The impact of a focused vascular lower limb arterial duplex (F-VLAD) scan in management decisions for acute limb ischaemia

Perfusion ◽  
2016 ◽  
Vol 32 (1) ◽  
pp. 74-80
Author(s):  
Pasha Normahani ◽  
Mohammed Aslam ◽  
Nigel J Standfield ◽  
Usman Jaffer
Keyword(s):  
Decision Making ◽  
Diagnostic Accuracy ◽  
Lower Limb ◽  
Predictive Value ◽  
Duplex Ultrasound ◽  
Full Duplex ◽  
Limb Ischaemia ◽  
Acute Limb Ischaemia ◽  
Significant Difference ◽  
The Impact

Objective: To establish the diagnostic accuracy of a ‘focused vascular lower limb arterial duplex scan (F-VLAD)’ developed to facilitate rapid decision-making for acute limb ischaemia (ALI). Methods: Ten cases of ALI were identified from our patient database; clinical details, history and examination findings were extracted from the clinical notes. Original ‘full’ duplex ultrasound (DUS) pictorial reports were ‘re-formatted’ to include only anatomical segments included in the ‘F-VLAD’ scan. The series of 10 reports were emailed to 1741 vascular surgeons. Each recipient received a random mixture of full and F-VLAD scans. Participants were asked regarding next step in management and confidence in decision-making (Likert scale; 1 strongly disagree, 5 strongly agree). The cases were again sent out to the same database and respondents were asked as to the cause of ischaemia (embolic or thrombosis). Results: Eighty-one participants responded to the first survey and 43 participants to the second survey. Participants felt more confident making decisions regarding management using the full duplex report compared to the F-VLAD report (4 (3-4) vs 3 (2-4), median (IQR); p<0.001). However, there was no significant difference in diagnostic accuracy (differentiating embolus from thrombosis) when comparing the F-VLAD and full DUS reports (85.4% vs 88.3%; p=0.461). F-VLAD and ‘full’ DUS reports had comparable sensitivity (85.1% vs 86.8%), specificity (85.6% vs 89.2%),positive predictive value (PPV) (80.4% vs 81.9%) and negative predictive value (NPV) (89.2% vs 92.2%), respectively. Conclusion: The F-VLAD scan has comparable accuracy to a traditional full DUS in diagnosing the underlying aetiology of ALI. This may facilitate surgeon-performed point-of-care DUS.

The Impact of Conflict- Generating Techniques on Student Reactions and Decision Quality

1995 ◽  
Vol 58 (4) ◽  
pp. 39-45
Author(s):  
Granger Macy ◽  
Joan C. Neal
Keyword(s):  
Decision Making ◽  
Business Students ◽  
Decision Quality ◽  
Structured Decision Making ◽  
Constructive Conflict ◽  
Significant Difference ◽  
Student Reactions ◽  
Graduate Business Students ◽  
The Impact

This study examined the effectiveness of conflict-generating decision-making techniques in the college classroom. Utiliz ing constructive conflict in classroom exercises may affect decision-making quality and student reactions. This study of undergraduate and graduate business students found significant difference in both the quality of the decisions and in student reactions to the techniques. The findings and discussion indicate the potential for appropriate use of structured decision-making techniques in the classroom.

Standardized Synoptic Cancer Pathology Reports — So What and Who Cares?: A Population-Based Satisfaction Survey of 970 Pathologists, Surgeons, and Oncologists

2013 ◽  
Vol 137 (11) ◽  
pp. 1599-1602 ◽  
Author(s):  
Sara Lankshear ◽  
John Srigley ◽  
Thomas McGowan ◽  
Marta Yurcan ◽  
Carol Sawka
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Physician Satisfaction ◽  
Cross Sectional ◽  
Cancer Pathology ◽  
Report Turnaround Time ◽  
Significant Difference ◽  
Pathology Reporting ◽  
The Impact

Context.—Cancer Care Ontario implemented synoptic pathology reporting across Ontario, impacting the practice of pathologists, surgeons, and medical and radiation oncologists. The benefits of standardized synoptic pathology reporting include enhanced completeness and improved consistency in comparison with narrative reports, with reported challenges including increased workload and report turnaround time. Objective.—To determine the impact of synoptic pathology reporting on physician satisfaction specific to practice and process. Design.—A descriptive, cross-sectional design was utilized involving 970 clinicians across 27 hospitals. An 11-item survey was developed to obtain information regarding timeliness, completeness, clarity, and usability. Open-ended questions were also employed to obtain qualitative comments. Results.—A 51% response rate was obtained, with descriptive statistics reporting that physicians perceive synoptic reports as significantly better than narrative reports. Correlation analysis revealed a moderately strong, positive relationship between respondents' perceptions of overall satisfaction with the level of information provided and perceptions of completeness for clinical decision making (r = 0.750, P &lt; .001) and ease of finding information for clinical decision making (r = 0.663, P &lt; .001). Dependent t tests showed a statistically significant difference in the satisfaction scores of pathologists and oncologists (t169 = 3.044, P = .003). Qualitative comments revealed technology-related issues as the most frequently cited factor impacting timeliness of report completion. Conclusion.—This study provides evidence of strong physician satisfaction with synoptic cancer pathology reporting as a clinical decision support tool in the diagnosis, prognosis, and treatment of cancer patients.

