scholarly journals Information-Based Medicine in Glioma Patients: A Clinical Perspective

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Joeky Tamba Senders ◽  
Maya Harary ◽  
Brittany Morgan Stopa ◽  
Patrick Staples ◽  
Marike Lianne Daphne Broekman ◽  
...  
Keyword(s):  
Machine Learning ◽  
Treatment Effectiveness ◽  
Primary Brain Tumor ◽  
Clinical Expertise ◽  
Patient Harm ◽  
Automated Inference ◽  
Future Challenges ◽  
The Individual ◽  
Based Medicine ◽  
Evidence Based Decision Making

Glioma constitutes the most common type of primary brain tumor with a dismal survival, often measured in terms of months or years. The thin line between treatment effectiveness and patient harm underpins the importance of tailoring clinical management to the individual patient. Randomized trials have laid the foundation for many neuro-oncological guidelines. Despite this, their findings focus on group-level estimates. Given our current tools, we are limited in our ability to guide patients on what therapy is best for them as individuals, or even how long they should expect to survive. Machine learning, however, promises to provide the analytical support for personalizing treatment decisions, and deep learning allows clinicians to unlock insight from the vast amount of unstructured data that is collected on glioma patients. Although these novel techniques have achieved astonishing results across a variety of clinical applications, significant hurdles remain associated with the implementation of them in clinical practice. Future challenges include the assembly of well-curated cross-institutional datasets, improvement of the interpretability of machine learning models, and balancing novel evidence-based decision-making with the associated liability of automated inference. Although artificial intelligence already exceeds clinical expertise in a variety of applications, clinicians remain responsible for interpreting the implications of, and acting upon, each prediction.

Evidence-Based Decision-Making (Part 1): Origins and Evolution in the Health Sciences

2009 ◽  
Vol 24 (4) ◽  
pp. 298-305 ◽  
Author(s):  
David A. Bradt
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Evidence Based Medicine ◽  
Strategic Decision ◽  
Systematic Research ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Strength Of Evidence ◽  
Based Medicine ◽  
Evidence Based Decision Making

AbstractEvidence is defined as data on which a judgment or conclusion may be based. In the early 1990s, medical clinicians pioneered evidence-based decision-making. The discipline emerged as the use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine required the integration of individual clinical expertise with the best available, external clinical evidence from systematic research and the patient's unique values and circumstances. In this context, evidence acquired a hierarchy of strength based upon the method of data acquisition.Subsequently, evidence-based decision-making expanded throughout the allied health field. In public health, and particularly for populations in crisis, three major data-gathering tools now dominate: (1) rapid health assessments; (2) population based surveys; and (3) disease surveillance. Unfortunately, the strength of evidence obtained by these tools is not easily measured by the grading scales of evidence-based medicine. This is complicated by the many purposes for which evidence can be applied in public health—strategic decision-making, program implementation, monitoring, and evaluation. Different applications have different requirements for strength of evidence as well as different time frames for decision-making. Given the challenges of integrating data from multiple sources that are collected by different methods, public health experts have defined best available evidence as the use of all available sources used to provide relevant inputs for decision-making.

Clinical Decision-Making for a Person Centered Medicine: the necessity of casuistic reasoning

2014 ◽  
Vol 2 (1) ◽  
pp. 71
Author(s):  
Mark Tonelli
Keyword(s):  
Decision Making ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Patient Choice ◽  
Clinical Expertise ◽  
Patient Centered ◽  
Patient Centered Medicine ◽  
The Individual ◽  
Based Medicine

In their call to develop a consistent, coherent and comprehensive notion of person-centered medicine, Miles and Mezzich have elucidated several specific challenges that need to be urgently addressed. One of these foundational tasks is the development of a more complete understanding of person-centered clinical decision-making. Miles and Mezzich note that while the emphasis on clinical research in evidence-based medicine has served to de-emphasize the importance of the individual patient, the alternative of patient-centered medicine has the potential to de-emphasize the judgment of the clinician by making unfettered patient choice paramount. A practice of medicine that reduces professional healers to an informational role only, one where they lay out potential interventions devoid of context and allow patients to choose from amongst them, undervalues clinical expertise and will clearly not lead to better outcomes. Person-centered medicine (PCM), then, must be able to develop and defend a model of clinical judgment and practice that strikes the correct balance between the science of medicine and the personal experience of the individual in search of care.

scholarly journals Is the Movement of Evidence-based Practice a Real Threat to Music Therapy?

