scholarly journals Differences in spatial distribution between WHO 2016 low-grade glioma molecular subgroups

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Maarten M J Wijnenga ◽  
Sebastian R van der Voort ◽  
Pim J French ◽  
Stefan Klein ◽  
Hendrikus J Dubbink ◽  
...  
Keyword(s):  
Decision Making ◽  
Spatial Distribution ◽  
Clinical Decision Making ◽  
Tumor Volume ◽  
Right Hemisphere ◽  
Clinical Decision ◽  
Low Grade Glioma ◽  
Low Grade ◽  
Wild Type ◽  
Significant Difference

Abstract Background Several studies reported a correlation between anatomic location and genetic background of low-grade gliomas (LGGs). As such, tumor location may contribute to presurgical clinical decision-making. Our purpose was to visualize and compare the spatial distribution of different WHO 2016 gliomas, frequently aberrated single genes and DNA copy number alterations within subgroups, and groups of postoperative tumor volume. Methods Adult grade II glioma patients (WHO 2016 classified) diagnosed between 2003 and 2016 were included. Tumor volume and location were assessed with semi-automatic software. All volumes of interest were mapped to a standard reference brain. Location heatmaps were created for each WHO 2016 glioma subgroup, frequently aberrated single genes and copy numbers (CNVs), as well as heatmaps according to groups of postoperative tumor volume. Differences between subgroups were determined using voxelwise permutation testing. Results A total of 110 IDH mutated astrocytoma patients, 92 IDH mutated and 1p19q co-deleted oligodendroglioma patients, and 22 IDH wild-type astrocytoma patients were included. We identified small regions in which specific molecular subtypes occurred more frequently. IDH-mutated LGGs were more frequently located in the frontal lobes and IDH wild-type tumors more frequently in the basal ganglia of the right hemisphere. We found no localizations of significant difference for single genes/CNVs in subgroups, except for loss of 9p in oligodendrogliomas with a predilection for the left parietal lobes. More extensive resections in LGG were associated with frontal locations. Conclusions WHO low-grade glioma subgroups show differences in spatial distribution. Our data may contribute to presurgical clinical decision-making in LGG patients.

scholarly journals Impact of the revised WHO classification of diffuse low-grade glioma on clinical decision making: A case report

2017 ◽  
Vol 8 (1) ◽  
pp. 223 ◽  
Author(s):  
TimA. M. Bouwens van der Vlis ◽  
Ann Hoeben ◽  
JanC Beckervordersandforth ◽  
Linda Ackermans ◽  
DaniëlleB. P. Eekers ◽  
...  
Keyword(s):  
Decision Making ◽  
Case Report ◽  
Who Classification ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Low Grade Glioma ◽  
Low Grade

scholarly journals Predicting mortality in adults with suspected infection in a Rwandan hospital: an evaluation of the adapted MEWS, qSOFA and UVA scores

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e040361
Author(s):  
Amanda Klinger ◽  
Ariel Mueller ◽  
Tori Sutherland ◽  
Christophe Mpirimbanyi ◽  
Elie Nziyomaze ◽  
...  
Keyword(s):  
Decision Making ◽  
Quality Improvement ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Tertiary Hospital ◽  
Early Warning Score ◽  
Receiver Operating Curve ◽  
Predictive Capacity ◽  
Suspected Infection ◽  
Significant Difference

RationaleMortality prediction scores are increasingly being evaluated in low and middle income countries (LMICs) for research comparisons, quality improvement and clinical decision-making. The modified early warning score (MEWS), quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA), and Universal Vital Assessment (UVA) score use variables that are feasible to obtain, and have demonstrated potential to predict mortality in LMIC cohorts.ObjectiveTo determine the predictive capacity of adapted MEWS, qSOFA and UVA in a Rwandan hospital.Design, setting, participants and outcome measuresWe prospectively collected data on all adult patients admitted to a tertiary hospital in Rwanda with suspected infection over 7 months. We calculated an adapted MEWS, qSOFA and UVA score for each participant. The predictive capacity of each score was assessed including sensitivity, specificity, positive and negative predictive value, OR, area under the receiver operating curve (AUROC) and performance by underlying risk quartile.ResultsWe screened 19 178 patient days, and enrolled 647 unique patients. Median age was 35 years, and in-hospital mortality was 18.1%. The proportion of data missing for each variable ranged from 0% to 11.7%. The sensitivities and specificities of the scores were: adapted MEWS >4, 50.4% and 74.9%, respectively; qSOFA >2, 24.8% and 90.4%, respectively; and UVA >4, 28.2% and 91.1%, respectively. The scores as continuous variables demonstrated the following AUROCs: adapted MEWS 0.69 (95% CI 0.64 to 0.74), qSOFA 0.65 (95% CI 0.60 to 0.70), and UVA 0.71 (95% CI 0.66 to 0.76); there was no statistically significant difference between the discriminative capacities of the scores.ConclusionThree scores demonstrated a modest ability to predict mortality in a prospective study of inpatients with suspected infection at a Rwandan tertiary hospital. Careful consideration must be given to their adequacy before using them in research comparisons, quality improvement or clinical decision-making.