scholarly journals Evaluation of Omics-Based Strategies for the Management of Advanced Lung Cancer

2020 ◽  
pp. OP.20.00117
Author(s):  
Ravi Salgia ◽  
Isa Mambetsariev ◽  
Rebecca Pharaon ◽  
Jeremy Fricke ◽  
Angel Ray Baroz ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Decision Making ◽  
Targeted Therapy ◽  
Predictive Value ◽  
Advanced Nsclc ◽  
Therapeutic Options ◽  
Advanced Lung Cancer ◽  
Molecular Testing ◽  
Cox Regression Analysis ◽  
The Impact

PURPOSE: Omic-informed therapy is being used more frequently for patients with non–small-cell lung cancer (NSCLC) being treated on the basis of evidence-based decision-making. However, there is a lack of a standardized framework to evaluate those decisions and understand the association between omics-based management strategies and survival among patients. Therefore, we compared outcomes between patients with lung adenocarcinoma who received omics-driven targeted therapy versus patients who received standard therapeutic options. PATIENTS AND METHODS: This was a retrospective study of patients with advanced NSCLC adenocarcinoma (N = 798) at City of Hope who received genomic sequencing at the behest of their treating oncologists. A thoracic oncology registry was used as a clinicogenomic database to track patient outcomes. RESULTS: Of 798 individuals with advanced NSCLC (median age, 65 years [range, 22-99 years]; 60% white; 50% with a history of smoking), 662 patients (83%) had molecular testing and 439 (55%) received targeted therapy on the basis of the omic-data. A fast-and-frugal decision tree (FFT) model was developed to evaluate the impact of omics-based strategy on decision-making, progression-free survival (PFS), and overall survival (OS). We calculated that the overall positive predictive value of the entire FFT strategy for predicting decisions regarding the use of tyrosine kinase inhibitor–based targeted therapy was 88% and the negative predictive value was 96%. In an adjusted Cox regression analysis, there was a significant correlation with survival benefit with the FFT omics-driven therapeutic strategy for both PFS (hazard ratio [HR], 0.56; 95% CI, 0.42 to 0.74; P < .001) and OS (HR, 0.51; 95% CI, 0.36 to 0.71; P < .001) as compared with standard therapeutic options. CONCLUSION: Among patients with advanced NSCLC who received care in the academic oncology setting, omics-driven therapy decisions directly informed treatment in patients and was correlated with better OS and PFS.

scholarly journals Revascularisation through the obturator foramen of lower limbs with a compromised ipsilateral groin due to infection

2020 ◽  
Vol 102 (1) ◽  
pp. 14-17
Author(s):  
G Zenunaj ◽  
L Traina ◽  
P Acciarri ◽  
C Spataro ◽  
V Gasbarro
Keyword(s):  
Lower Limb ◽  
Graft Infection ◽  
Vascular Reconstruction ◽  
Lower Limbs ◽  
Closure Device ◽  
Limb Ischaemia ◽  
Obturator Foramen ◽  
Acute Limb Ischaemia ◽  
Femoral Vessels ◽  
Autologous Grafts

IntroductionInfra-inguinal vascular reconstruction with active groin infection is a concerning issue. Using resistant grafts to infection is the most adopted approach. However, in absence of these materials in acute situations, the trans-obturator approach allows for limb revascularisation avoiding the infected site. We evaluated the effectiveness of this approach in patients who needed lower limb revascularisation with an ipsilateral groin infection.Materials and methodsA retrospective study was conducted over a four-year period.ResultsOver this period, 13 patients underwent trans-obturator reconstructions (13 external iliac–popliteal above-knee and one aortobipopliteal above-knee bypass). Seven patients had been previously revascularised and were admitted for graft infection (six infra-inguinal bypasses, one axillo-bifemoral bypass). Four presented with acute limb ischaemia, three with groin haematoma and one with a groin abscess. The remaining cases consisted of drug-addicted patients with injury of femoral vessels due to self-injection of drugs. The patients underwent reconstructions with autologous grafts which complicated early with groin haematoma. After transobturator revascularisation, the groin underwent debridement with applying vacuum-assisted wound closure device.ConclusionThe transobturator approach could be considered as a chance for lower limb revascularisation in case of ipsilateral groin infection. Moreover, avoiding the infected site allowed us to focus separately and safely on the treatment of the inguinal wound.