2013 ◽  
Vol 13 (2) ◽  
Author(s):  
Masako Otera
Keyword(s):  
Music Therapy ◽  
Evidence Based Practice ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Music Therapists ◽  
Treatment Protocols ◽  
Empirically Supported ◽  
Standardized Treatment ◽  
The Individual ◽  
Based Medicine

The author discusses what music therapists must work on to establish Evidence-based practice (EBP) in music therapy by referring to Saito's discussion of the misunderstandings and various interpretations of Evidence-based medicine (EBM), the issue of Empirically Supported Treatments (ESTs) in EBP in psychology (EBPP), and related discussions. Although the EBP movement tends to be recognized as a threat to music therapy, some recent discussions of EBM and EBP are encouraging for the development of EBP in music therapy. This paper shows that an integration of evidence of multiple types with clinical expertise and the individual needs in clients has become a consensus of EBP. However, the issues related to conducting Randomized controlled Trials (RCTs) and employment of standardized treatment protocols in music therapy have persisted as difficult problems. Because the issue of EBP is very complex and easily biased, effective learning of this issue should be promoted among music therapists so that they can successfully relate to the EBP movement and bring benefits to the field of music therapy. The author suggests that incorporating the ideas of EBP positively into the field of music therapy and constructing methodologies and theories will enhance EBP.

The Gap between What is Knowable and What We Do in Clinical Practice

2011 ◽  
pp. 1900-1921
Author(s):  
Maartje H.J. Swennen
Keyword(s):  
Clinical Practice ◽  
Routine Practice ◽  
Evidence Based ◽  
Clinical Expertise ◽  
High Quality ◽  
The Road ◽  
Closing The Gap ◽  
The Individual ◽  
Based Medicine ◽  
Quality Evidence

Evidence-based Medicine (EBM) is a tool that aims to bring science and medicine together by enabling doctors to integrate the latest best evidence with their clinical expertise and the individual patient’s wishes and needs. However, EBM has both strong supporters and antagonists and is confronted with many barriers that impede uptake of the best evidence by doctors. To date, it remains poorly understood why doctors, do, and do not, incorporate high quality evidence into their routine practice. I will take you down the road of how I became more and more intrigued by all the challenges that EBM faces. In addition, I will explain to you how I hope to contribute to closing the gap between what is knowable using EBM methods and what we do.

The Gap between What is Knowable and What We Do in Clinical Practice

2011 ◽  
pp. 335-356
Author(s):  
Maartje H.J. Swennen
Keyword(s):  
Clinical Practice ◽  
Routine Practice ◽  
Evidence Based ◽  
Clinical Expertise ◽  
High Quality ◽  
The Road ◽  
Closing The Gap ◽  
The Individual ◽  
Based Medicine ◽  
Quality Evidence

Evidence-based Medicine (EBM) is a tool that aims to bring science and medicine together by enabling doctors to integrate the latest best evidence with their clinical expertise and the individual patient’s wishes and needs. However, EBM has both strong supporters and antagonists and is confronted with many barriers that impede uptake of the best evidence by doctors. To date, it remains poorly understood why doctors, do, and do not, incorporate high quality evidence into their routine practice. I will take you down the road of how I became more and more intrigued by all the challenges that EBM faces. In addition, I will explain to you how I hope to contribute to closing the gap between what is knowable using EBM methods and what we do.

scholarly journals L'assistenza sanitaria basata sul valore

2020 ◽  
Vol 28 (4) ◽  
pp. 227-228
Author(s):  
Giovanni Battista Zito
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Evidence Based Medicine ◽  
Cost Reduction ◽  
Evidence Based ◽  
Related Concept ◽  
New Approach ◽  
The Individual ◽  
Based Medicine ◽  
Evidence Based Decision Making

