Clinical Diagnosis and the Order of Information

1998 ◽  
Vol 18 (4) ◽  
pp. 412-417 ◽  
Author(s):  
George R. Bergus ◽  
Gretchen B. Chapman ◽  
Barcey T. Levy ◽  
John W. Ely ◽  
Robert A. Oppliger
Keyword(s):  
Urinary Tract ◽  
Physical Examination ◽  
Clinical Decision Making ◽  
Laboratory Data ◽  
Clinical Information ◽  
Clinical History ◽  
Clinical Decision ◽  
Background Information ◽  
Likelihood Ratios ◽  
Patient’S History

Background. Information order can influence judgment. However, it remains unclear whether the order of clinical data affects physicians' interpretations of these data when they are engaged in familiar diagnostic tasks. Methods. Of 400 randomly selected family physicians who were given a questionnaire involving a brief written scenario about a young woman with acute dysuria, 315 (79%) returned usable responses. The physicians had been randomized into two groups, and both groups had received the same clinical information but in different orders. After learning the patient's chief com plaint, physicians received either the patient's history and physical examination results followed by the laboratory data (the H&P-first group) or the laboratory data followed by the history and physical examination results (the H&P-last group). The results of the history and physical examination were supportive of the diagnosis of UTI, while the laboratory data were not. All physicians judged the probability of a urinary tract infection (UTI) after each piece of information. Results. The two groups had similar mean estimates of the probability of a UTI after learning the chief complaint (67.4% vs 67.8%, p = 0.85). At the end of the scenario, the H&P-first group judged UTI to be less likely than did the H&P-last group (50.9% vs 59.1 %, p = 0.03) despite having identical information. Comparison of the mean likelihood ratios attributed to the clinical information showed that the H&P-first group gave less weight to the history and phys ical than did the H&P-last group (p = 0.04). Conclusions. The order in which clinical information was presented influenced physicians' estimates of the probability of dis ease. The clinical history and physical examination were given more weight by phy sicians who received this information last. Key words: diagnosis; urinary tract infec tions ; judgment; primary care; clinical decision making. (Med Decis Making 1998;18: 412-417)

scholarly journals Laboratory predictors of death from coronavirus disease 2019 (COVID-19) in the area of Valcamonica, Italy

2020 ◽  
Vol 58 (7) ◽  
pp. 1100-1105 ◽  
Author(s):  
Graziella Bonetti ◽  
Filippo Manelli ◽  
Andrea Patroni ◽  
Alessandra Bettinardi ◽  
Gianluca Borrelli ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Clinical Decision Making ◽  
Troponin I ◽  
Laboratory Data ◽  
High Sensitivity ◽  
Clinical Decision ◽  
International Normalized Ratio ◽  
Serum Glucose ◽  
Hospital Death ◽  
Laboratory Findings

AbstractBackgroundComprehensive information has been published on laboratory tests which may predict worse outcome in Asian populations with coronavirus disease 2019 (COVID-19). The aim of this study is to describe laboratory findings in a group of Italian COVID-19 patients in the area of Valcamonica, and correlate abnormalities with disease severity.MethodsThe final study population consisted of 144 patients diagnosed with COVID-19 (70 who died during hospital stay and 74 who survived and could be discharged) between March 1 and 30, 2020, in Valcamonica Hospital. Demographical, clinical and laboratory data were collected upon hospital admission and were then correlated with outcome (i.e. in-hospital death vs. discharge).ResultsCompared to patients who could be finally discharged, those who died during hospital stay displayed significantly higher values of serum glucose, aspartate aminotransferase (AST), creatine kinase (CK), lactate dehydrogenase (LDH), urea, creatinine, high-sensitivity cardiac troponin I (hscTnI), prothrombin time/international normalized ratio (PT/INR), activated partial thromboplastin time (APTT), D-dimer, C reactive protein (CRP), ferritin and leukocytes (especially neutrophils), whilst values of albumin, hemoglobin and lymphocytes were significantly decreased. In multiple regression analysis, LDH, CRP, neutrophils, lymphocytes, albumin, APTT and age remained significant predictors of in-hospital death. A regression model incorporating these variables explained 80% of overall variance of in-hospital death.ConclusionsThe most important laboratory abnormalities described here in a subset of European COVID-19 patients residing in Valcamonica are highly predictive of in-hospital death and may be useful for guiding risk assessment and clinical decision-making.

