Abstract W P266: A Simple Score for Prediction of Outcome after Cerebral Venous Thrombosis

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Miguel A Barboza ◽  
Erwin Chiquete ◽  
Antonio Arauz ◽  
Jonathan Colín ◽  
Alejandro Quiroz-Compean ◽  
...  
Keyword(s):  
Decision Making ◽  
Venous Thrombosis ◽  
Predictive Value ◽  
Cerebral Venous Thrombosis ◽  
Goodness Of Fit ◽  
Clinical Decision Making ◽  
Case Fatality ◽  
Clinical Decision ◽  
Classification Systems ◽  
Cox Proportional Hazards Model

Background and purpose: Cerebral venous thrombosis (CVT) not always implies a good prognosis. There is a need for robust and simple classification systems of severity after CVT that help in clinical decision-making. Methods: We studied 467 patients (81.6% women, median age: 29 years, interquartile range: 22-38 years) with CVT who were hospitalized from 1980 to 2014 in two third-level referral hospitals. Bivariate analyses were performed to select variables associated with 30-day mortality to integrate a further multivariate analysis. The resultant model was evaluated with the Hosmer-Lemeshow test for goodness of fit, and on Cox proportional hazards model for reliability of the effect size. After the scale was configured, security and validity were tested for 30-day mortality and modified Rankin scale (mRS) >2. The prognostic performance was compared with that of the CVT risk score (CVT-RS, 0-6 points) as the reference system. Results: The 30-day case fatality rate was 8.7%. The CVT grading scale (CVT-GS, 0-9 points) was integrated by stupor/coma (4 points), parenchymal lesion >6 cm (2 points), mixed (superficial and deep systems) CVT (1 point), meningeal syndrome (1 point) and seizures (1 point). CVT-GS was categorized into mild (0-3 points, 1.1% mortality), moderate (4-6 points, 19.6% mortality) and severe (7-9 points, 61.4% mortality). For 30-day mortality prediction, as compared with CVT-RS (cut-off 4 points), CVT-GS (cut-off 5 points) was globally better in sensitivity (85% vs 37%), specificity (90% vs 95%), positive predictive value (44% vs 40%), negative predictive value (98% vs 94%), and accuracy (94% vs 80%). For 30-day mRS >2 the performance of CVT-GS over CVT-RS was comparably improved. Conclusion: The CVT-GS is a simple and reliable score for predicting outcome that may help in clinical decision-making and that could be used to stratify patients recruited into clinical trials.

Likelihood Ratio, Skull Roentgenograms, and Clinical Decision-Making

PEDIATRICS ◽  
1983 ◽  
Vol 71 (4) ◽  
pp. 673-674
Author(s):  
JOHN C. LEONIDAS ◽  
ANNA BINKIEWICZ ◽  
R. MICHAEL SCOTT ◽  
STEPHEN G. PAUKER
Keyword(s):  
Decision Making ◽  
Likelihood Ratio ◽  
Predictive Value ◽  
Clinical Finding ◽  
Posterior Probability ◽  
Clinical Decision Making ◽  
Skull Fracture ◽  
Clinical Decision ◽  
Negative Finding ◽  
The Individual

In Reply.— We appreciate the thoughtful comments of Leventhal and Lembo and concur with their conclusion that the clinician needs to know "the probability of skull fracture in a patient with head trauma." Unfortunately, their proposed "clinical likelihood ratio" (CR) will not further that end because it compares the predictive value (or, more precisely, the posterior probability) of a skull fracture after a positive clinical finding to the posterior probability after a negative finding. After the patient has been examined, the patient does not have both findings; thus, the CR cannot apply to the individual patient.

