Do Physician Practice Styles Persist over Time? Continuities in Patterns of Clinical Decision-Making among General Practitioners

2000 ◽  
Vol 5 (4) ◽  
pp. 200-207 ◽  
Author(s):  
Peter Davis ◽  
Barry Gribben ◽  
Alastair Scott ◽  
Roy Lay-Yee
Keyword(s):  
Decision Making ◽  
General Practitioners ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Physician Practice ◽  
Over Time

scholarly journals QOLP-03. MEASURING CHANGE IN HEALTH-RELATED QUALITY OF LIFE: THE ADDED VALUE OF ANALYSIS ON THE INDIVIDUAL PATIENT LEVEL IN GLIOMA PATIENTS IN CLINICAL DECISION MAKING

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi197-vi198 ◽  
Author(s):  
Marijke Coomans ◽  
Martin Taphoorn ◽  
Neil Aaronson ◽  
Brigitta Baumert ◽  
Martin van den Bent ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Scale Item ◽  
Individual Patient Level ◽  
Patient Level ◽  
Related Quality ◽  
The Individual ◽  
The Impact ◽  
Over Time

Abstract BACKGROUND: Health-related quality of life (HRQoL) is an important outcome in glioma research, reflecting the impact of disease and treatment on a patient’s functioning and wellbeing. Data on changes in HRQoL scores provide important information for clinical decision-making, but different analytical methods may lead to different interpretations of the impact of treatment on HRQoL. This study aimed to study whether different methods to evaluate change in HRQoL result in different interpretations. Methods: HRQoL and sociodemographical/clinical data from 15 randomized clinical trials were combined. Change in HRQoL scores was analyzed: (1)at the group level, comparing mean changes in scale/item scores between treatment arms over time, (2)at the patient level per scale/item by calculating the percentage of patients that deteriorated, improved or remained stable on a scale/item per scale/item, and (3)at the individual patient level combining all scales/items. Results: Data were available for 3727 patients. At the group scale/item level (method 1), only the item ‘hair loss’ showed a significant and clinically relevant change (i.e. ≥10 points) over time, whereas change scores on the other scales/items showed a statistically significant change only (all p< .001, range in change score:0.1–6.2). Analyses on the patient level per scale (method 2) indicated that, while a large proportion of patients had stable HRQoL over time (range:27–84%), many patients deteriorated (range:6–43%) or improved (range:8–32%) on a specific scale/item. At the individual patient level (method 3), the majority of patients (86%) showed both deterioration and improvement, while only 1% of the patients remained stable on all scales. Conclusion: Different analytical methods of changes in HRQoL result in distinct interpretations of treatment effects, all of which may be relevant for clinical decision-making. Additional information about the joint impact of treatment on all outcomes may help patients and physicians to make the best treatment decision.

scholarly journals OS7.2 Measuring change in health-related quality of life: the added value of analysis on the individual patient level in glioma patients in clinical decision making

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii14-iii14
Author(s):  
M Coomans ◽  
M J B Taphoorn ◽  
N Aaronson ◽  
B G Baumert ◽  
M van den Bent ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Scale Item ◽  
Individual Patient Level ◽  
Patient Level ◽  
Related Quality ◽  
The Individual ◽  
The Impact ◽  
Over Time

Abstract BACKGROUND Health-related quality of life (HRQoL) is often used as an outcome in glioma research, reflecting the impact of disease and treatment on a patient’s functioning and wellbeing. Data on changes in HRQoL scores may provide important information for clinical decision-making, but different analytical methods may lead to different interpretations of the impact of treatment on HRQoL. This study aimed to examine three different methods to evaluate change in HRQoL, and to study whether these methods result in different interpretations. MATERIAL AND METHODS HRQoL and sociodemographical/clinical data from 15 randomized clinical trials were combined. Change in HRQoL scores was analyzed in three ways: (1) at the group level, comparing mean changes in scale/item scores between treatment arms over time, (2) at the patient level per scale/item by calculating the percentage of patients that deteriorated, improved or remained stable on a scale/item per scale/item, and (3) at the individual patient level combining all scales/items. RESULTS Baseline and first follow-up HRQoL data were available for 3727 patients. At the group scale/item level (method 1), only the item ‘hair loss’ showed a significant and clinically relevant change (i.e. ≥10 points) over time, whereas change scores on the other scales/items showed a statistically significant change only (all p<.001, range in change score: 0.1–6.2). Analyses on the patient level per scale (method 2) indicated that, while a large proportion of patients had stable HRQoL over time (range 27–84%), many patients deteriorated (range: 6–43%) or improved (range: 8–32%) on a specific scale/item. At the individual patient level (method 3), the majority of patients (86%) showed both deterioration and improvement, while only 1% of the patients remained stable on all scales. Clustering on clinical characteristics (WHO performance status, sex, tumor type, type of resection, newly diagnosed versus recurrent tumor and age) did not identify subgroups of patients with a specific pattern of change in their HRQoL score. CONCLUSION Different analytical methods of changes in HRQoL result in distinct interpretations of treatment effects, all of which may be relevant for clinical decision-making. Additional information about the joint impact of treatment on all outcomes, showing that most patients experience both deterioration and improvement, may help patients and physicians to make the best treatment decision.

scholarly journals Correlation of Hydronephrosis Index to Society of Fetal Urology Hydronephrosis Scale

2009 ◽  
Vol 2009 ◽  
pp. 1-4 ◽  
Author(s):  
Krishnan Venkatesan ◽  
Joel Green ◽  
Steven R. Shapiro ◽  
George F. Steinhardt
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Quantitative Measure ◽  
Clinical Decision ◽  
Grade Ii ◽  
Grade Average ◽  
Calculated Average ◽  
Over Time ◽  
Grade Iii