scholarly journals Diagnostic accuracy of symptoms as a diagnostic tool for SARS-CoV 2 infection: a cross-sectional study in a cohort of 2,173 patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Carlos Alfonso Romero-Gameros ◽  
Tania Colin-Martínez ◽  
Salomón Waizel-Haiat ◽  
Guadalupe Vargas-Ortega ◽  
Eduardo Ferat-Osorio ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Diagnostic Tool ◽  
Clinical Decision Making ◽  
Multivariate Logistic Regression Analysis ◽  
Clinical Decision ◽  
Cross Sectional Study ◽  
World Health ◽  
Likelihood Ratios ◽  
Cross Sectional ◽  
Health Organization

Abstract Background The SARS-CoV-2 pandemic continues to be a priority health problem; According to the World Health Organization data from October 13, 2020, 37,704,153 confirmed COVID-19 cases have been reported, including 1,079,029 deaths, since the outbreak. The identification of potential symptoms has been reported to be a useful tool for clinical decision-making in emergency departments to avoid overload and improve the quality of care. The aim of this study was to evaluate the performances of symptoms as a diagnostic tool for SARS -CoV-2 infection. Methods An observational, cross-sectional, prospective and analytical study was carried out, during the period of time from April 14 to July 21, 2020. Data (demographic variables, medical history, respiratory and non-respiratory symptoms) were collected by emergency physicians. The diagnosis of COVID-19 was made using SARS-CoV-2 RT-PCR. The diagnostic accuracy of these characteristics for COVID-19 was evaluated by calculating the positive and negative likelihood ratios. A Mantel-Haenszel and multivariate logistic regression analysis was performed to assess the association of symptoms with COVID-19. Results A prevalence of 53.72% of SARS-CoV-2 infection was observed. The symptom with the highest sensitivity was cough 71%, and a specificity of 52.68%. The symptomatological scale, constructed from 6 symptoms, obtained a sensitivity of 83.45% and a specificity of 32.86%, taking ≥2 symptoms as a cut-off point. The symptoms with the greatest association with SARS-CoV-2 were: anosmia odds ratio (OR) 3.2 (95% CI; 2.52–4.17), fever OR 2.98 (95% CI; 2.47–3.58), dyspnea OR 2.9 (95% CI; 2.39–3.51]) and cough OR 2.73 (95% CI: 2.27–3.28). Conclusion The combination of ≥2 symptoms / signs (fever, cough, anosmia, dyspnea and oxygen saturation < 93%, and headache) results in a highly sensitivity model for a quick and accurate diagnosis of COVID-19, and should be used in the absence of ancillary diagnostic studies. Symptomatology, alone and in combination, may be an appropriate strategy to use in the emergency department to guide the behaviors to respond to the disease. Trial registration Institutional registration R-2020-3601-145, Federal Commission for the Protection against Sanitary Risks 17 CI-09-015-034, National Bioethics Commission: 09 CEI-023-2017082.

Quality specifications: self pleasure for clinical laboratories or added value for patient management?

2007 ◽  
Vol 45 (4) ◽  
Author(s):  
Mario Plebani
Keyword(s):  
Decision Making ◽  
Patient Management ◽  
Clinical Decision Making ◽  
Laboratory Data ◽  
Clinical Decision ◽  
Added Value ◽  
Internal Quality ◽  
Laboratory Services ◽  
Management Procedures ◽  
Quality Specifications

AbstractAnalytical quality specifications play a key role in assuring and continuously improving high-quality laboratory services. However, I believe, that there are two “missing links” in the effective management of quality specifications in the delivery of laboratory services. The first is the evidence that pre-analytical variation and related problems are not taken into great consideration by laboratory professionals. The second missing link is the communication of quality specifications to clinicians and other possible stakeholders. If quality specifications represent “the level of performance required to facilitate clinical decision-making”, they cannot be used only for internal quality management procedures but must be communicated to facilitate clinical reasoning, decision-making and patient management. A consensus should be achieved in the scientific community on these issues to assure better utilization of laboratory data and, ultimately, improved clinical outcomes.Clin Chem Lab Med 2007;45:462–6.

