic Oncology ◽  
Clinical Decision ◽  
Management Plan ◽  
Malignant Bowel Obstruction ◽  
Cancer Centre

e18322 Background: Though patients (pts) with gynecological cancer are at higher risk of MBO, clinical management is not well defined. We implemented a coordinated team approach to evaluate MBO at Princess Margaret Cancer Centre. The Princess Margaret Cancer Centre inter-professional MBO management program includes nurse led ambulatory symptom management, inpatient treatment algorithm, patient directed bowel management education & MCCs. This study evaluates the utility of MBO MCC on clinical decision making in gynecologic oncology. Methods: Monthly MBO MCCs are conducted to discuss complex clinical management issues. A clinical summary is presented prior to the discussion with each case incorporating radiology review followed by interdisciplinary discussion. In this study, the initial management plan was compared to post-MCC consensus. A change in plan was defined as a consensus plan different from the pre-MCC plan or no definite plan prior to MCC. Barriers to implementation of the consensus were analyzed. Results: From December 2016 to November 2018, 90 pts were discussed in 22 MCCs. Of these, 60 had high grade serous ovarian carcinoma (67%) & 64 had small bowel obstruction (71%). Discussion in MCCs lead to a change in management plan in 49 cases(54%). These changes included recommendations for palliative surgery (25%) or radiation (10%), interventional radiology (23%), pharmacologic management alone (14%), imaging studies (4%) & total parenteral nutrition (TPN) (4%). Chemotherapy continuation, break or regimen changes were recommended in 20%. MCC consensus plan could not be implemented in 11 cases (23%). The barriers were refusal of surgery (8%), interventional radiology procedures (2%), TPN (4%) by patients, functional decline (6%) & inability to create a colostomy due to dense adhesions (2%). During MCC referrals to the dietitian & palliative care team were planned for 16 (18%) & 22 (24%) pts respectively. Conclusions: Interdisciplinary MBO MCCs have a significant impact on decision making in complex MBO cases. Radiology review & group discussion facilitates greater clarity in formulation of a management plan.

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

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.

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

2009 ◽  
Vol 14 (1) ◽  
pp. 4-11 ◽  
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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