Standardized Synoptic Cancer Pathology Reports — So What and Who Cares?: A Population-Based Satisfaction Survey of 970 Pathologists, Surgeons, and Oncologists

2013 ◽  
Vol 137 (11) ◽  
pp. 1599-1602 ◽  
Author(s):  
Sara Lankshear ◽  
John Srigley ◽  
Thomas McGowan ◽  
Marta Yurcan ◽  
Carol Sawka
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Physician Satisfaction ◽  
Cross Sectional ◽  
Cancer Pathology ◽  
Report Turnaround Time ◽  
Significant Difference ◽  
Pathology Reporting ◽  
The Impact

Context.—Cancer Care Ontario implemented synoptic pathology reporting across Ontario, impacting the practice of pathologists, surgeons, and medical and radiation oncologists. The benefits of standardized synoptic pathology reporting include enhanced completeness and improved consistency in comparison with narrative reports, with reported challenges including increased workload and report turnaround time. Objective.—To determine the impact of synoptic pathology reporting on physician satisfaction specific to practice and process. Design.—A descriptive, cross-sectional design was utilized involving 970 clinicians across 27 hospitals. An 11-item survey was developed to obtain information regarding timeliness, completeness, clarity, and usability. Open-ended questions were also employed to obtain qualitative comments. Results.—A 51% response rate was obtained, with descriptive statistics reporting that physicians perceive synoptic reports as significantly better than narrative reports. Correlation analysis revealed a moderately strong, positive relationship between respondents' perceptions of overall satisfaction with the level of information provided and perceptions of completeness for clinical decision making (r = 0.750, P < .001) and ease of finding information for clinical decision making (r = 0.663, P < .001). Dependent t tests showed a statistically significant difference in the satisfaction scores of pathologists and oncologists (t169 = 3.044, P = .003). Qualitative comments revealed technology-related issues as the most frequently cited factor impacting timeliness of report completion. Conclusion.—This study provides evidence of strong physician satisfaction with synoptic cancer pathology reporting as a clinical decision support tool in the diagnosis, prognosis, and treatment of cancer patients.

CytoProcessorTM: A New Cervical Cancer Screening System for Remote Diagnosis

2019 ◽  
Vol 63 (3) ◽  
pp. 215-223 ◽  
Author(s):  
Elizabeth Faris Crowell ◽  
Cyril Bazin ◽  
François Saunier ◽  
Romain Brixtel ◽  
Yann Caillot ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Imaging System ◽  
Virtual Slide ◽  
Clinical Decision ◽  
Diagnostic Sensitivity ◽  
Low Grade ◽  
Remote Diagnosis ◽  
Automated Screening ◽  
Screening Systems