A Comparison of GFR Estimation Formulae in Pediatric Oncology

2018 ◽  
Vol 230 (03) ◽  
pp. 142-150
Author(s):  
Tobias Rechenauer ◽  
Jakob Zierk ◽  
Daniel Gräfe ◽  
Wolfgang Rascher ◽  
Manfred Rauh ◽  
...  
Keyword(s):  
Cystatin C ◽  
Clinical Decision Making ◽  
Estimating Equations ◽  
Clinical Decision ◽  
Chemotherapeutic Agents ◽  
Laboratory Method ◽  
Background Information ◽  
Data Set ◽  
Therapeutic Consequences ◽  
Gfr Estimation

Abstract Background Application of potentially nephrotoxic chemotherapy requires continuous monitoring of renal function for toxicity and dosing. Novel pediatric glomerular filtration rate (GFR) estimating equations including cystatin C have been proposed to enhance the reliability of GFR calculation. Materials and methods We examined a pediatric oncologic data set with a total of 363 GFR measurements. An analysis of distribution characteristics and comparison of medians was performed to compare creatinine and cystatin C-based GFR estimating formulae. Furthermore, we investigated the clinical impact of different equations in regard to therapeutic consequences. Results Significant differences in estimated GFR values were calculated depending on the applied formula (range of median GFR from 94.8 to 180.9 mL/min per 1.73 m2) which may result in different therapeutic consequences for the use of potentially nephrotoxic chemotherapeutic agents. Significant correlation for all examined formulae was identified, however there were large fluctuations among the correlation coefficients ranging from 0.254 to 1.0. Conclusion This study compares proposed pediatric GFR estimating equations in a clinical setting. It underlines the current limitations and difficulties of GFR estimation including potential dosing errors. Cystitis C-based equations can be used as alternatives to creatinine-based estimations when the appropriate laboratory method has been applied. A comparative calculator for pediatric GFR estimating equations along with background information is provided at http://gfr.pedz.de and may support clinical decision-making.

scholarly journals Multiple Injuries to the Lower Urinary Tract: Two Cases and Comparison with the EAU Guidelines

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
N. Lumen ◽  
D. Sharma ◽  
Y. Abu-Ghanem ◽  
N. Djakovic ◽  
F. Kuehhas ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Lower Urinary Tract ◽  
Clinical Decision Making ◽  
Case Reports ◽  
Clinical Decision ◽  
Pelvic Fractures ◽  
Urethral Injury ◽  
Concomitant Injuries ◽  
Strict Adherence ◽  
Lower Urinary

Blunt trauma to the lower urinary tract is usually associated with pelvic fractures. The European Association of Urology (EAU) provides guidelines to diagnose and treat these injuries. The guidelines summarise the available evidence and provide recommendations on diagnosis and treatment of these patients. Therefore, these guidelines are important adjuncts to the urologist and emergency physician in the clinical decision-making. However, strict adherence to the guidelines is not always easy or possible because of concomitant injuries obscuring the clinical picture. This is illustrated by two case reports of concomitant injuries of the lower urinary tract (bladder with urethral injury). The clinical decisions will be discussed point by point and should serve as a practical teaching moment for the reader.

scholarly journals Influence of psychiatric or social backgrounds on clinical decision making: a randomized, controlled multi-centre study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Yosuke Yamauchi ◽  
Takashi Shiga ◽  
Kiyoshi Shikino ◽  
Takahiro Uechi ◽  
Yasuaki Koyama ◽  
...  
Keyword(s):  
Decision Making ◽  
Repeated Measures ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Background Information ◽  
Accuracy Score ◽  
Multi Centre Study ◽  
Additional Information ◽  
Free Care ◽  
History Of

