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

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.

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

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Md. Hasnat Ali ◽  
Brian Wainwright ◽  
Alexander Petersen ◽  
Ganesh B. Jonnadula ◽  
Meghana Desai ◽  
...  
Keyword(s):  
Structural Damage ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Structural Heterogeneity ◽  
Age Group ◽  
Multiple Sources ◽  
Modeling And Analysis ◽  
Functional Clustering ◽  
Neuroretinal Rim ◽  
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 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.

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

2019 ◽  
Vol 40 (03) ◽  
pp. 151-161 ◽  
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.

Integrating research and evidence-based guidance into prescribing practice

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

Neuralgic amyotrophy: a paradigm shift in diagnosis and treatment

2020 ◽  
Vol 91 (8) ◽  
pp. 879-888 ◽  
Author(s):  
Clemens Gstoettner ◽  
Johannes A Mayer ◽  
Stephanie Rassam ◽  
Laura A Hruby ◽  
Stefan Salminger ◽  
...  
Keyword(s):  
High Resolution ◽  
Peripheral Nerve ◽  
Clinical Decision Making ◽  
Current Knowledge ◽  
Treatment Options ◽  
Treatment Algorithm ◽  
Clinical Decision ◽  
Neuralgic Amyotrophy ◽  
Positive Effects ◽  
Nerve Surgery

Neuralgic amyotrophy (NA), also known as Parsonage-Turner syndrome, is characterised by sudden pain attacks, followed by patchy muscle paresis in the upper extremity. Recent reports have shown that incidence is much higher than previously assumed and that the majority of patients never achieve full recovery. Traditionally, the diagnosis was mainly based on clinical observations and treatment options were confined to application of corticosteroids and symptomatic management, without proven positive effects on long-term outcomes. These views, however, have been challenged in the last years. Improved imaging methods in MRI and high-resolution ultrasound have led to the identification of structural peripheral nerve pathologies in NA, most notably hourglass-like constrictions. These pathognomonic findings have paved the way for more accurate diagnosis through high-resolution imaging. Furthermore, surgery has shown to improve clinical outcomes in such cases, indicating the viability of peripheral nerve surgery as a valuable treatment option in NA. In this review, we present an update on the current knowledge on this disease, including pathophysiology and clinical presentation, moving on to diagnostic and treatment paradigms with a focus on recent radiological findings and surgical reports. Finally, we present a surgical treatment algorithm to support clinical decision making, with the aim to encourage translation into day-to-day practice.

Integrating research and evidence-based guidance into prescribing practice

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

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 checklists and research reporting tools.

scholarly journals Recommendations of the Russian Gastroenterological Association on Clinical Use of High-Resolution Manometry in Diagnosis of Esophageal Disorders

2020 ◽  
Vol 30 (3) ◽  
pp. 61-88 ◽  
Author(s):  
V. T. Ivashkin ◽  
I. V. Mayev ◽  
A. S. Trukhmanov ◽  
O. A. Storonova ◽  
S. A. Abdulkhakov ◽  
...  
Keyword(s):  
High Resolution ◽  
Motor Function ◽  
Clinical Data ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Upper Esophageal Sphincter ◽  
Motor Disorders ◽  
Clinical Use ◽  
High Resolution Manometry ◽  
Esophageal Sphincter

Aim. Current recommendations of the Russian Gastroenterological Association on clinical use of high-resolution manometry in diagnosis of esophageal disorders are intended to assist in clinical decision making, terminology standardisation and interpretation of clinical data.Key points. In 2018, a joint meeting of the Russian Gastroenterological Association and Russian Neurogastroenterology and Motility Group approved unified terminology and classification of esophageal motor function disorders for high-resolution manometry diagnosis.Gastrointestinal patient complaints typically concern esophageal disorders such as dysphagia, regurgitation, heart-burn, chest pain or belching. To exclude erosive and ulcerative lesions, eosinophilic esophagitis and organic changes, esophagogastroduodenoscopy and biopsy are recommended in pre-treatment. Upon excluding mucosal lesions and esophageal lumen obstruction as causal for symptoms, use of high-resolution manometry is recommended. This method of esophageal examination has become the “gold standard” in diagnosis of motor disorders.High-resolution manometry enables detailed investigation of integral quantitative and qualitative characteristics of esophagus motor function and specific related disorders, analysis of esophageal contractile propagation and strictly coordinated synchronous peristalsis of upper esophageal sphincter, esophagus and lower esophageal sphincter, which malfunction may provoke development of achalasia, esophagospasm, hiatal hernia, ineffective eso pha geal motility and other motor disorders.Conclusion. High-resolution manometry is a relatively new method for study of esophagus motor function gaining increasingly wide application in clinical practice. It enables a medical professional to obtain evidence that may critically affect the choice of optimal patient care strategy and effective treatment. Current recommendations are based on an extensive review of up-to-date information and will be updated with new corpus of clinical data and assessment emerging in evidential medicine to provide gastroenterologists country-wide with latest scientific and practical guidelines.

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

2019 ◽  
Vol 25 (3) ◽  
pp. 500-510 ◽  
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.

Sonography versus Plain x Rays in Diagnosis of Nasal Fractures

2008 ◽  
Vol 22 (6) ◽  
pp. 613-616 ◽  
Author(s):  
Robert Giirkov ◽  
Eike Krause ◽  
Dirk Clevert
Keyword(s):  
High Resolution ◽  
Clinical Decision Making ◽  
High Sensitivity ◽  
Clinical Decision ◽  
Diagnostic Value ◽  
Lateral Nasal Wall ◽  
X Rays ◽  
Imaging Procedure ◽  
High Resolution Ultrasonography ◽  
Nasal Fractures

Background The standard imaging procedure for suspected nasal fractures has been radiography (XR). However, its usefulness for clinical decision making is highly controversial. High-resolution ultrasonography now offers a promising new diagnostic imaging option. In this study we compared the diagnostic value of high-resolution ultrasonography and conventional XR in the evaluation of suspected nasal fractures. Methods A prospective single-blinded study was performed. Ultrasound (US) and XR findings in 80 patients with suspected nasal fractures were compared with the definite clinical diagnosis with respect to sensitivity, specificity, and accuracy. Results For detection of fractures of the nasal dorsum, both modalities had high sensitivity (98 and 88% for US and XR, respectively) and specificity (95% for both US and XR). In lateral nasal wall fractures, specificity was higher for XR (75% versus 94%). Sensitivity was significantly higher for the US examination (98% versus 28%). In summary, the accuracy was higher for US. Conclusion When available, US should be the first-line imaging procedure in the evaluation of nasal fractures.

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

2020 ◽  
Vol 29 (4) ◽  
pp. 2155-2169 ◽  
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.

Sign in / Sign up

Export Citation Format

Share Document