In the last decades, paternalistic medicine based on the principles of “science and conscience”, has been definitively replaced by evidence-based medicine, in order to ensure that only interventions with strong evidence of clinical efficacy/utility will be used. Evidence-based medicine, however, has two main limitations. The first one is that it fits with difficulty to the individual pa-tient. To overcome this limitation, precision medicine has been founded. The second and main limitation is that evidence-based medicine and the related concept of clinical appropriateness do not consider the costs of health services. Clinical appropriate-ness should therefore be closely associated with organizing appropriateness, to give absolute relevance to both the concepts of risk/effectiveness and cost/effectiveness of the healthcare. Accordingly, every intervention aimed at improving individual and public health should include evidence-based decision making, quality improvement and cost reduction. These features are all nec-essary but not sufficient. A new approach is emerging, called value-based healthcare, which aims to privilege activities capable of generating value, in a new model of healtcare in which interventions are reimbursed on the base of the results obtained on the whole community health.

Mol2vec: Unsupervised Machine Learning Approach with Chemical Intuition

2017 ◽  
Author(s):  
Sabrina Jaeger ◽  
Simone Fulle ◽  
Samo Turk
Keyword(s):  
Machine Learning ◽  
Language Processing ◽  
Supervised Machine Learning ◽  
Learning Approach ◽  
Learning Approaches ◽  
Unsupervised Machine Learning ◽  
Feature Representations ◽  
Machine Learning Approach ◽  
The Individual ◽  
Vector Representations

Inspired by natural language processing techniques we here introduce Mol2vec which is an unsupervised machine learning approach to learn vector representations of molecular substructures. Similarly, to the Word2vec models where vectors of closely related words are in close proximity in the vector space, Mol2vec learns vector representations of molecular substructures that are pointing in similar directions for chemically related substructures. Compounds can finally be encoded as vectors by summing up vectors of the individual substructures and, for instance, feed into supervised machine learning approaches to predict compound properties. The underlying substructure vector embeddings are obtained by training an unsupervised machine learning approach on a so-called corpus of compounds that consists of all available chemical matter. The resulting Mol2vec model is pre-trained once, yields dense vector representations and overcomes drawbacks of common compound feature representations such as sparseness and bit collisions. The prediction capabilities are demonstrated on several compound property and bioactivity data sets and compared with results obtained for Morgan fingerprints as reference compound representation. Mol2vec can be easily combined with ProtVec, which employs the same Word2vec concept on protein sequences, resulting in a proteochemometric approach that is alignment independent and can be thus also easily used for proteins with low sequence similarities.

scholarly journals The Evolving Field of Genetic Epidemiology: From Familial Aggregation to Genomic Sequencing

2019 ◽  
Vol 188 (12) ◽  
pp. 2069-2077
Author(s):  
Priya Duggal ◽  
Christine Ladd-Acosta ◽  
Debashree Ray ◽  
Terri H Beaty
Keyword(s):  
Genetic Epidemiology ◽  
Disease Risk ◽  
Familial Aggregation ◽  
Rna Expression ◽  
Entire Genome ◽  
The Past ◽  
Future Challenges ◽  
The Individual ◽  
Study Designs ◽  
Health Applications

Abstract The field of genetic epidemiology is relatively young and brings together genetics, epidemiology, and biostatistics to identify and implement the best study designs and statistical analyses for identifying genes controlling risk for complex and heterogeneous diseases (i.e., those where genes and environmental risk factors both contribute to etiology). The field has moved quickly over the past 40 years partly because the technology of genotyping and sequencing has forced it to adapt while adhering to the fundamental principles of genetics. In the last two decades, the available tools for genetic epidemiology have expanded from a genetic focus (considering 1 gene at a time) to a genomic focus (considering the entire genome), and now they must further expand to integrate information from other “-omics” (e.g., epigenomics, transcriptomics as measured by RNA expression) at both the individual and the population levels. Additionally, we can now also evaluate gene and environment interactions across populations to better understand exposure and the heterogeneity in disease risk. The future challenges facing genetic epidemiology are considerable both in scale and techniques, but the importance of the field will not diminish because by design it ties scientific goals with public health applications.

scholarly journals Applying evidence-based medicine in general practice: a video-stimulated interview study on workplace-based observation

