scholarly journals An Electronic Clinical Decision-Making Tool for Patients with Suspected Colorectal Cancer—Preliminary Evaluation in Patients Presenting with Rectal Bleeding

2019 ◽  
Vol 3 (5) ◽  
pp. 204-209
Author(s):  
Nauzer Forbes ◽  
Mohan Cooray ◽  
Michael Hackett ◽  
Nishwa Shah ◽  
Yuhong Yuan ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Decision Making ◽  
Rectal Bleeding ◽  
Test Performance ◽  
Clinical Decision Making ◽  
A Priori ◽  
Clinical Decision ◽  
Preliminary Evaluation ◽  
Clinical Criteria ◽  
Urgent Referral

Abstract Background and Objectives The CarePath-CRC electronic clinical decision-making application was designed to assist physicians with evaluation of patients with suspected colorectal cancer (CRC). The physician completes an interactive checklist of evidence-based clinical parameters, and a recommended referral urgency is generated based on the post-test probability of CRC. This study aimed toward validation of the tool in symptomatic patients presenting with rectal bleeding. Methods The medical records of a sample of patients with histologically confirmed CRC from 2010 to 2014 were reviewed. The CarePath-CRC tool was applied retrospectively to all patients who initially presented with rectal bleeding, to determine its sensitivity for detecting CRC in this population. A generated recommendation of ‘immediate referral’ (referral ≤24 hours, expected endoscopy ≤2 weeks) or ‘urgent referral’ (expected consultation and endoscopy ≤4 and ≤8 weeks) was considered a positive test result. An a priori sensitivity of 90% was deemed adequate, based on test characteristics of the tool’s individual clinical criteria. Results The tool was applied to 281 patients. A total of 69 (24.6%) and 211 (75.1%) patients met criteria for immediate and urgent referral, respectively. The remaining patient (0.4%) met criteria for ‘possible priority referral’, while none met criteria for ‘no specific action recommended’. This resulted in a calculated sensitivity of 99.6% (95% confidence interval 98.0 to 99.9%). Conclusions The CarePath-CRC tool is sensitive in the prediction of CRC in patients presenting with rectal bleeding. A prospective cohort study is being designed to allow for acquisition of comprehensive test performance characteristics and full validation of the instrument.

Highly specific detection of KRAS single nucleotide polymorphism by asymmetric PCR/SERS assay

The Analyst ◽  
2021 ◽  
Author(s):  
Nana Lyu ◽  
Vinoth Kumar Rajendran ◽  
Jun Li ◽  
Alexander Engel ◽  
Mark P. Molloy ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Nucleotide Polymorphism ◽  
Asymmetric Pcr ◽  
Specific Detection ◽  
Kras Mutations ◽  
Single Nucleotide ◽  
The Common

The molecular diagnosis of KRAS mutations has become crucial for clinical decision-making in colorectal cancer (CRC) treatments. Currently, the common methods for detecting mutations are based on quantitative PCR, DNA...

scholarly journals Empowering Clinical Decision Making in Oligometastatic Colorectal Cancer: The Potential Role of Drug Screening of Patient-Derived Organoids

2021 ◽  
pp. 1192-1199
Author(s):  
Gianluca Mauri ◽  
Erika Durinikova ◽  
Alessio Amatu ◽  
Federica Tosi ◽  
Andrea Cassingena ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Decision Making ◽  
Drug Screening ◽  
Potential Role ◽  
Clinical Decision Making ◽  
Clinical Decision

scholarly journals Evaluation of a clinical decision-making aid for nutrition advice in age-related macular degeneration

2017 ◽  
Vol 35 (3) ◽  
pp. 185-196 ◽  
Author(s):  
Rebekah Stevens ◽  
Hannah Bartlett ◽  
Richard Cooke
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Central Area ◽  
Clinical Decision ◽  
Age Related Macular Degeneration ◽  
Preliminary Evaluation ◽  
Eye Care ◽  
Eligibility Criteria ◽  
Age Related ◽  
Clinical Scenarios