A Study of Impact of IFRS Convergence in India on Debt–Equity Components of Financial Statements

2020 ◽  
pp. 097215092091846
Author(s):  
Saumya Jain ◽  
Chandra Prakash Gupta
Keyword(s):  
Decision Making ◽  
Financial Reporting ◽  
Financial Statements ◽  
Annual Reports ◽  
Practical Relevance ◽  
Reporting Standards ◽  
Financial Instruments ◽  
Financial Reporting Standards ◽  
Significant Difference ◽  
The Impact

The present article analyses the impact of International Financial Reporting Standards (IFRS) convergence on financial statements in India. Our focus is on the most significant and challenging standard, that is, IND-AS (financial instruments). Our focus is on the most significant and challenging standard i.e IND-AS(Financial Instruments) and their impact on debt-equity classification brought about by the new standard(s). We analyse the annual reports of 30 listed entities having outstanding preference share capital for the years 2015–2016 and 2016–2017. We redefine the formulae of ratios most commonly used in loan agreements (popularly referred to as ‘debt covenants’) from lenders’ perspective and empirically examine the impact of IFRS convergence on the value of these ratios for the same financial year, that is, 2015–2016. Our results show that there is a significant difference in the value of ratios calculated using newly developed formulae and by applying the old formulae on new data. The study is the first of its kind to empirically examine the impact of IND-AS specifically standard relating to financial instruments on debt ratios in India. Our contribution to the literature is that we not only examine the impact on ratios on transition to IND-AS but also offer a solution as to how the users can mitigate this impact by making adjustments to the debt ratios taking into account the recognition, measurement and presentation changes brought about by IND-AS, so that they can apply our newly developed formulae directly on IND-AS statements and derive the same meaning and interpretation from the ratios as before retaining their practical usage. Thus, our study is of immediate practical relevance to lenders, credit managers and investors aiding their decision making.

scholarly journals The effect of Women’s decision-making autonomy on family Planning acces in Senegal in 2017

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
N M Sougou ◽  
O Bassoum ◽  
M M M M Leye ◽  
A Tal-Dia
Keyword(s):  
Decision Making ◽  
Family Planning ◽  
Contraceptive Method ◽  
Contraceptive Use ◽  
Modern Contraceptive ◽  
Contraceptive Methods ◽  
Modern Contraceptive Method ◽  
Significant Difference ◽  
Modern Contraceptive Use ◽  
The Impact

Abstract Background The impact of access to decision-making on women’s health in the choice of fertility control has been highlighted by research. The aim of this study was to analyze the impact of access to decision-making for women’s health on access to family planning in Senegal in 2017. Methods The analyses of this study had been done on the Individual Records file of Senegal’s Demographic Health Survey 2017. This data covered 8865 women aged 15 to 49 years. The propensity scores matching method had been done. The variable access to the decision was considered as the variable of interest. Matching was done using variables that were not modified by the effect of the treatment. These were religion and socio-economic level. The outcome variables were modern contraceptive use, the existence of unmet needs and the type of modern contraceptive method used. Significance was at 5%. The condition of common support had been respected. The analysis was done with the STATA.15 software. Results Six percent (6.26%) of women could decide about their health on their own. Access to decision-making increased significantly with the woman’s age (p &lt; 0.05). Fifteen percent (15.24%) women used a modern contraceptive method. Women using a contraceptive method were more numerous in the group with access to decision-making (29.43%) with a significant difference with the other group of 8% (p &lt; 0.05). After matching, there was no significant difference between women in terms of modern contraceptive use and the existence of unmet needs. There was a significant difference in the type of contraceptive method used between the two groups of women. These differences were 23.17% for Intra Uterine Device, 52.98% for injections, 08.9% for implants and 10.79% for condoms. Conclusions Access to decision-making for health would facilitate women’s access to long-acting contraceptive methods. These findings show the importance of implementing gender transformative interventions in improving access to family planning. Key messages Access to decision-making for health would allow better access to modern contraceptive methods, especially those with a long duration of action. Better consideration of gender disparity reduction could improve access to family planning in Senegal.

