Clinical Decision Making: Assumptions Made in the Absence of Evidence

2011 ◽  
Vol 16 (2) ◽  
pp. 1-3
Author(s):  
Patrick Sexton
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Absence Of Evidence ◽  
Made In

Diagnostic conversations: Clinical Decision Making in surgery – Part 2

Diagnosis ◽  
2014 ◽  
Vol 1 (2) ◽  
pp. 189-193 ◽  
Author(s):  
David Allan Watters ◽  
Spencer Wynyard Beasley ◽  
Wendy Crebbin
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Learning Opportunities ◽  
Clinical Decisions ◽  
Decision Making Processes ◽  
Royal Australasian College ◽  
Insight Into ◽  
Made In

AbstractProceduralists who fail to review their decision making are unlikely to learn from their experiences, irrespective of whether the operative outcome is successful or not. Teaching junior surgeons to develop ‘insight’ into their own decision making has long been a challenge. Surgeons and staff of the Royal Australasian College of Surgeons worked together to develop a model to help explain the processes around clinical decision making and incorporated this model into a Clinical Decision Making (CDM) training course. In this course, faculty apply the model to specific surgical cases, within the model’s framework of how clinical decisions are made; thus providing an opportunity to identify specific decision making processes as they occur and to highlight some of the learning opportunities they provide. The conversation in this paper illustrates the kinds of case-based interactions which typically occur in the development and teaching of the CDM course.The focus in this, the second of two papers, is on reviewing post-operative clinical decisions made in relation to one case, to improve the quality of subsequent decision making.

Klinischer Nutzen der Flüssigkeitsbiopsie beim uvealen Melanom

2021 ◽  
pp. 1-3
Author(s):  
Ira Seibel
Keyword(s):  
Decision Making ◽  
Liquid Biopsy ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
High Rate ◽  
Precision Oncology ◽  
Noninvasive Biomarker ◽  
Biopsy Methods ◽  
Disease Understanding ◽  
Made In

In the era of precision oncology, major strides are being made to use individual tumor information for clinical decision-making. Differing from traditional biopsy methods, the emerging practice of liquid biopsy provides a minimally invasive way of obtaining tumor cells and derived molecules. Liquid biopsy provides a means to detect and monitor disease progression, recurrence, and treatment response in a noninvasive way, and to potentially complement classical biopsy. Uveal melanoma (UM) is a unique malignancy, with diagnosis heavily reliant on imaging, few repeat biopsies, and a high rate of metastasis, which occurs hematogenously and often many years after diagnosis. In this disease setting, a noninvasive biomarker to detect, monitor, and study the disease in real time could lead to better disease understanding and patient care. While advances have been made in the detection of tumor-disseminated components, sensitivity and specificity remain important challenges. Ambiguity remains in how to interpret current findings and in how liquid biopsy can have a place in clinical practice. Related publications in UM are few compared to other cancers, but with further studies we may be able to uncover more about the biology of disseminated molecules and the mechanisms involved in the progression to metastasis.

scholarly journals Measuring and Quantifying Collateral Information in Psychiatry: Feasibility study of the McLean Collateral Information and Clinical Actionability scale (M-CICAS) (Preprint)

2020 ◽  
Author(s):  
Praise Owoyemi ◽  
Sarah Salcone ◽  
Christopher King ◽  
Heejung Julie Kim ◽  
Kerry James Ressler ◽  
...  
Keyword(s):  
Decision Making ◽  
Medical Records ◽  
Interrater Reliability ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Collateral Information ◽  
Psychiatric Setting ◽  
Study Staff ◽  
Minimal Research ◽  
Made In

BACKGROUND The review of collateral information is an essential component of patient care. Though this is standard practice, minimal research has been devoted to quantifying collateral information collection and to understanding how collateral information translates to clinical decision-making. To address this, we developed and piloted a novel measure (the McLean collateral information and clinical actionability scale (M-CICAS)) to evaluate the types and number of collateral sources viewed and resulting actions made in a psychiatric setting. OBJECTIVE Study aims included: 1) feasibility testing of the M-CICAS measure, 2) validating this measure against clinician notes via medical records, and 3) evaluating whether reviewing a higher volume of collateral sources is associated with more clinical actions taken. METHODS For the M-CICAS measure, we developed a three-part instrument, focusing on measuring collateral sources reviewed, clinical actions taken, and shared decision-making between clinician and patient. We recruited clinicians providing psychotherapy services at McLean hospital (N = 7) to complete the M-CICAS measure after individual clinical sessions. We also independently completed the M-CICAS using only the clinician’s corresponding note from that session, in order to validate the reported measure against the electronic health record which served as the objective point of comparison. Based on this, we estimated inter-rater reliability, reporting validity and whether significant variance in clinical actions taken could be attributed to inter-clinician differences. RESULTS Study staff had high interrater reliability on the M-CICAS for the sources reviewed (r=0.98, P<.001) and actions taken (r=0.97, P <.001). Clinician and study staff ratings were moderately correlated and statistically significant on the M-CICAS summary scores for the sources viewed (r’s=0.24 and 0.25, P=.02202 and P=.0188, respectively). Univariate regression modelling demonstrated a significant association between collateral sources and clinical actions taken when clinicians completed the M-CICAS (B=.27, t=2.47, P =.015). Multilevel fixed slopes random intercepts model confirmed a significant association even when accounting for clinician differences (B=.23, t=2.13, P =.037). CONCLUSIONS This pilot study establishes feasibility and preliminary validity for the M-CICAS measure in assessing collateral sources and clinical decision-making in psychiatry. This study also indicated that reviewing more collateral sources may lead to an increased number of clinical actions following a session.

scholarly journals The Influence of Personalised Sarcoma Care (PERSARC) Prediction Modelling on Clinical Decision Making in a Multidisciplinary Setting

Sarcoma ◽  
2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
H. S. Femke Hagenmaier ◽  
Annelies G. K. van Beeck ◽  
Rick L. Haas ◽  
Veroniek M. van Praag ◽  
Leti van Bodegom-Vos ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Treatment Decision ◽  
Clinical Decision ◽  
Patient Centered ◽  
Treatment Protocols ◽  
Treatment Decision Making ◽  
Heterogenous Group ◽  
Centered Care ◽  
Made In

Background. With soft-tissue sarcoma of the extremity (ESTS) representing a heterogenous group of tumors, management decisions are often made in multidisciplinary team (MDT) meetings. To optimize outcome, nomograms are more commonly used to guide individualized treatment decision making. Purpose. To evaluate the influence of Personalised Sarcoma Care (PERSARC) on treatment decisions for patients with high-grade ESTS and the ability of the MDT to accurately predict overall survival (OS) and local recurrence (LR) rates. Methods. Two consecutive meetings were organised. During the first meeting, 36 cases were presented to the MDT. OS and LR rates without the use of PERSARC were estimated by consensus and preferred treatment was recorded for each case. During the second meeting, OS/LR rates calculated with PERSARC were presented to the MDT. Differences between estimated OS/LR rates and PERSARC OS/LR rates were calculated. Variations in preferred treatment protocols were noted. Results. The MDT underestimated OS when compared to PERSARC in 48.4% of cases. LR rates were overestimated in 41.9% of cases. With the use of PERSARC, the proposed treatment changed for 24 cases. Conclusion. PERSARC aids the MDT to optimize individualized predicted OS and LR rates, hereby guiding patient-centered care and shared decision making.

Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

2011 ◽  
Vol 20 (4) ◽  
pp. 121-123
Author(s):  
Jeri A. Logemann
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Clinical Outcomes ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Method ◽  
Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

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