Characterizing Potential Conflicts of Interest Among UpToDate and DynaMed Content Contributors

BACKGROUND: Financial conflicts of interest among physicians have the potential to negatively impact patient care. Physicians contribute content to two popular, evidence-based websites, UpToDate and DynaMed; while other physicians use these websites to influence their clinical decision making. Each website maintains a conflict-of-interest policy, and contributors are required to self-report a disclosure status. This research investigated the occurrence for potential conflicts of interest among the self-reported statuses of UpToDate and DynaMed content contributors. METHODS: An initial list of contributors for each website was compiled using the Centers for Disease Control and Preventions 2017 Leading Causes of Death. The top 50 causes were used to determine a relevant article with clinical implications from each database. All named authors and editors of those articles comprised our list of investigated contributors. Contributor disclosure status was then compared with public records of financial remuneration as reported in the Open Payments database maintained by the Centers for Medicare and Medicaid Services and ProPublicas Dollar for Docs website from 2013 to 2018. Descriptive analysis and Fishers exact tests were performed on the data. RESULTS: Of 76 UpToDate contributors, 57.9% reported nothing to disclose but had a record of receiving a financial payment on Open Payments, which was found to be statistically significant (p = 0.0002). Of DynaMeds 42 contributors who reported nothing to disclose, 83.3% had an entry on Open Payments. However, this was not statistically significant. The sum total of industry payments between 2013-2018 made to UpToDate contributors was $68.1 million. The top ten UpToDate contributors who received the most financial remuneration earned approximately $56.1 million (82.4% of all UpToDate renumeration), were all male, and only one had a nothing-to-disclose status. The sum total of compensation reported for the discordant UpToDate contributors between 2013-2018 was approximately $4.81 million (or 7.07% of the total monies reported to UpToDate contributors.) In that same time frame, DynaMed contributors received a sum total of $9.58 million from industry, while the top ten DynaMed contributors earned $8.88 million (or 92.8%) of that. The top ten DynaMed contributors were 80% male and 20% female, and six individuals reported nothing to disclose, yet had an Open Payments entry. The sum total of money reported for all discordant DynaMed contributors between 2013-2018 was approximately $2.79 million (or 29.2% of the total monies reported to DynaMed contributors). CONCLUSIONS: While this research does not ascertain that a conflict of interest or anything untoward, it does provide evidence that there was a significant difference between having an Open Payment entry among those who did versus those who did not disclose a conflict of interest. Websites such as UpToDate and DynaMed should consider implementing a more stringent conflict of interest policy and employ an unbiased team to verify self-reported disclosure statuses among its content contributors. Similarly, physicians who use such informational websites to inform their clinical decision making should look beyond a contributors self-reported disclosure status and verify relevant financial remuneration from the healthcare industry via Open Payments or Dollars for Docs.

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

BMJ Open ◽

10.1136/bmjopen-2020-040361 ◽

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.

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

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2012-0656-oa ◽

2013 ◽

Vol 137 (11) ◽

pp. 1599-1602 ◽

Cited By ~ 37

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.

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

Neuro-Oncology Advances ◽

10.1093/noajnl/vdz001 ◽

2019 ◽

Vol 1 (1) ◽

Cited By ~ 3

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.

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

Cardio-Oncology ◽

10.1186/s40959-019-0052-7 ◽

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.

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

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1350 ◽

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 < 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 < 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

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

Pharmacy ◽

10.3390/pharmacy9020087 ◽

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.

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

10.20944/preprints202010.0530.v1 ◽

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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Smartphone-Based Pelvic Movement Asymmetry Measures for Clinical Decision Making in Equine Lameness Assessment

Animals ◽

10.3390/ani11061665 ◽

2021 ◽

Vol 11 (6) ◽

pp. 1665

Author(s):