Background: Current automated cervical cytology screening systems still heavily depend on manipulation of glass slides. We developed a new system called CytoProcessorTM (DATEXIM, Caen, France), which increases sensitivity and takes advantage of virtual slide technology to simplify the workflow and save worker time. We used an approach based on artificial intelligence to identify abnormal cells among the tens of thousands in a cervical preparation. Objectives: We set out to compare the diagnostic sensitivity and specificity of CytoProcessorTM and the ThinPrep Imaging System (HOLOGIC, Marlborough, MA, USA). Methods: A representative population of 1,352 cases was selected from the routine workflow in a private laboratory. Diagnoses were established using the ThinPrep Imaging System and CytoProcessorTM. All discordances were resolved by a consensus committee. Results: Compared to the ThinPrep Imaging System, CytoProcessorTM significantly improves diagnostic sensitivity without compromising specificity. The sensitivity of detection of “atypical squamous cells of undetermined significance (ASC-US) and more severe” and “low-grade squamous intraepithelial lesion and more severe” was significantly higher using CytoProcessorTM. Considering that cases with a truth diagnosis of ASC-US or more severe required clinical follow-up, 1.5% of the cases (21/1,360) would have been missed if the CytoProcessorTM diagnosis had been used for clinical decision-making. In contrast, 4% of the cases (54/1,360) were missed when the ThinPrep Imaging System diagnosis was used for clinical decision-making. There were 2.6 times fewer false negatives using CytoProcessorTM. The CytoProcessorTM workflow was 1.5 times faster in terms of worker time. Conclusions: CytoProcessorTM is the first of a new generation of automated screening systems, demonstrating improved sensitivity and yielding significant gains in processing time. In addition, the fully digital nature of slide presentation in CytoProcessorTM allows the remote diagnosis of Papanicolaou tests for the first time.

scholarly journals Comprehensive Genomic Analysis in NRG Oncology/RTOG 9802: A Phase III Trial of Radiation Versus Radiation Plus Procarbazine, Lomustine (CCNU), and Vincristine in High-Risk Low-Grade Glioma

2020 ◽  
Vol 38 (29) ◽  
pp. 3407-3417 ◽  
Author(s):  
Erica H. Bell ◽  
Peixin Zhang ◽  
Edward G. Shaw ◽  
Jan C. Buckner ◽  
Geoffrey R. Barger ◽  
...  
Keyword(s):  
High Risk ◽  
Low Grade Glioma ◽  
Phase Iii ◽  
Adjuvant Chemoradiotherapy ◽  
Rank Test ◽  
Low Grade ◽  
Wild Type ◽  
450K Array ◽  
Significant Difference ◽  
Post Hoc

PURPOSE NRG Oncology/RTOG 9802 (ClinicalTrials.gov Identifier: NCT00003375 ) is a practice-changing study for patients with WHO low-grade glioma (LGG, grade II), as it was the first to demonstrate a survival benefit of adjuvant chemoradiotherapy over radiotherapy. This post hoc study sought to determine the prognostic and predictive impact of the WHO-defined molecular subgroups and corresponding molecular alterations within NRG Oncology/RTOG 9802. METHODS IDH1/2 mutations were determined by immunohistochemistry and/or deep sequencing. A custom Ion AmpliSeq panel was used for mutation analysis. 1p/19q codeletion and MGMT promoter methylation were determined by copy-number arrays and/or Illumina 450K array, respectively. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Hazard ratios (HRs) were calculated using the Cox proportional hazard model and tested using the log-rank test. Multivariable analyses (MVAs) were performed incorporating treatment and common prognostic factors as covariates. RESULTS Of the eligible patients successfully profiled for the WHO-defined molecular groups (n = 106/251), 26 (24%) were IDH-wild type, 43 (41%) were IDH-mutant/non-codeleted, and 37(35%) were IDH-mutant/codeleted. MVAs demonstrated that WHO subgroup was a significant predictor of PFS after adjustment for clinical variables and treatment. Notably, treatment with postradiation chemotherapy (PCV; procarbazine, lomustine (CCNU), and vincristine) was associated with longer PFS (HR, 0.32; P = .003; HR, 0.13; P < .001) and OS (HR, 0.38; P = .013; HR, 0.21; P = .029) in the IDH-mutant/non-codeleted and IDH-mutant/codeleted subgroups, respectively. In contrast, no significant difference in either PFS or OS was observed with the addition of PCV in the IDH-wild-type subgroup. CONCLUSION This study is the first to report the predictive value of the WHO-defined diagnostic classification in a set of uniformly treated patients with LGG in a clinical trial. Importantly, this post hoc analysis supports the notion that patients with IDH-mutant high-risk LGG regardless of codeletion status receive benefit from the addition of PCV.

scholarly journals Influence of breast reconstruction on technical aspects of echocardiographic image acquisition compared with physician-assessed image quality

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Joaquin Duarte Ow ◽  
Mohamad Hemu ◽  
Anel Yakupovich ◽  
Parva Bhatt ◽  
Hannah Gaddam ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Image Quality ◽  
Cardiac Function ◽  
Breast Reconstruction ◽  
Clinical Decision Making ◽  
Image Acquisition ◽  
Clinical Decision ◽  
Echocardiographic Image ◽  
Significant Difference