Abstract Background Frequent and repeated visits from patients with mental illness or free medical care recipients may elicit physicians’ negative emotions and influence their clinical decision making. This study investigated the impact of the psychiatric or social background of such patients on physicians’ decision making about whether to offer recommendations for further examinations and whether they expressed an appropriate disposition toward the patient. Methods A randomized, controlled multi-centre study of residents in transitional, internal medicine, or emergency medicine was conducted in five hospitals. Upon randomization, participants were stratified by gender and postgraduate year, and they were allocated to scenario set 1 or 2. They answered questions pertaining to decision-making based on eight clinical vignettes. Half of the eight vignettes presented to scenario set 1 included additional patient information, such as that the patient had a past medical history of schizophrenia or that the patient was a recipient of free care who made frequent visits to the doctor (biased vignettes). The other half included no additional information (neutral vignettes). For scenario set 2, the four biased vignettes presented to scenario set 1 were neutralized, and the four neutral vignettes were rendered biased by providing additional information. After reading, participants answered decision-making questions regarding diagnostic examination, interventions, or patient disposition. The primary analysis was a repeated-measures ANOVA on the mean management accuracy score, with patient background information as a within-subject factor (no bias, free care recipients, or history of schizophrenia). Results A total of 207 questionnaires were collected. Repeated-measures ANOVA showed that additional background information had influence on mean accuracy score (F(7, 206) = 13.84, p <  0.001 partial η2 = 0.063). Post hoc pairwise multiple comparison test, Sidak test, showed a significant difference between schizophrenia and no bias condition (p <  0.05). The ratings for patient likability were lower in the biased vignettes compared to the neutral vignettes, which was associated with the lower utilization of medical resources by the physicians. Conclusions Additional background information on past medical history of schizophrenia increased physicians’ mistakes in decision making. Patients’ psychiatric backgrounds should not bias physicians’ decision-making. Based on these findings, physicians are recommended to avoid being influenced by medically unrelated information.

Analytical performance and diagnostic accuracy of six different faecal calprotectin assays in inflammatory bowel disease

2017 ◽  
Vol 55 (10) ◽  
Author(s):  
Matthijs Oyaert ◽  
An Boel ◽  
Julie Jacobs ◽  
Stefanie Van den Bremt ◽  
Maxime De Sloovere ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Diagnostic Accuracy ◽  
Disease Control ◽  
Bowel Disease ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Analytical Performance ◽  
Likelihood Ratios ◽  
Faecal Calprotectin ◽  
Inflammatory Bowel

AbstractBackground:We evaluated the analytical performance of six different faecal calprotectin immunoassays together with their diagnostic accuracy in the discrimination between functional and organic bowel disorders.Methods:The faecal samples were obtained from inflammatory bowel disease patients (n=27) at the time of diagnosis [Crohn’s disease (n=15), colitis ulcerosa (n=12)], gastroenterologic disease control patients (n=52) and rheumatologic disease control patients (n=26). All individuals included in the study underwent a concurrent ileocolonoscopy. Analytical performance (imprecision, accuracy, carry-over, correlation and agreement) and diagnostic accuracy (sensitivity, specificity, likelihood ratios) of the different assays were evaluated.Results:All methods demonstrated good analytical performance, but within-run and total imprecision varied depending on the assay methodology used. Using Passing Bablok and Bland-Altman analyses, low quantitative agreement was observed between the assays. All assays showed excellent diagnostic accuracy, with areas under the receiver operating characteristic curves (ROC) ranging from 0.974 to 0.998. The AUCs were not significantly different between assays (p>0.05). Diagnostic sensitivity at the cut-off at a fixed specificity of 75% ranged from 95.2% to 100%. Introduction of multiple result intervals increased the clinical interpretation of all the assays.Conclusions:Analytical and diagnostic performance of the evaluated faecal calprotectin assays is good, but numerical values differ substantially between the assays necessitating the use of different clinical cut-offs. Introduction of multiple result intervals aids in clinical decision-making.

scholarly journals NEWS2 score in the practice of infectious diseases hospital in COVID-19 patients. Implementation and results

2021 ◽  
Vol 18 (1) ◽  
pp. 7-16
Author(s):  
К. N. Popova ◽  
A. A. Zhukov ◽  
I. L. Zykina ◽  
D. V. Troschanskiy ◽  
I. N. Tyurin ◽  
...  
Keyword(s):  
Mobile Application ◽  
Clinical Decision Making ◽  
Medical Information ◽  
Prognostic Significance ◽  
Clinical Information ◽  
Clinical Decision ◽  
Clinical State ◽  
Medical Assistance ◽  
Therapy Effectiveness ◽  
Analytical System

