Abstract TP87: Comparative Analysis of 3-Dimensional Rotation Angiography versus 3-Dimensional Computed Tomography Angiography for Intracranial Aneurysm Treatment Detection and Planning

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Jonathan Park ◽  
Noriko Salamon ◽  
Gary Duckwiler ◽  
Fernando Vinuela ◽  
James Sayer ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Neck Size ◽  
3 Dimensional ◽  
Imaging Tool ◽  
Final Treatment ◽  
Agreement Coefficient ◽  
Majority Consensus ◽  
Management Recommendations

Introduction: 3D Rotational Angiography (3DRA) is the gold standard for intracranial aneurysm (IA) detection, but is invasive and time consuming. While 3DCTA has shown to be sensitive for IA detection, no published studies have compared 3DRA to 3DCTA in guiding clinical management. Our aim was to compare suggested treatment for IA based on 3DRA and 3DCTA vs actual final treatment and outcome. Hypothesis: Management recommendations based on blinded review of 3DRA and 3DCTA for IA do not differ significantly. Methods: Prospective blinded review of contemporaneous 3DRA and 3DCTA was performed for patients with suspected IA. Two interventionalists and two neuroradiologists performed blinded, prospective review of 3DRA or 3DCTA, respectively. IA size, location, and morphology were assessed. After IA characterization, each observer independently recommended optimal therapy (conservative, coil, surgery, combined/other) while blinded to other reviewers’ decisions. Findings were analyzed with Spearman, and agreement coefficient 1 (AC1) inter-rater reliability statistics. Results: 41/52 enrolled patients had IA confirmed by 3DRA (52 IA total). 50/52 (96%) IA were initially identified by 3DCTA (both false negatives seen retrospectively). Average IA sac and neck size measured by 3DRA and 3DCTA correlated closely (p<0.01) and were 9.8 and 5.0 mm vs 9.5 and 4.5 mm, respectively. Treatment recommendations by reviewers for 3DRA vs 3DCTA correlated very strongly (AC1= 0.77), as did reader recommendations within a modality (3DRA, AC1=0.66; 3DCTA, AC1=0.79). For 39/52 (75%) of IA, majority consensus for all readers was reached (3/4 or 4/4 reviewers), which correlated well with final executed treatments (95%). Conclusions: Recommendations for IA treatment based on 3DCTA correlate closely with those based on 3DRA, as well as with actual treatment in a majority of patients. 3DCTA holds promise as a primary imaging tool for IA detection and clinical decision making.

scholarly journals Gait Re-education Based on the Bobath Concept in Two Patients With Hemiplegia Following Stroke

2001 ◽  
Vol 81 (3) ◽  
pp. 924-935 ◽  
Author(s):  
Sheila Lennon
Keyword(s):  
Physical Therapy ◽  
Cerebrovascular Accident ◽  
Clinical Decision Making ◽  
Sagittal Plane ◽  
Movement Patterns ◽  
Clinical Decision ◽  
Normal Movement ◽  
3 Dimensional ◽  
Therapy Sessions ◽  
Hip Extension

Abstract Background and Purpose. This case report describes the use of gait re-education based on the Bobath concept to measure the changes that occurred in the gait of 2 patients with hemiplegia who were undergoing outpatient physical therapy. Case Description. One patient (“NM”), a 65-year-old woman, was referred for physical therapy 6 weeks following a right cerebrovascular accident. She attended 30 therapy sessions over a 15-week period. The other patient (“SA”), a 71-year-old woman, was referred for physical therapy 7 weeks following a left cerebrovascular accident. She attended 28 therapy sessions over a 19-week period. Clinical indexes of impairment and disability and 3-dimensional gait data were obtained at the start of treatment and at discharge. Therapy was based on the Bobath concept. Outcomes. At discharge, NM demonstrated improvements in her hip and knee movements, reduced tone, and improved mobility. At discharge, SA demonstrated improved mobility. During gait, both patients demonstrated more normal movement patterns at the level of the pelvis, the knee, and the ankle in the sagittal plane. SA also demonstrated an improvement in hip extension. Discussion. These cases demonstrate that recovery of more normal movement patterns and functional ability can be achieved following a cardiovascular accident and provide insight into the clinical decision making of experienced practitioners using Bobath's concept.

scholarly journals The validity and applicability of CAD-RADS in the management of patients with coronary artery disease

2019 ◽  
Vol 10 (1) ◽  
Author(s):  
Mohammad Abd Alkhalik Basha ◽  
Sameh Abdelaziz Aly ◽  
Ahmad Abdel Azim Ismail ◽  
Hanan A. Bahaaeldin ◽  
Samar Mohamad Shehata
Keyword(s):  
Coronary Artery Disease ◽  
Decision Making ◽  
Coronary Artery ◽  
Clinical Decision Making ◽  
Invasive Coronary Angiography ◽  
Clinical Decision ◽  
Intra Class Correlation ◽  
Artery Disease ◽  
Management Recommendations ◽  
Sensitivity Specificity