Purpose. We seek to correlate conventional hydronephrosis (HN) grade and hydronephrosis index (HI).Methods. We examined 1207 hydronephrotic kidneys by ultrasound. HN was classified by Society of Fetal Urology guidelines. HN was then gauged using HI, a reproducible, standardized, and dimensionless measurement of renal area. We then calculated average HI for each HN grade.Results. Comparing HI to standard SFU HN grade, average HI is 89.3 for grade I; average HI is 83.9 for grade II; average HI is 73.0 for grade III; average HI is 54.6 for SFU grade IV.Conclusions. HI correlates well with SFU HN grade. The HI serves as a quantitative measure of HN. HI can be used to track HN over time. Versus conventional grading, HI may be more sensitive in defining severe (grades III and IV) HN, and in indicating resolving, stable, or worsening HN, thus providing more information for clinical decision-making and HN management.

A 52-Year-Old Man With Progressive Weakness and Incontinence

2021 ◽  
pp. 194187442110395
Author(s):  
Ayse Altintas ◽  
Ayca Ersen Danyeli ◽  
Subutay Berke Bozkurt ◽  
Sanem Pinar Uysal ◽  
Sergin Akpek ◽  
...  
Keyword(s):  
Decision Making ◽  
Urinary Retention ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Diagnostic Testing ◽  
Clinical Decision ◽  
Diagnostic Tools ◽  
Progressive Weakness ◽  
Over Time

Here we report a challenging case of a 52-year-old man presenting with subacute constipation, urinary retention, impotence, absent Achilles reflexes, and hypoesthesia in S2-S5 dermatomes. We review the clinical decision-making as the symptoms evolved and diagnostic testing changed over time. Once the diagnosis is settled, we discuss the sign and symptoms, additional diagnostic tools, treatment options and prognosis.

General practitioners' decision to refer patients to dietitians: insight into the clinical reasoning process

2010 ◽  
Vol 16 (2) ◽  
pp. 147 ◽  
Author(s):  
Sylvia E. M. Pomeroy ◽  
Robyn P. Cant
Keyword(s):  
Decision Making ◽  
General Practitioners ◽  
Mixed Methods Research ◽  
Clinical Decision Making ◽  
Treatment Plan ◽  
Clinical Decision ◽  
Nutrition Intervention ◽  
Enabling Factors ◽  
Reasoning Process ◽  
The Impact

The aim of this project was to describe general practitioners’ (GPs’) decision-making process for reducing nutrition risk in cardiac patients through referring a patient to a dietitian. The setting was primary care practices in Victoria. The method we employed was mixed methods research: in Study 1, 30 GPs were interviewed. Recorded interviews were transcribed and narratives analysed thematically. Study 2 involved a survey of statewide random sample of GPs. Frequencies and analyses of variance were used to explore the impact of demographic variables on decisions to refer. We found that the referral decision involved four elements: (i) synthesising management information; (ii) forecasting outcomes; (iii) planning management; and (iv) actioning referrals. GPs applied cognitive and collaborative strategies to develop a treatment plan. In Study 2, doctors (248 GPs, 30%) concurred with identified barriers/enabling factors for patients’ referral. There was no association between GPs’ sex, age or hours worked per week and referral factors. We conclude that a GP’s judgment to offer a dietetic referral to an adult patient is a four element reasoning process. Attention to how these elements interact may assist clinical decision making. Apart from the sole use of prescribed medications/surgical procedures for cardiac care, patients offered a dietetic referral were those who were considered able to commit to dietary change and who were willing to attend a dietetic consultation. Improvements in provision of patients’ nutrition intervention information to GPs are needed. Further investigation is justified to determine how to resolve this practice gap.

scholarly journals Enhanced Visualization of Optimal Cerebral Perfusion Pressure Over Time to Support Clinical Decision Making*

2016 ◽  
Vol 44 (10) ◽  
pp. e996-e999 ◽  
Author(s):  
Marcel J. H. Aries ◽  
Robin Wesselink ◽  
Jan Willem J. Elting ◽  
Joseph Donnelly ◽  
Marek Czosnyka ◽  
...  
Keyword(s):  
Decision Making ◽  
Cerebral Perfusion Pressure ◽  
Cerebral Perfusion ◽  
Clinical Decision Making ◽  
Perfusion Pressure ◽  
Clinical Decision ◽  
Optimal Cerebral Perfusion Pressure ◽  
Over Time

Personality Assessment in Clinical Psychology

2018 ◽  
Author(s):  
Katy W. Martin-Fernandez ◽  
Yossef S. Ben-Porath
Keyword(s):  
Decision Making ◽  
Clinical Psychology ◽  
Personality Assessment ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Self Report ◽  
Assessment Instruments ◽  
Test Taker ◽  
Individual Assessment ◽  
Over Time

Attempts at informal personality assessment can be traced back to our distant ancestors. As the field of Clinical Psychology emerged and developed over time, efforts were made to create reliable and valid measures of personality and psychopathology that could be used in a variety of contexts. There are many assessment instruments available for clinicians to use, with most utilizing either a projective or self-report format. Individual assessment instruments have specific administration, scoring, and interpretive guidelines to aid clinicians in making accurate decisions based on a test taker’s answers. These measures are continuously adapted to reflect the current conceptualization of personality and psychopathology and the latest technology. Additionally, measures are adapted and validated to be used in a variety of settings, with a variety of populations. Personality assessment continues to be a dynamic process that can be utilized to accurately and informatively represent the test taker and aid in clinical decision making and planning.

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