Abstract Introduction Assessment of cardiac function after treatment for breast cancer relies on interval evaluation of ventricular function through echocardiography. Women who undergo mastectomy more frequently choose to undergo breast reconstruction with implant. This could impede assessment of cardiac function in those with left-sided implant. We aimed to examine whether left-sided breast reconstruction with tissue expanders (TE) affect echo image acquisition and quality, possibly affecting clinical decision-making. Methods A retrospective case-control study was conducted in 190 female breast cancer patients who had undergone breast reconstruction with TE at an urban academic center. Echocardiographic technical assessment and image quality were respectively classified as excellent/good or adequate/technically difficult by technicians; and excellent/good or adequate/poor by 2 board-certified cardiologist readers. Likelihood ratio was used to test multivariate associations between image quality and left-sided TE. Results We identified 32 women (81.3% white; mean age 48 years) with left-sided/bilateral TE, and 158 right-sided/no TE (76.6% white, mean age 57 years). In multivariable analyses, we found a statistically significant difference in technician-assessed difficulty in image acquisition between cases and controls (p = 0.01); but no differences in physician-assessed image quality between cases and controls (p = 0.09, Pearson’s r = 0.467). Conclusions Left-sided breast TE appears to affect the technical difficulty of echo image acquisition, but not physician-assessed echo image quality. This likely means that echo technicians absorb most of the impediments associated with imaging patients with breast TE such that the presence of TE has no bearing on downstream clinical decision-making associated with echo image quality.

scholarly journals 1157. Determining the Clinical Utility of 16S rRNA in the Management of Pediatric Infections

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S670-S670
Author(s):  
Peter Paul Lim ◽  
Ankita P Desai ◽  
Sree Sarah Cherian ◽  
Sindhoosha Malay
Keyword(s):  
Decision Making ◽  
16S Rrna ◽  
Clinical Utility ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Joint Fluid ◽  
Significant Difference ◽  
Pediatric Infections ◽  
Tissue Specimens ◽  
Antimicrobial Regimen

Abstract Background Conventional culture remains the gold standard to facilitate a targeted antimicrobial regimen in the treatment of bacterial infections. However, certain pediatric infections are caused by fastidious organisms and treatment with antibiotics prior to specimen collection may hamper growth of pathogens in routine culture. The use of 16S rRNA in culture negative infections has improved identification of bacterial pathogens in select scenarios. However, the specific impact of 16S rRNA on clinical decision making, especially in pediatric infections, is not well-defined. This study aims to elucidate the utility of 16S rRNA on clinical management of pediatric infections. Methods A retrospective analysis was done on different clinical specimens which had 16S rRNA performed from August 2016 – March 2020 in our institution. Detailed chart review was performed to determine how the 16S rRNA result impacted clinical decision making. Clinical utility was defined as change in patient’s overall antimicrobial regimen, pathogen confirmation, and treatment duration. Results Seventy-four samples from 71 pediatric patients were included in the analysis: 32 (43%) were fluid specimens and 42 (57%) were tissue specimens. Significant clinical utility was identified in 30 (40.5%) of 74 clinical samples (p &lt; 0.0001). Of all specimens, pulmonary samples yielded the most clinical utility (n=9, 30%) followed equally by joint fluid (n=6, 20%) and bone (n=6, 20%). There was no significant difference in clinical utility between fluid and tissue specimens (p= 0.346). In 64 patients whose antimicrobial spectrum coverage was analyzed, patients with broad spectrum coverage was decreased from 48 to 21 and narrow spectrum coverage increased from 16 to 43 using 16S rRNA result, though not significant (p= 0.4111). Of all patients included in the analysis, the median number of antibiotics used before 16S rRNA result, 2, was significantly decreased to 1 (p &lt; 0.0001). Conclusion 16S rRNA has a significant impact in terms of decreasing number of antibiotics used in treatment of pediatric infections. Pulmonary specimens have the highest clinical utility among all samples. Additional cost benefit analysis needs to be completed to further determine clinical benefit. Disclosures All Authors: No reported disclosures

scholarly journals Molecular Markers for Bladder Cancer Screening, Early Diagnosis, and Surveillance: The WHO/ICUD Consensus