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Lisanne S. Welink ◽  
Kaatje Van Roy ◽  
Roger A. M. J. Damoiseaux ◽  
Hilde A. Suijker ◽  
Peter Pype ◽  
...  
Keyword(s):  
Decision Making ◽  
General Practice ◽  
Evidence Based Medicine ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Stimulated Recall ◽  
Previous Discussion ◽  
Based Medicine ◽  
Stimulated Recall Interviews ◽  
Gp Training

Abstract Background Evidence-based medicine (EBM) in general practice involves applying a complex combination of best-available evidence, the patient’s preferences and the general practitioner’s (GP) clinical expertise in decision-making. GPs and GP trainees learn how to apply EBM informally by observing each other’s consultations, as well as through more deliberative forms of workplace-based learning. This study aims to gain insight into workplace-based EBM learning by investigating the extent to which GP supervisors and trainees recognise each other’s EBM behaviour through observation, and by identifying aspects that influence their recognition. Methods We conducted a qualitative multicentre study based on video-stimulated recall interviews (VSI) of paired GP supervisors and GP trainees affiliated with GP training institutes in Belgium and the Netherlands. The GP pairs (n = 22) were shown fragments of their own and their partner’s consultations and were asked to elucidate their own EBM considerations and the ones they recognised in their partner’s actions. The interview recordings were transcribed verbatim and analysed with NVivo. By comparing pairs who recognised each other’s considerations well with those who did not, we developed a model describing the aspects that influence the observer’s recognition of an actor’s EBM behaviour. Results Overall, there was moderate similarity between an actor’s EBM behaviour and the observer’s recognition of it. Aspects that negatively influence recognition are often observer-related. Observers tend to be judgemental, give unsolicited comments on how they would act themselves and are more concerned with the trainee-supervisor relationship than objective observation. There was less recognition when actors used implicit reasoning, such as mindlines (internalised, collectively reinforced tacit guidelines). Pair-related aspects also played a role: previous discussion of a specific topic or EBM decision-making generally enhanced recognition. Consultation-specific aspects played only a marginal role. Conclusions GP trainees and supervisors do not fully recognise EBM behaviour through observing each other’s consultations. To improve recognition of EBM behaviour and thus benefit from informal observational learning, observers need to be aware of automatic judgements that they make. Creating explicit learning moments in which EBM decision-making is discussed, can improve shared knowledge and can also be useful to unveil tacit knowledge derived from mindlines.

scholarly journals Serological Evaluation of Specific-Antibody Levels in Patients Treated for Chronic Chagas' Disease

2007 ◽  
Vol 15 (2) ◽  
pp. 297-302 ◽  
Author(s):  
Olga Sánchez Negrette ◽  
Fernando J. Sánchez Valdéz ◽  
Carlos D. Lacunza ◽  
María Fernanda García Bustos ◽  
María Celia Mora ◽  
...  
Keyword(s):  
Chagas Disease ◽  
Treatment Effectiveness ◽  
Enzyme Linked Immunosorbent Assay ◽  
Serum Samples ◽  
Serological Tests ◽  
Recombinant Antigens ◽  
Antibody Titers ◽  
Laboratory Procedures ◽  
The Individual ◽  
Antibody Levels

ABSTRACT Serological tests are the main laboratory procedures used for diagnosis during the indeterminate and chronic stages of Chagas' disease. A serological regression to negativity is the main criterion used to define parasitological cure in treated patients. The aim of this work was to monitor the individual specificities of antibody levels for 3 years posttreatment in 18 adult patients. Conventional serological techniques (hemagglutination assays and enzyme-linked immunosorbent assay [ELISA]) were modified by using recombinant antigens to detect early markers of treatment effectiveness. For this purpose, serum samples were taken before and during treatment and every 6 months after treatment for at least 3 years. When hemagglutination assays were used, a decrease in antibody levels was observed in only one patient. When ELISA with serum dilutions was used, antibody clearance became much more apparent: in 77.7% (14/18) of the patients, antibody titers became negative with time. This was observed at serum dilutions of 1/320 and occurred between the 6th and the 30th months posttreatment. The immune response and the interval for a serological regression to negativity were different for each patient. For some of the recombinant antigens, only 50% (9/18) of the patients reached the serological regression to negativity. Recombinant antigen 13 might be a good marker of treatment effectiveness, since 66.6% (six of nine) of the patients presented with an early regression to negativity for specific antibodies to this antigen (P = 0.002).

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