Amidst the new COVID-19 pandemic, there is a need for a reliable medical tool to monitor patients’ vital conditions with clinical information continuity. This tool is essential for timely detection of the risk of the patient’s clinical state deterioration throughout all the stages of medical assistance.  The objective is to assess results of the NEWS2 score implementation at the in-patient stage of medical care.Methods. 183,732 scores of the NEWS2 score in 10,290 hospitalized patients were analyzed.  All the assessed results of the NEWS2 score were retrospectively analyzed. The NEWS2 score results were added to the United Medical Information and Analytical System of Moscow (EMIAS) database through the NEWS2 mobile application. The researchers analyzed the descriptive statistics of the score; the prognostic significance of NEWS2 in the prediction of the disease outcome was assessed as well as the accuracy of the used methods. Results. As the result of the research, deviations from standard methods in the application of the NEWS2 score were outlined, which allowed the researchers to develop the corrective measures.  The received data confirmed that interval assessment by the NEWS2 score and the trend analysis were important when making clinical and organizational decisions. Specific parameters of the score use during the COVID-19 pandemic were outlined, which helped to adjust the in-hospital procedures for clinical decision-making process, routing, and the continuity of all stages of medical assistance was established. Conclusion. The use of the NEWS2 score in medical practice makes it possible to predict the risks of clinical deterioration in the patient's condition, conduct bedside monitoring of therapy effectiveness, and optimize in-hospital routing. However, to ensure the validity of the score, it is necessary to plan activities for the personnel training and motivation, as well as to monitor careful adherence to the protocol. 

scholarly journals Case Report: Detection of Symptomatic Treatment-Related Changes in a Patient With Anaplastic Oligodendroglioma Using FET PET

2021 ◽  
Vol 11 ◽  
Author(s):  
Elena Katharina Bauer ◽  
Jan-Michael Werner ◽  
Gereon R. Fink ◽  
Karl-Josef Langen ◽  
Norbert Galldiks
Keyword(s):  
Clinical Decision Making ◽  
Systemic Treatment ◽  
Clinical Information ◽  
Symptomatic Treatment ◽  
Clinical Decision ◽  
Anaplastic Oligodendroglioma ◽  
Mri Findings ◽  
Fet Pet ◽  
Conventional Mri ◽  
Amino Acid Pet

Following local and systemic treatment of gliomas, the differentiation between glioma relapse and treatment-related changes such as pseudoprogression or radiation necrosis using conventional MRI is limited. To overcome this limitation, various amino acid PET tracers such as O-[2-(18F)-fluoroethyl]-L-tyrosine (FET) are increasingly used and provide valuable additional clinical information. We here report neuroimaging findings in a clincally symptomatic 53-year-old woman with a recurrent anaplastic oligodendroglioma with MRI findings highly suspicious for tumor progression. In contrast, FET PET imaging suggested treatment-related changes considerably earlier than the regression of contrast enhancement on MRI. In patients with oligodendroglioma, the phenomenon of symptomatic treatment-related changes is not well described, making these imaging findings unique and important for clinical decision-making.

scholarly journals Radiogenomics and Radiomics in Liver Cancers

Diagnostics ◽  
2018 ◽  
Vol 9 (1) ◽  
pp. 4 ◽  
Author(s):  
Aman Saini ◽  
Ilana Breen ◽  
Yash Pershad ◽  
Sailendra Naidu ◽  
M. Knuttinen ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Clinical Information ◽  
Clinical Decision ◽  
Molecular Profile ◽  
Imaging Features ◽  
Imaging Data ◽  
Prognostic Information ◽  
Cross Sectional ◽  
Related Field ◽  
Liver Cancers

Radiogenomics is a computational discipline that identifies correlations between cross-sectional imaging features and tissue-based molecular data. These imaging phenotypic correlations can then potentially be used to longitudinally and non-invasively predict a tumor’s molecular profile. A different, but related field termed radiomics examines the extraction of quantitative data from imaging data and the subsequent combination of these data with clinical information in an attempt to provide prognostic information and guide clinical decision making. Together, these fields represent the evolution of biomedical imaging from a descriptive, qualitative specialty to a predictive, quantitative discipline. It is anticipated that radiomics and radiogenomics will not only identify pathologic processes, but also unveil their underlying pathophysiological mechanisms through clinical imaging alone. Here, we review recent studies on radiogenomics and radiomics in liver cancers, including hepatocellular carcinoma, intrahepatic cholangiocarcinoma, and metastases to the liver.

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