2014 ◽  
Vol 94 (1) ◽  
pp. 1-24 ◽  
Author(s):  
Bernd J. Schmitz-Dräger ◽  
Michael Droller ◽  
Vinata B. Lokeshwar ◽  
Yair Lotan ◽  
M''Liss A. Hudson ◽  
...  
Keyword(s):  
Decision Making ◽  
Bladder Cancer ◽  
Molecular Markers ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Urine Cytology ◽  
Added Value ◽  
Current Status ◽  
Low Grade ◽  
Screening And Surveillance

Due to the lack of disease-specific symptoms, diagnosis and follow-up of bladder cancer has remained a challenge to the urologic community. Cystoscopy, commonly accepted as a gold standard for the detection of bladder cancer, is invasive and relatively expensive, while urine cytology is of limited value specifically in low-grade disease. Over the last decades, numerous molecular assays for the diagnosis of urothelial cancer have been developed and investigated with regard to their clinical use. However, although all of these assays have been shown to have superior sensitivity as compared to urine cytology, none of them has been included in clinical guidelines. The key reason for this situation is that none of the assays has been included into clinical decision-making so far. We reviewed the current status and performance of modern molecular urine tests following systematic analysis of the value and limitations of commercially available assays. Despite considerable advances in recent years, the authors feel that at this stage the added value of molecular markers for the diagnosis of urothelial tumors has not yet been identified. Current data suggest that some of these markers may have the potential to play a role in screening and surveillance of bladder cancer. Well-designed protocols and prospective, controlled trials will be needed to provide the basis to determine whether integration of molecular markers into clinical decision-making will be of value in the future.

scholarly journals Enhancing Student Knowledge of Diabetes through Virtual Choose Your Own Adventure Patient Case Format

Pharmacy ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 87
Author(s):  
Tyler Marie Kiles ◽  
Elizabeth A. Hall ◽  
Devin Scott ◽  
Alina Cernasev
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Diabetes Management ◽  
Group Discussion ◽  
Clinical Decision ◽  
Pharmacy Students ◽  
Patient Case ◽  
Student Knowledge ◽  
Innovative Teaching ◽  
Significant Difference

Educational strategies to teach pharmacy students about diabetes are necessary to prepare future pharmacists to manage complex patients. The Choose Your Own Adventure (CYOA) patient case format is an innovative activity that presents a patient case in an engaging way. The objectives of this study were (1) to describe the development of the innovative teaching activity and (2) to assess its effect on student knowledge and confidence in outpatient management of diabetes. The CYOA patient case activity was designed by transforming a traditional paper patient case involving outpatient diabetes management into an interactive format utilizing an online platform. The activity was conducted with 186 second-year pharmacy students in a skills-based course. This activity was administered virtually through a combination of small group work and large group discussion. After completion of the activity, students completed an online self-assessment questionnaire. Of 178 completed questionnaires, there was a statistically significant difference in students’ self-ratings after versus before the activity for all survey items (p < 0.001). The CYOA activity improved self-reported knowledge of outpatient diabetes management and increased self-reported confidence in clinical decision-making skills. This format shows promise as an educational tool that may be adapted for other disease states to enhance clinical decision-making skills.

scholarly journals The Development and Effect of a Simulation Education Program Based on the Korean Triage and Acuity Scale (KTAS)

2020 ◽  
Author(s):  
Jae-Hyuk Jang ◽  
Sang Suk Kim ◽  
Sunghee Kim
Keyword(s):  
Job Satisfaction ◽  
Decision Making ◽  
Education Program ◽  
Clinical Decision Making ◽  
Customer Orientation ◽  
Medical Center ◽  
Clinical Decision ◽  
Simulation Education ◽  
Emergency Medical ◽  
Significant Difference

This study focused on the development and implementation of an educational simulation program based on Korean Triage and Acuity Scale (KTAS) for nurses in emergency medical centers who completed KTAS training. We also examined its educational effects based on the evaluation of clinical decision-making ability, job satisfaction, and customer orientation. The study participants were 30 nurses in the emergency medical center of a general hospital. Data were collected from May 3 to 24, 2017, and analyzed using SPSS 22.0. There was a significant difference in the mean scores in clinical decision-making ability, job satisfaction, and customer orientation before and after simulation education. In other words, emergency nurses who received KTAS-based simulation education program improved their clinical decision making ability, job satisfaction, and customer orientation. Based on the results of this study, it is expected that it can be used for KTAS education, and it was found that simulation-based education is a useful learning method for triage nurses in emergency medical center.

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