The predictive value of microbiological findings on teeth, internal and external implant portions in clinical decision making

2016 ◽  
Vol 28 (5) ◽  
pp. 512-519 ◽  
Author(s):  
Luigi Canullo ◽  
Sandro Radovanović ◽  
Boris Delibasic ◽  
Juan Antonio Blaya ◽  
David Penarrocha ◽  
...  
Keyword(s):  
Decision Making ◽  
Predictive Value ◽  
Clinical Decision Making ◽  
Clinical Decision

Cross-Cultural Adaptation and Psychometric Evaluation of the Persian Version of the Clinical Decision-Making in Nursing Scale

2021 ◽  
pp. JNM-D-20-00052
Author(s):  
Zhaleh Kouravand ◽  
Fereshteh Aein ◽  
Abbas Ebadi ◽  
Ghasem Yadegarfar
Keyword(s):  
Decision Making ◽  
Cultural Adaptation ◽  
Goodness Of Fit ◽  
Clinical Decision Making ◽  
Psychometric Evaluation ◽  
Clinical Decision ◽  
Cross Cultural ◽  
Cross Cultural Adaptation ◽  
Persian Version ◽  
Fit Index

Background and PurposeThe aim of this study was the cross-cultural adaptation and psychometric evaluation of the Persian version of Clinical Decision Making in Nursing Scale (CDMNS).MethodsThe original CDMNS was translated into Persian using the Beaton's guideline. Its qualitative face validity, qualitative and quantitative content validity, its construct validity, and reliability was assessed.ResultsEleven items out of forty items were deleted due to factor loading values less than 0.3. Subsequently, model fit indices changed as follows: Chi-square value divided by degree of freedom (𝜒2/DF): 2.8, root mean score error of approximation (RMSEA): 0.07, standardized root mean square residual (SRMR): 0.06, comparative fit index (CFI): 0.93, goodness of fit index (GFI): 0.80, and adjusted goodness of fit index (AGFI): 0.77. The Cronbach's alpha values and test.retest intraclass correlation coefficient of the 29-item scale and its subscales also increased afte deleted.ConclusionThe 29-item Persian CDMNS is a valid and reliable instrument for assessing Iranian nurses' perceptions of clinical decision-making.

scholarly journals Perceptions and experiences of wrist surgeons on the management of triangular fibrocartilage complex tears: a qualitative study

2019 ◽  
Vol 44 (6) ◽  
pp. 572-581
Author(s):  
Vanessa I. Robba ◽  
Alexia Karantana ◽  
Andrew P. G. Fowler ◽  
Claire Diver
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Triangular Fibrocartilage Complex ◽  
Classification Systems ◽  
Structured Interviews ◽  
Level Of Evidence ◽  
Related Factors ◽  
Data Saturation ◽  
Triangular Fibrocartilage

There is lack of consensus on the management of triangular fibrocartilage injuries. The aim of this study was to investigate wrist surgeons’ experiences and perceptions regarding treatment of triangular fibrocartilage complex injuries and to explore the rationale behind clinical decision-making. A purposive sample of consultant wrist surgeons ( n = 10) was recruited through ‘snow-balling’ until data saturation was reached. Semi-structured interviews were conducted, digitally recorded and transcribed verbatim. Two researchers independently analysed data using an iterative/thematic approach. Findings suggest that surgeons rely more on their own training and experience, and patient-related factors such as individual expectations, to inform their decision-making, rather than on published material. Current classification systems are largely considered to be unhelpful. Level of evidence: V

Dogma without Data: A Clinical Decision-Making Tool for Postoperative Blood Cultures

2018 ◽  
Vol 84 (8) ◽  
pp. 1339-1344
Author(s):  
Libby R. Copeland-Halperin ◽  
Erica Emery ◽  
Devon Collins ◽  
Chang Liu ◽  
Jonathan Dort
Keyword(s):  
Decision Making ◽  
Predictive Value ◽  
Clinical Decision Making ◽  
Positive Culture ◽  
Clinical Decision ◽  
Blood Cultures ◽  
Maximum Temperature ◽  
Clinical Predictors ◽  
Data Set ◽  
Clinical Algorithm