Eva Marunova ◽

Leea Dod ◽

Stefan Witte ◽

Thilo Pfau

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Clinical Decision ◽

Upward Movement ◽

Discriminative Power ◽

Visual Evaluation ◽

Significant Difference ◽

Pelvic Movement ◽

Movement Asymmetry ◽

Asymmetry Measures

Visual evaluation of hindlimb lameness in the horse is challenging. Objective measurements, simultaneous to visual assessment, are used increasingly to aid clinical decision making. The aim of this study was to investigate the association of pelvic movement asymmetry with lameness scores (UK scale 0–10) of one experienced veterinarian. Absolute values of pelvic asymmetry measures, quantifying differences between vertical minima (AbPDMin), maxima (AbPDMax) and upward movement amplitudes (AbPDUp), were recorded during straight-line trot with a smartphone attached to the sacrum (n = 301 horses). Overall, there was a significant difference between lameness grades for all three asymmetry measures (p < 0.001). Five pair-wise differences (out of 10) were significant for AbPDMin (p ≤ 0.02) and seven for AbPDMax (p ≤ 0.03) and AbPDUp (p ≤ 0.02). Receiver operating curves assessed sensitivity and specificity of asymmetry measures against lameness scores. AbPDUp had the highest discriminative power (area under curve (AUC) = 0.801–0.852) followed by AbPDMax (AUC = 0.728–0.813) and AbPDMin (AUC = 0.688–0.785). Cut-off points between non-lame (grade 0) and lame horses (grades 1–4) with a minimum sensitivity of 75% were identified as AbPDUp ≥ 7.5 mm (67.6% specificity), AbPDMax ≥ 4.5 mm (51.9% specificity) and AbPDMin ≥ 2.5 mm (33.3% specificity). In conclusion, pelvic upward movement amplitude difference (AbPDUp) was the asymmetry parameter with the highest discriminative power in this study.

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Personality Assessment in Clinical Psychology

Oxford Research Encyclopedia of Psychology ◽

10.1093/acrefore/9780190236557.013.71 ◽

2018 ◽

Author(s):

Katy W. Martin-Fernandez ◽

Yossef S. Ben-Porath

Keyword(s):

Decision Making ◽

Clinical Psychology ◽

Personality Assessment ◽

Clinical Decision Making ◽

Clinical Decision ◽

Self Report ◽

Assessment Instruments ◽

Test Taker ◽

Individual Assessment ◽

Over Time

Attempts at informal personality assessment can be traced back to our distant ancestors. As the field of Clinical Psychology emerged and developed over time, efforts were made to create reliable and valid measures of personality and psychopathology that could be used in a variety of contexts. There are many assessment instruments available for clinicians to use, with most utilizing either a projective or self-report format. Individual assessment instruments have specific administration, scoring, and interpretive guidelines to aid clinicians in making accurate decisions based on a test taker’s answers. These measures are continuously adapted to reflect the current conceptualization of personality and psychopathology and the latest technology. Additionally, measures are adapted and validated to be used in a variety of settings, with a variety of populations. Personality assessment continues to be a dynamic process that can be utilized to accurately and informatively represent the test taker and aid in clinical decision making and planning.

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Conflicts of Interest in Inflammatory Bowel Disease Articles on UpToDate

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwz030 ◽

2019 ◽

Author(s):

Rishad Khan ◽

Juana Li ◽

Michael A Scaffidi ◽

Nikko Gimpaya ◽

Bianca Pivetta ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Clinical Decision Making ◽

Conflicts Of Interest ◽

Point Of Care ◽

Clinical Decision ◽

Cross Sectional ◽

Inflammatory Bowel ◽

Sectional Analysis ◽

Open Payments

Abstract Background Financial conflicts of interest (FCOIs) are widespread in inflammatory bowel disease (IBD) and may be particularly important in point-of-care (POC) resources, such as UpToDate, that are used to aid clinical decision making. In this study, we determined the prevalence of industry payments from companies making biologic medications for IBD to contributors of UpToDate articles on IBD. Methods This cross-sectional analysis included UpToDate articles that mention the use of biologic medications for IBD. We collected the names of the contributors (authors and editors) and their disclosures on UpToDate. We then searched for their names on the Center for Medicare and Medicaid Open Payments database and compared the payment information from 2013 to 2018 with UpToDate's disclosures. We presented data per episode, which describes one instance of participation by one person in one article, regardless of whether that person contributed to multiple articles. Results We identified 23 articles on the treatment of Crohn's disease and ulcerative colitis that mentioned the use of biologic medications, with 86 total episodes. Sixty-two (72%) episodes involved FCOIs. The median payment associated with each episode was $$55 (interquartile range = $44 to $145,241). Contributors did not fully disclose FCOIs in 41 (48%) episodes. Deputy editors, who are required to be free of FCOIs, in general did not have substantial episodes involving FCOI. Conclusions We found that UpToDate articles on inflammatory bowel disease involve substantial FCOI, many of which are not disclosed. The presence of these FCOIs may hamper trust in the objectivity of treatment recommendations.

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