Abstract Background The coronary artery disease reporting and data system (CAD-RADS) is designed for a uniform standardization of coronary computed tomography angiography (CCTA) reporting and further management recommendations of coronary artery disease (CAD). This study aimed to assess clinical validity, applicability, and reproducibility of CAD-RADS in the management of patients with CAD. Methods and results A single-center prospective study included 287 patients with clinically suspected or operated CAD who underwent CCTA. Four reviewers evaluated the CCTA images independently and assigned a CAD-RADS category to each patient. The invasive coronary angiography (ICA) was used as the reference standard for calculating diagnostic performance of CAD-RADS for categorizing the degree of coronary artery stenosis. The intra-class correlation (ICC) was used to test the inter-reviewer agreement (IRA). Reporting was provided to referring consultants according to the CAD-RADS. Based on ICA results, we have 156 patients with non-significant CAD and 131 patients with significant CAD. On a patient-based analysis, regarding those patients classified as CAD-RADS 4 and CAD-RADS 5 for predicting significant CAD, the CAD-RADS had a sensitivity, specificity, and an accuracy of 100%, 96.8 to 98.7%, and 98.3 to 99.3%, respectively, depending on the reviewer. There was an excellent IRA for CAD-RADS categories (ICC = 0.9862). The best cutoff value for predicting significant CAD was > CAD-RADS 3. Eighty-seven percentage of referring consultants considered CAD-RADS reporting system to be “quite helpful” or “completely helpful” for clinical decision-making in CAD. Conclusion CAD-RADS is valuable for improving CCTA structural reports and facilitating decision-making with high diagnostic accuracy and high reproducibility.

Preliminary Findings on the Use of Session Questionnaires to Improve Clinician-Client Alliance With Special Consideration to Clinical Education

2015 ◽  
Vol 25 (1) ◽  
pp. 50-60
Author(s):  
Anu Subramanian
Keyword(s):  
Graduate Students ◽  
Clinical Education ◽  
Clinical Decision Making ◽  
Rating Scale ◽  
Treatment Effectiveness ◽  
Clinical Decision ◽  
Added Value ◽  
Therapeutic Outcomes ◽  
Specific Feedback ◽  
Stakeholder Perspective

ASHA's focus on evidence-based practice (EBP) includes the family/stakeholder perspective as an important tenet in clinical decision making. The common factors model for treatment effectiveness postulates that clinician-client alliance positively impacts therapeutic outcomes and may be the most important factor for success. One strategy to improve alliance between a client and clinician is the use of outcome questionnaires. In the current study, eight parents of toddlers who attended therapy sessions at a university clinic responded to a session outcome questionnaire that included both rating scale and descriptive questions. Six graduate students completed a survey that included a question about the utility of the questionnaire. Results indicated that the descriptive questions added value and information compared to using only the rating scale. The students were varied in their responses regarding the effectiveness of the questionnaire to increase their comfort with parents. Information gathered from the questionnaire allowed for specific feedback to graduate students to change behaviors and created opportunities for general discussions regarding effective therapy techniques. In addition, the responses generated conversations between the client and clinician focused on clients' concerns. Involving the stakeholder in identifying both effective and ineffective aspects of therapy has advantages for clinical practice and education.

Clinical Decision-Making for Stroke and Aphasia in the Older Adult

2009 ◽  
Vol 14 (1) ◽  
pp. 4-11 ◽  
Author(s):  
Jacqueline Hinckley
Keyword(s):  
Executive Function ◽  
Cerebrovascular Disease ◽  
Cognitive Abilities ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Cognitive Profile ◽  
Focal Lesion ◽  
Cognitive Profiles ◽  
Supportive Communication ◽  
Spaced Retrieval

Abstract A patient with aphasia that is uncomplicated by other cognitive abilities will usually show a primary impairment of language. The frequency of additional cognitive impairments associated with cerebrovascular disease, multiple (silent or diagnosed) infarcts, or dementia increases with age and can complicate a single focal lesion that produces aphasia. The typical cognitive profiles of vascular dementia or dementia due to cerebrovascular disease may differ from the cognitive profile of patients with Alzheimer's dementia. In order to complete effective treatment selection, clinicians must know the cognitive profile of the patient and choose treatments accordingly. When attention, memory, and executive function are relatively preserved, strategy-based and conversation-based interventions provide the best choices to target personally relevant communication abilities. Examples of treatments in this category include PACE and Response Elaboration Training. When patients with aphasia have co-occurring episodic memory or executive function impairments, treatments that rely less on these abilities should be selected. Examples of treatments that fit these selection criteria include spaced retrieval and errorless learning. Finally, training caregivers in the use of supportive communication strategies is helpful to patients with aphasia, with or without additional cognitive complications.

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.

Management of thoracic aortic lesions - the future is endovascular

VASA ◽  
2012 ◽  
Vol 41 (3) ◽  
pp. 163-176 ◽  
Author(s):  
Weidenhagen ◽  
Bombien ◽  
Meimarakis ◽  
Geisler ◽  
A. Koeppel
Keyword(s):  
Thoracic Aorta ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Clinical Decision ◽  
Clinical Results ◽  
Treatment Modalities ◽  
Traumatic Rupture ◽  
Descending Thoracic Aorta ◽  
New Treatment ◽  
Aneurysm Dissection

Open surgical repair of lesions of the descending thoracic aorta, such as aneurysm, dissection and traumatic rupture, has been the “state-of-the-art” treatment for many decades. However, in specialized cardiovascular centers, thoracic endovascular aortic repair and hybrid aortic procedures have been implemented as novel treatment options. The current clinical results show that these procedures can be performed with low morbidity and mortality rates. However, due to a lack of randomized trials, the level of reliability of these new treatment modalities remains a matter of discussion. Clinical decision-making is generally based on the experience of the vascular center as well as on individual factors, such as life expectancy, comorbidity, aneurysm aetiology, aortic diameter and morphology. This article will review and discuss recent publications of open surgical, hybrid thoracic aortic (in case of aortic arch involvement) and endovascular repair in complex pathologies of the descending thoracic aorta.

Sign in / Sign up

Export Citation Format

Share Document