Age-related macular disease (AMD) is a multifactorial degenerative condition affecting the central area of the retina. Patients with AMD report that eye care practitioners are not giving consistent advice regarding nutrition and reported confusion as to what advice, if any, to follow. The aim of this study was to design and conduct a preliminary evaluation of a flowchart to support eye care practitioners in providing accurate, evidence-based nutritional advice to their patients. A flowchart was designed to take practitioners through a decision-making process that would determine whether a patient matched the Age-Related Eye Disease Study (AREDS) 2 eligibility criteria for supplementation. The flowchart was evaluated using a qualified and student optometrist cohort, with both cohorts completing confidence scales and students completing clinical scenarios. Qualified participants showed a significant increase in confidence scores from the initial survey ( M = 69.7%, standard deviation [ SD] = 16.2%) to the second survey after use of the flowchart for 2 weeks ( M = 82.1%, SD = 11.6%; t(45) = 7.33, p < .001; rs = .61, p < .001). The student participants also increased confidence scored after receiving the flowchart ( M of first survey = 41.7, SD = 14.6; M of second survey = 69.1, SD = 1.7; t(25) = 7.92, d = .81, p < .001) and increased the number of correct answers on five clinical scenarios. Overall, the flowchart has proved to be useful in boosting the self-efficacy of both qualified practitioners and student practitioners, as well as improving clinical decisions made by student practitioners.

scholarly journals Risk assessment and clinical decision making for colorectal cancer screening

2013 ◽  
Vol 18 (5) ◽  
pp. 1327-1338 ◽  
Author(s):  
Paul C. Schroy ◽  
Sarah E. Caron ◽  
Bonnie J. Sherman ◽  
Timothy C. Heeren ◽  
Tracy A. Battaglia
Keyword(s):  
Colorectal Cancer ◽  
Risk Assessment ◽  
Decision Making ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
Clinical Decision Making ◽  
Clinical Decision

scholarly journals Recent developments in the treatment of metastatic colorectal cancer

2017 ◽  
Vol 9 (8) ◽  
pp. 551-564 ◽  
Author(s):  
Jonathan M. Loree ◽  
Scott Kopetz
Keyword(s):  
Colorectal Cancer ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Growth Factor Receptor ◽  
Low Frequency ◽  
Clinical Decision ◽  
Tumor Location ◽  
Targeted Agents ◽  
Braf Mutations ◽  
Exon 2

Over the past decade there have been significant advances in the molecular characterization of colorectal cancer (CRC) that are driving treatment decisions. Expanded RAS testing beyond KRAS exon 2 was established as crucial for identifying patients who will respond to anti-epidermal growth factor receptor (EGFR) therapies and low-frequency mutations in RAS/tumor heterogeneity are gaining recognition as potential mechanisms of resistance. Despite this progress, the fact that we do not understand why left-sided but not right-sided tumors have improved outcomes following anti-EGFR therapy highlights our superficial understanding of this disease. Even with few new targeted agents receiving approval in CRC, the incorporation of next-generation sequencing into clinical decision making represents an important step forward. Biomarkers such as BRAF mutations, microsatellite instability, and HER2 amplification represent promising molecular aberrations with therapies in various stages of development, and highlight the importance of companion diagnostics in supporting targeted agents. In this review, we will discuss the importance of incorporating biomarkers into clinical decision making and regimen selection in CRC. We will particularly focus on the recent evidence suggesting an important role for tumor location in selecting first-line therapy, the importance of recent advances in biomarker development and molecular subtyping, as well as recently approved agents (regorafenib and TAS-102) and promising targeted agents that have the potential to change the standard of care.

Integrating Biomarkers and Targeted Therapy Into Colorectal Cancer Management

2019 ◽  
pp. 207-215 ◽  
Author(s):  
Christopher H. Lieu ◽  
Ryan B. Corcoran ◽  
Michael J. Overman
Keyword(s):  
Colorectal Cancer ◽  
Decision Making ◽  
Clinical Trials ◽  
Targeted Therapy ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Prognostic Indicators ◽  
Molecular Characteristics ◽  
Cancer Management ◽  
The Past

There have been substantial advances in the treatment of metastatic colorectal cancer (mCRC) over the past 15 years. Molecular characteristics of mCRC and identification of specific mutations can serve as predictive and prognostic indicators of disease and response to targeted therapies. When incorporated into clinical decision-making, these biomarkers can serve as critical tools in personalizing therapy to ensure the best outcomes. Additional improvements in the survival of patients with mCRC will be made possible with the identification of new predictive molecular biomarkers and their evaluation using rational and innovative clinical trials.

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