The clinical utility of the ICD-11 classification of personality disorders and related traits: A preliminary scoping review

2021 ◽  
pp. 000486742110256
Author(s):  
Mikaela Tracy ◽  
Nikolaos Tiliopoulos ◽  
Louise Sharpe ◽  
Bo Bach
Keyword(s):  
Clinical Utility ◽  
Clinical Decision Making ◽  
Strong Support ◽  
Diagnostic System ◽  
Clinical Decision ◽  
International Classification Of Diseases ◽  
Ease Of Use ◽  
Electronic Screening ◽  
Study Characteristics

Objectives: A diagnostic system that fails to deliver clinically useful information will not be utilized and consequently will be unable to provide valuable data for health policy and clinical decision making. Therefore, it is imperative to obtain an accurate depiction of the clinical utility of the eleventh revision of the International Classification of Diseases (ICD-11) Personality Disorder (PD) model. The current mixed-methods systematic review aimed to determine the clinical utility of the ICD-11 PD classification system. Method: An electronic screening of six databases was conducted and resulting studies were subjected to specific exclusion criteria, which elicited eight studies of interest. Study characteristics were tabulated and methodological quality was appraised. Results: Four studies offered strong support for the model’s clinical utility, three offered some support accompanied by notable limitations and one study could only offer criticisms. Conclusion: Future investigation of the ICD-11 PD classification system’s (a) communicative value between clinicians and their patients, and between clinicians and their patient’s families; (b) ease of use; and (c) feasibility in terms of practical application is required to achieve a complete understanding of its clinical utility and ultimately bring clarity to the current ambiguous findings.

scholarly journals Clinical utility of targeted SARS-CoV-2 serology testing to aid the diagnosis and management of suspected missed, late or post-COVID-19 infection syndromes: Results from a pilot service implemented during the first pandemic wave

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249791
Author(s):  
Nicola Sweeney ◽  
Blair Merrick ◽  
Rui Pedro Galão ◽  
Suzanne Pickering ◽  
Alina Botgros ◽  
...  
Keyword(s):  
Clinical Utility ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Performance Characteristics ◽  
Direct Care ◽  
Serological Testing ◽  
Internal Validation ◽  
Assay Performance ◽  
Adults And Children ◽  
Test Probability

During the first wave of the global COVID-19 pandemic the clinical utility and indications for SARS-CoV-2 serological testing were not clearly defined. The urgency to deploy serological assays required rapid evaluation of their performance characteristics. We undertook an internal validation of a CE marked lateral flow immunoassay (LFIA) (SureScreen Diagnostics) using serum from SARS-CoV-2 RNA positive individuals and pre-pandemic samples. This was followed by the delivery of a same-day named patient SARS-CoV-2 serology service using LFIA on vetted referrals at central London teaching hospital with clinical interpretation of result provided to the direct care team. Assay performance, source and nature of referrals, feasibility and clinical utility of the service, particularly benefit in clinical decision-making, were recorded. Sensitivity and specificity of LFIA were 96.1% and 99.3% respectively. 113 tests were performed on 108 participants during three-week pilot. 44% participants (n = 48) had detectable antibodies. Three main indications were identified for serological testing; new acute presentations potentially triggered by recent COVID-19 e.g. pulmonary embolism (n = 5), potential missed diagnoses in context of a recent COVID-19 compatible illness (n = 40), and making infection control or immunosuppression management decisions in persistently SARS-CoV-2 RNA PCR positive individuals (n = 6). We demonstrate acceptable performance characteristics, feasibility and clinical utility of using a LFIA that detects anti-spike antibodies to deliver SARS-CoV-2 serology service in adults and children. Greatest benefit was seen where there is reasonable pre-test probability and results can be linked with clinical advice or intervention. Experience from this pilot can help inform practicalities and benefits of rapidly implementing new tests such as LFIAs into clinical service as the pandemic evolves.

Histomolecular Phenotypes and Outcome in Adenocarcinoma of the Ampulla of Vater

2013 ◽  
Vol 31 (10) ◽  
pp. 1348-1356 ◽  
Author(s):  
David K. Chang ◽  
Nigel B. Jamieson ◽  
Amber L. Johns ◽  
Christopher J. Scarlett ◽  
Marina Pajic ◽  
...  
Keyword(s):  
Clinical Utility ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Ampulla Of Vater ◽  
Therapeutic Strategies ◽  
Prognostic Variables ◽  
Histologic Subtype ◽  
Prognostic Group ◽  
Potential Clinical Utility ◽  
Novel Therapeutic Strategies