Comparison of the Predictive Value of MRD and PVA Score in Pediatric ALL.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1520-1520
Author(s):  
Anja Troeger ◽  
Gabriele Escherich ◽  
Udo zur Stadt ◽  
M. L Den Boer ◽  
Rob Pieters ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Correlation Coefficient ◽  
Predictive Value ◽  
Genetic Alterations ◽  
Relevant Parameter ◽  
Response To Chemotherapy ◽  
Significant Difference ◽  
The Impact

Abstract Early identification of patients (pts) at risk for relapse allows for development of risk-adapted treatment strategies, thus steadily improving the outcome in pediatric acute lymphoblastic leukemia (ALL). Besides classic prognostic factors such as age, initial leukocyte count (WBC), genetic alterations and the immune phenotype, the so called PVA Score, summarizing the in vitro resistance of blasts against prednisone, vincristine and asparaginase, has been applied for treatment stratification in the CoALL protocol, a German multicenter study for children with ALL. Over the past years it has become increasingly clear that the in vivo response to chemotherapy assessed by detection of residual malignant cells (MRD) by PCR technique can be predictive of prognosis. Here we compare for the first time the relevance of in vitro (PVA Score) and in vivo (MRD) treatment response in a large cohort of 275 children with ALL, age 1–17 years, uniformly treated according to the CoALL protocols 05–92 to 07–03. Children with B cell precursor ALL (BCP-ALL) and T-ALL were analyzed separately. Bone marrow samples of 160 children with BCP-ALL and of 115 T-ALL pts diagnosed between 1992–2005 were prospectively assessed for PVA Score at diagnosis and MRD levels at day (d) 15, 29 and 43 after informed consent was obtained from the parents or legal guardians at the time of enrolment. Of note, 7 of the BCP-ALL and 14 of the T-ALL pts with late morphological response were excluded from analysis. Overall median MRD levels in BCP-ALL pts (MRDd15: 6×10e-4; MRDd29: 2×10e-5) were one log lower than in T-ALL (MRDd15: 9×10e-3; MRDd29: 3×10e-4). We detected no association between PVA Score and MRD level in BCP-ALL (correlation coefficient: r=0.15; p=0.15) and only a weak correlation in T-ALL pts (correlation coefficient: r=0.43; p=0.0003). When assessing the impact of the PVA Score on relapse free survival (RFS), in BCP-ALL only score 3+4 (good response) vs. 8+9 (poor response) was prognostically relevant (RFS 0.86±0.05 vs. 0.59±0.12; p=0.03), whereas in T-ALL no significant difference between these subgroups was found (RFS 0.71±0.1 vs. 0.68±0.1; p=0.62). In multivariate analysis PVA Score 3+4 vs. 8+9 remained the most relevant parameter for RFS in BCP-ALL (p=0.05) when compared to age and initial WBC. However, MRD levels were of even higher predictive power, especially at later time points: MRD negativity at d29 in BCP-ALL identified pts with significantly superior RFS (RFS MRD neg.: 0.9±0.05 vs. pos.: 0.7±0.05; p=0.003) and low MRD levels indicated a favorable outcome in T-ALL (RFS MRD &lt;10e-3: 0.89±0.05 vs. MRD &gt;10e-3: 0.68±0.07; p=0.001). Moreover, both BCP-ALL and T-ALL pts characterized by MRD levels &gt;10e-3 on d43 exhibited a poor outcome (RFS BCP-ALL: 0.42±0.17; RFS T-ALL: 0.47±0.14). MRD remained an independent marker in multivariate analysis including initial WBC and age, both in BCP- (MRDd29: p=0.006; MRDd43: p=0.001) and T-ALL (MRDd29: p=0.003; MRDd43: p=0.015). By multivariate analysis, in T-ALL low MRD levels on d29 predicted superior RFS independently from the PVA Score (MRD: p=0.002 vs. PVA: p=0.09), whereas in BPC-ALL these parameters were not completely independent from each other at that early time point (MRD: p= 0.059 vs. PVA: p= 0.063) but became independent at d43 (MRD: p= 0.018 vs. PVA: p= 0.253). While the predictive value of the PVA Score was limited to BCP-ALL, MRD was an independent prognostic marker for both BCP- and T-ALL and reliably identified pts at low and high risk for relapse.

scholarly journals Subclavian Artery Pseudoaneurysm Formation 3 Months after a Game of Rugby Union

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
T. Evans ◽  
S. Roy ◽  
M. Rocker
Keyword(s):  
Subclavian Artery ◽  
Rare Complication ◽  
Delayed Diagnosis ◽  
Duplex Ultrasound ◽  
Final Diagnosis ◽  
Rugby Union ◽  
Limb Ischaemia ◽  
Artery Pseudoaneurysm ◽  
Pseudoaneurysm Formation ◽  
Acute Limb Ischaemia