Bacteremia is a worrisome postoperative complication and blood cultures (BCx) are often nondiagnostic. We previously reported a 4 per cent overall yield of positive cultures in postoperative patients. To reduce unnecessary testing, we present a predictive model to identify patients in whom growth of pathogens is unlikely and provide a clinical decision-making guide. Retrospective analysis of nonpregnant patients ≥18 years who had BCx within 10 days postoperatively was performed. Generalized linear mixed models identified clinical predictors of high- and low-yield cultures. A clinical algorithm was created using significant predictors, and positive predictive value, negative predictive value, sensitivity, and specificity calculated. Among 1759 BCx, hypotension, maximum temperature ≥101.5 °F within 24 hours of culture, and culture collected after postoperative day (POD) two were statistically significant predictors of positive cultures. Forty nine per cent of BCx were sent ≤ POD 2, and <1 per cent of these were positive. When all three criteria were met, the probability of a positive culture increased to 17 per cent. When absent, the probability of a negative culture was 99 per cent. When applied to the initial data set, the model resulted in 85 per cent reduction of cultures with 9 per cent yield of positive cultures. Drawing BCx based on a single predictor is inadequate. Reducing the number of cultures reflexively ordered within the first two POD could significantly reduce the number of unnecessary BCx. Several clinical features identified patients most likely to have positive BCx within the first 10 POD and could reduce unnecessary BCx. This model should be validated in an independent, prospective cohort.

scholarly journals DOP55 Histopathological features at diagnosis to predict long-term disease course of Crohn’s Disease

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S090-S091
Author(s):  
A Rezazadeh Ardabili ◽  
D Goudkade ◽  
D S J Wintjens ◽  
M J L Romberg-Camps ◽  
B Winkens ◽  
...  
Keyword(s):  
Decision Making ◽  
Chronic Inflammation ◽  
Predictive Value ◽  
Clinical Decision Making ◽  
Severe Disease ◽  
Clinical Decision ◽  
Disease Course ◽  
Histopathological Features ◽  
Baseline Characteristics

Abstract Background Crohn’s disease (CD) is characterized by a heterogeneous disease course and treatment response. There is a clinical need to identify CD patients at diagnosis who are at risk for developing a severe disease course. Patient stratification using state-of-the-art clinical, serological or genetic markers does not predict disease course sufficiently to facilitate clinical decision making. The current study aimed to investigate the additive predictive value of histopathological features at diagnosis to discriminate between patients with a long-term mild and severe disease course. Methods Diagnostic biopsies from treatment-naïve CD patients with mild or severe disease courses in the first 10 years after diagnosis (i.e. based on the number of quarterly flares) were reviewed by two senior gastrointestinal pathologists after developing a standardized form comprising 15 histopathological features related to acute and chronic inflammation. Multivariable logistic regression models were built to identify predictive features and compute receiver operating characteristics (ROC) curves. Model 1 included clinically relevant baseline characteristics (Montreal classification, smoking status and gender). Next, histopathological were added by applying two different model-building strategies (forward selection and purposeful selection algorithm)(Model 2). Prediction models were internally validated using bootstrapping to obtain optimism-corrected performance estimates. Results In total, 817 biopsies from 137 CD patients (64 mild disease course, 73 severe disease course) were included. Based on clinical baseline characteristics alone, disease course could only be moderately predicted (Model 1 Area under ROC (AUROC): 0.738 (optimism 0.018), 95%CI 0.65–0.83, sensitivity 83.6%, specificity 53.1%). When adding histopathological features, in colonic, but not ileal, biopsies a combination of (1) basal plasmacytosis, (2) severe lymphocyte and plasma cell infiltration in the lamina propria, (3) Paneth cell metaplasia and (4) absence of ulcers were identified and resulted in significantly better prediction of a severe disease course (Model 2 AUROC: 0.883 (optimism 0.033), 95%CI 0.82–0.94, sensitivity 80.4%, specificity 84.2%, model 2 vs. model 1 AUROC p = 0.001)[Figure 1]. Conclusion In this first study investigating the additive predictive value of multiple histopathological features in biopsies at CD diagnosis, we found that certain features of chronic inflammation in colonic biopsies contributed to prediction of a severe disease course, thereby presenting a novel approach to improve stratification and facilitate clinical 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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