Purpose Individuals with adenocarcinoma of the ampulla of Vater demonstrate a broad range of outcomes, presumably because these cancers may arise from any one of the three epithelia that converge at that location. This variability poses challenges for clinical decision making and the development of novel therapeutic strategies. Patients and Methods We assessed the potential clinical utility of histomolecular phenotypes defined using a combination of histopathology and protein expression (CDX2 and MUC1) in 208 patients from three independent cohorts who underwent surgical resection for adenocarcinoma of the ampulla of Vater. Results Histologic subtype and CDX2 and MUC1 expression were significant prognostic variables. Patients with a histomolecular pancreaticobiliary phenotype (CDX2 negative, MUC1 positive) segregated into a poor prognostic group in the training (hazard ratio [HR], 3.34; 95% CI, 1.69 to 6.62; P < .001) and both validation cohorts (HR, 5.65; 95% CI, 2.77 to 11.5; P < .001 and HR, 2.78; 95% CI, 1.25 to 7.17; P = .0119) compared with histomolecular nonpancreaticobiliary carcinomas. Further stratification by lymph node (LN) status defined three clinically relevant subgroups: one, patients with histomolecular nonpancreaticobiliary (intestinal) carcinoma without LN metastases who had an excellent prognosis; two, those with histomolecular pancreaticobiliary carcinoma with LN metastases who had a poor outcome; and three, the remainder of patients (nonpancreaticobiliary, LN positive or pancreaticobiliary, LN negative) who had an intermediate outcome. Conclusion Histopathologic and molecular criteria combine to define clinically relevant histomolecular phenotypes of adenocarcinoma of the ampulla of Vater and potentially represent distinct diseases with significant implications for current therapeutic strategies, the ability to interpret past clinical trials, and future trial design.

Myocarditis

2018 ◽  
pp. 290-308
Author(s):  
Vanessa M Ferreira ◽  
Juliano L Fernandes ◽  
Cristina Basso ◽  
Matthias G Friedrich
Keyword(s):  
Clinical Decision Making ◽  
Clinical Decision ◽  
Myocardial Inflammation ◽  
Aged Patients ◽  
Non Invasive ◽  
Quantitative Mapping ◽  
Patients With Heart Failure ◽  
High Prevalence ◽  
Mapping Techniques

Myocarditis has a high prevalence, especially in young and middle-aged patients. It is the most important differential diagnosis in patients with acute cardiac disease and evidence for cellular injury (positive troponin). In clinical decision-making, it is important to rule in or rule out myocardial inflammation. While endomyocardial biopsy, which remains the gold standard to achieve an aetiopathogenetic diagnosis, can be helpful in patients with heart failure, it is less used in the majority of cases. Cardiovascular magnetic resonance (CMR) imaging has become the most efficient non-invasive diagnostic tool for patients with suspected myocarditis. Its unique value is based on the ability to identify inflammation and myocardial injury, in combination with an accurate assessment of ventricular volumes, as well as regional and global function. In many centres, myocarditis is the most frequent indication for CMR. The diagnostic criteria include markers for myocardial oedema, hyperaemia, and necrosis, while regional or global dysfunction and pericardial effusion serve as supportive criteria. Novel markers, such as quantitative mapping techniques, may allow for even better identification and classification of myocarditis.

scholarly journals Driver somatic mutations identify distinct disease entities within myeloid neoplasms with myelodysplasia

Blood ◽  
2014 ◽  
Vol 124 (9) ◽  
pp. 1513-1521 ◽  
Author(s):  
Luca Malcovati ◽  
Elli Papaemmanuil ◽  
Ilaria Ambaglio ◽  
Chiara Elena ◽  
Anna Gallì ◽  
...  
Keyword(s):  
Somatic Mutations ◽  
Clinical Decision Making ◽  
Myeloproliferative Neoplasms ◽  
Clinical Decision ◽  
Driver Mutations ◽  
Myeloid Neoplasms ◽  
Key Points ◽  
Distinct Disease ◽  
Disease Entities

Key Points Different driver mutations have distinct effects on phenotype of myelodysplastic syndromes (MDS) and myelodysplastic/myeloproliferative neoplasms (MDS/MPN). Accounting for driver mutations may allow a classification of these disorders that is considerably relevant for clinical decision-making.

scholarly journals Precision physiology and rescue of brain ion channel disorders

2017 ◽  
Vol 149 (5) ◽  
pp. 533-546 ◽  
Author(s):  
Jeffrey Noebels
Keyword(s):  
Ion Channel ◽  
Clinical Utility ◽  
Clinical Decision Making ◽  
Central Nervous System Disease ◽  
Clinical Decision ◽  
Channel Structure ◽  
Clinical Severity ◽  
Developmental Relationships ◽  
System Disease ◽  
Phenotypic Spectrum

Ion channel genes, originally implicated in inherited excitability disorders of muscle and heart, have captured a major role in the molecular diagnosis of central nervous system disease. Their arrival is heralded by neurologists confounded by a broad phenotypic spectrum of early-onset epilepsy, autism, and cognitive impairment with few effective treatments. As detection of rare structural variants in channel subunit proteins becomes routine, it is apparent that primary sequence alone cannot reliably predict clinical severity or pinpoint a therapeutic solution. Future gains in the clinical utility of variants as biomarkers integral to clinical decision making and drug discovery depend on our ability to unravel complex developmental relationships bridging single ion channel structure and human physiology.