Pseudoaneurysms of the subclavian artery remain a rare complication after fracture of the clavicle. We report a case of delayed diagnosis of a subclavian artery pseudoaneurysm after a closed fracture of the clavicle in a 15-year-old patient, 3 months after the original injury while playing rugby union. Despite several attendances to the Emergency Department with vague symptoms, the final diagnosis was confirmed by duplex ultrasound and Computed Tomography of the thorax. Surgical repair was indicated due to acute limb ischaemia from distal embolisation from a large pseudoaneurysm, with the patient making a full recovery. This case highlights the need for clinical vigilance when assessing patients, particularly on repeated occasions when their recovery appears to be impaired. A thorough history and clinical examination can raise suspicion of even rare occurrences and aid prompt management.

scholarly journals Presentation and Outcome of Acute Limb Ischaemia

2019 ◽  
Vol 14 (1) ◽  
pp. 59-61
Author(s):  
Md Humayun Kabir ◽  
Munshi Md Mojibur Rahman ◽  
AKM Musa Khan ◽  
Alamgir Rashid Chowdhury ◽  
AT Shahrier Ahmed
Keyword(s):  
Upper Limb ◽  
Lower Limb ◽  
Armed Forces ◽  
Late Presentation ◽  
Morbidity And Mortality ◽  
Military Hospital ◽  
High Morbidity ◽  
Limb Ischaemia ◽  
Acute Limb Ischaemia ◽  
Co Morbidity

Introduction: Outcome of acute limb ischaemia (ALI) is depends on the timely intervention. Delayed reperfusion of acute occlusive limb ischemia causes local and systemic serious consequences and is the main cause of morbidity and mortality in these patients. Objective: To identify the factors impeding the management and outcome of ALI in a tertiary level hospital. Materials and Methods: This cross sectional study evaluated reporting time and management of 42 patients with ALI between Jan 2016 to Jan 2018 in Combined Military Hospital Dhaka. Late presentation of ALI is defined as reporting of patient after 72 hours of symptoms. Time of presentation, Grades of ischemia, co-morbidities, morbidities and mortality were recorded. Results: During the study period, 42 patients were included, 25 female (59.5%) and 17 male (40.5%). Average age was 63 years (30 years – 87 years). 38 (90%) patients with lower limb ischaemia and 4 (10%) patients with upper limb ischaemia. 2 patients (4.7%) reported within 6 hours of symptom, 6 patients (14.3%) presented within 24 hours, 11 patients (26.3%) within 72 hours and 23 patients (54.7%) after 72 hours. On admission, 16 patients had grade III ischemia, 18 had grade IIb, 8 had grade IIa. 12 patients died (28.5%) and 19 (45%) patients had amputation. The risk factors of amputation were grade of ischemia, extremity (lower limb 45% vs. Upper limb 0%), age and co-morbidity. Conclusion: Late presentation of acute occlusive ischemia carries high morbidity and mortality. Lack of awareness and Negligence of symptoms delay the reporting time to hospital. Journal of Armed Forces Medical College Bangladesh Vol.14(1) 2018: 59-61

scholarly journals A COVID-19 patient with recurrent acute limb ischaemia despite two successive types of therapeutic dose anticoagulation and thrombolysis

2021 ◽  
Vol 14 (8) ◽  
pp. e245040
Author(s):  
Eva Teng ◽  
Marcelle Pignanelli ◽  
Faiza Hammad ◽  
David Wisa
Keyword(s):  
Lower Limb ◽  
Arterial Thrombosis ◽  
Distress Syndrome ◽  
Respiratory Illness ◽  
Limb Ischaemia ◽  
Heparin Infusion ◽  
Recurrent Ischaemia ◽  
Acute Limb Ischaemia ◽  
Upper Respiratory ◽  
Infusion Protocol

COVID-19 is caused by the SARS-CoV-2, and its presentation ranges from mild upper respiratory illness to critical disease including acute respiratory distress syndrome and multiorgan dysfunction. While it was initially believed to primarily target the respiratory system, numerous studies have demonstrated it to cause a hypercoagulable state that predisposes to arterial and venous thrombosis. We present a case where a patient with COVID-19 developed acute lower limb ischaemia due to arterial thrombosis in the setting of full-dose enoxaparin, followed by heparin infusion protocol. The patient developed recurrent ischaemia despite thrombolysis in addition to anticoagulation, and eventually required open thrombectomy before making a full recovery.

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