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

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 &lt; 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 &lt; 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

scholarly journals Intra and Inter-observer Concordance of a New Classification System for Myopic Maculopathy

2020 ◽  
Author(s):  
Rong-rong Zhang ◽  
Yan Yu ◽  
Yin-fen Hou ◽  
Chang-fan Wu
Keyword(s):  
Classification System ◽  
Clinical Decision Making ◽  
Interobserver Reliability ◽  
Type A ◽  
Clinical Decision ◽  
Intraobserver Agreement ◽  
Intraobserver Reproducibility ◽  
Fundus Photographs ◽  
Myopic Maculopathy

Abstract Background: Myopic maculopathy (MM) is one of the major causes of visual impairment and irreversible blindness in eyes with PM. However, the classification of each type of lesion associated with MM has not been determined. Recently, a new MM classification system was proposed, known as the ATN grading and classification system, which was based on the fundus photographs and OCT images, including three variable components: atrophy (A), traction (T), and neovascularization (N). Hence, this study aimed to perform an independent interobserver and intraobserver agreement evaluation of the recently developed ATN grading system for MM. Methods: This was a retrospective study. Fundus photographs and the optical coherence tomography (OCT) images of 125 patients (226 eyes) with various of MM were evaluated and classified using the ATN grading of the new MM classification system by four evaluators (2 attending ophthalmologists and 2 ophthalmic residents). All cases were repeatedly evaluated by the same evaluators after an interval of 6 weeks. The Kappa coefficient (κ) and 95% confidence interval (CI) were used to determine the interobserver and intraobserver agreement.Results: The interobserver reliability was substantial when considering the maculopathy type (A, T, and N). The weighted Fleiss κ values for each MM type (A, T, and N) were 0.651 (95% CI: 0.602–0.700), 0.734 (95% CI: 0.689–0.779), and 0.702 (95% CI: 0.649–0.755), respectively. The interobserver agreement when considering the sub-types was good or excellent, except for stages A1, A2, and N1 which weighted κ value was less than 0.6, with a moderate agreement. The intraobserver reproducibility of types or sub-types was excellent, with κ>0.8. No significant differences were observed between attending ophthalmologists and residents in the interobserver reliability and intraobserver reproducibility.Conclusions: The ATN classification allows an adequate agreement among ophthalmologists with different qualifications and by the same observer on separate occasions. Future prospective studies should further evaluate whether this classification can be better implemented at clinical decision-making and disease progression assessment.

scholarly journals ecTMB: a robust method to estimate and classify tumor mutational burden

2019 ◽  
Author(s):  
Lijing Yao ◽  
Yao Fu ◽  
Marghoob Mohiyuddin ◽  
Hugo YK Lam
Keyword(s):  
Somatic Mutations ◽  
Clinical Decision Making ◽  
Patient Survival ◽  
Clinical Decision ◽  
Statistical Framework ◽  
Mutational Burden ◽  
Mutation Model ◽  
Tumor Mutational Burden ◽  
Multiple Challenges

AbstractTumor Mutational Burden (TMB) is a measure of the abundance of somatic mutations in a tumor, which has been shown to be an emerging biomarker for both anti-PD-(L)1 treatment and prognosis. Nevertheless, multiple challenges still hinder the adoption of TMB for clinical decision-making. The key challenges are the inconsistency of TMB measurement among assays and a lack of meaningful threshold for TMB classification. We describe a powerful and flexible statistical framework for estimation and classification of TMB (ecTMB). ecTMB uses an explicit background mutation model to predict TMB robustly and consistently. In addition to the two known TMB subtypes, TMB-high and TMB-low, we discovered a novel TMB subtype, named TMB-extreme, which was significantly associated with patient survival outcome. This discovery enabled ecTMB to classify samples to biologically and clinically relevant subtypes defined by TMB.

scholarly journals Progress in Clinical Neurosciences: Evidence Based Care in the Neurosciences

2002 ◽  
Vol 29 (2) ◽  
pp. 115-119 ◽  
Author(s):  
Samuel Wiebe ◽  
Bart Demaerschalk
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Ease Of Use ◽  
Evidence Based ◽  
Content Accessibility ◽  
Evidence Based Care

Abstract:We examine the relevance of Evidence Based Care (EBC) to the field of clinical neurosciences, with particular emphasis on feasible methods of implementing EBC in clinical practice. By using pre-appraised EBC summaries, busy clinicians can move toward EBC without engaging in the laborious process of searching and critically appraising the literature. After reviewing the neurological content, accessibility and ease of use of current sources of EBC summaries, we find them substantially lacking in coverage of the neurosciences, and therefore of limited use to clinicians in this field. We emphasize a particular type of EBC summary, the critically appraised topic, and comment on its usefulness and limitations as a tool to assist clinical decision-making in the neurosciences. Finally, we propose that a collection of easily accessible, good quality, peer reviewed critically appraised topics, covering a breadth of relevant topics, is a reasonable way of moving toward EBC in the clinical neurosciences.

Sign in / Sign up

Export Citation Format

Share Document