scholarly journals Data ambiguity and clinical decision making: A qualitative case study of the use of predictive information technologies in a personalized cancer clinical trial

2019 ◽  
Vol 25 (3) ◽  
pp. 500-510 ◽  
Author(s):  
Nadav Even Chorev
Keyword(s):  
Clinical Trial ◽  
Information Technologies ◽  
Clinical Decision Making ◽  
Qualitative Case Study ◽  
Clinical Decision ◽  
Clinical Decisions ◽  
Multiple Sources ◽  
Advanced Cancer Patients ◽  
High Resolution Data

Personalized medicine aims to tailor the treatment to the specific characteristics of the individual patient. In the process, physicians engage with multiple sources of data and information to decide on a personalized treatment. This article draws on a qualitative case study of a clinical trial testing a method for matching treatments for advanced cancer patients. Specialists in the trial used data and information processed by a specifically developed drug-efficacy predictive algorithm and other information artifacts to make personalized clinical decisions. While using high-resolution data in the trial was expected to provide a more accurate basis for action, sociomaterial engagements of oncologists with data and its representation by artifacts paradoxically hindered personalized clinical decisions. I contend that the engagement between human discretion, ambiguous data, and malleable artifacts in this non-standardized trial produced moments of contradiction within entanglement. Sociomaterial approaches should acknowledge such conflicts in further analyses of medical practice transitions.

Personalized Medicine in Practice: Postgenomics from Multiplicity to Immutability

2019 ◽  
Vol 26 (1) ◽  
pp. 26-54
Author(s):  
Nadav Even Chorev
Keyword(s):  
Clinical Trial ◽  
Personalized Medicine ◽  
Information Technologies ◽  
Information Sources ◽  
Qualitative Case Study ◽  
The Body ◽  
Cancer Clinical Trial ◽  
Social Data ◽  
Personalized Cancer

This article explores the ways in which predictive information technologies are used in the field of personalized medicine and the relations between this use and how patients and disease are perceived. This is examined in a qualitative case study of a personalized cancer clinical trial, where oncologists made clinical decisions for each patient based on drug matchings and efficacy predictions produced by bioinformatic technologies and algorithms. I focus on personalized practice itself, as a postgenomic phenomenon, rather than on epistemic, ethical and institutional critiques. Personalized medicine aims to process molecular, clinical, environmental and social data into individually tailored decisions. In this case, however, the engagement of clinicians with data and digital artefacts that processed multiple information sources resulted in treatment choices that were paradoxically both immutable and uncertain. In contrast to the situatedness of the body in postgenomics, this practice subverted the personalized medical approach while decontextualizing both cancer and patients.

Is the Deductive Falsification Approach a Better Basis for Clinical Trial Appraisal?

2019 ◽  
Vol 14 (3) ◽  
pp. 224-228
Author(s):  
Steffen Mickenautsch
Keyword(s):  
Clinical Trial ◽  
Decision Making ◽  
Empirical Evidence ◽  
Clinical Decision Making ◽  
Inductive Reasoning ◽  
Clinical Decision ◽  
Future Trial ◽  
Grading Systems ◽  
Component Scores ◽  
Current Clinical Trial

Background: Inductive reasoning relies on an infinite regress without sufficient factual basis and verification is at any time vulnerable to single contrary observation. Thus, appraisal based on inductive verification, as applied in current clinical trial appraisal scales, checklists or grading systems, cannot prove or justify trial validity. Discussion: Trial appraisal based on deductive falsification can identify invalid trials and give evidence for the recommendation to exclude these from clinical decision-making. Such appraisal remains agnostic towards corroborated trials that pass all appraisal criteria. The results of corroborated trials cannot be considered more robust than falsified trials since nothing within a particular set of complied trial criteria can give certainty for trial compliance with any other appraisal criterion in future. A corroborated trial may or may not reflect therapeutic truth and may thus be the basis for clinical guidance, pending results of any future trial re-appraisal. Conclusion: Trial grading following appraisal based on deductive falsification should be binary (0 = Invalid or 1 = Unclear) and single component scores should be multiplied. Appraisal criteria for the judgment of trial characteristics require a clear rationale, quantification of such rationale and empirical evidence concerning the effect of trial characteristics on trial results.

Supporting the Development of Clinical Reasoning of Preprofessional Novices in Dysphagia Management

2019 ◽  
Vol 40 (03) ◽  
pp. 151-161 ◽  
Author(s):  
Sebastian Doeltgen ◽  
Stacie Attrill ◽  
Joanne Murray
Keyword(s):  
Clinical Reasoning ◽  
Clinical Decision Making ◽  
Management Practice ◽  
Clinical Decision ◽  
Assessment Process ◽  
Evidence Based ◽  
Sources Of Information ◽  
Multiple Sources ◽  
Implicit Processing ◽  
Reasoning Skills

AbstractProficient clinical reasoning is a critical skill in high-quality, evidence-based management of swallowing impairment (dysphagia). Clinical reasoning in this area of practice is a cognitively complex process, as it requires synthesis of multiple sources of information that are generated during a thorough, evidence-based assessment process and which are moderated by the patient's individual situations, including their social and demographic circumstances, comorbidities, or other health concerns. A growing body of health and medical literature demonstrates that clinical reasoning skills develop with increasing exposure to clinical cases and that the approaches to clinical reasoning differ between novices and experts. It appears that it is not the amount of knowledge held, but the way it is used, that distinguishes a novice from an experienced clinician. In this article, we review the roles of explicit and implicit processing as well as illness scripts in clinical decision making across the continuum of medical expertise and discuss how they relate to the clinical management of swallowing impairment. We also reflect on how this literature may inform educational curricula that support SLP students in developing preclinical reasoning skills that facilitate their transition to early clinical practice. Specifically, we discuss the role of case-based curricula to assist students to develop a meta-cognitive awareness of the different approaches to clinical reasoning, their own capabilities and preferences, and how and when to apply these in dysphagia management practice.

Clinical decision making in spastic bilateral CP – Planning interventions using clinical gait analysis: A case study

2015 ◽  
Vol 42 ◽  
pp. S37
Author(s):  
M. Alvela ◽  
M. Bergmann ◽  
M.-L. Ööpik ◽  
Ü. Kruus ◽  
K. Englas ◽  
...  
Keyword(s):  
Decision Making ◽  
Gait Analysis ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Clinical Gait Analysis

scholarly journals My Client Knows That He's About to Stutter: How Can We Address Stuttering Anticipation during Therapy with Young People Who Stutter?

2018 ◽  
Vol 39 (04) ◽  
pp. 356-370 ◽  
Author(s):  
Hope Gerlach ◽  
Naomi Rodgers ◽  
Patricia Zebrowski ◽  
Eric Jackson
Keyword(s):  
Decision Making ◽  
Young People ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Hypothetical Case ◽  
Clinical Tool ◽  
Goal Development ◽  
Internal Experience

AbstractStuttering anticipation is endorsed by many people who stutter as a core aspect of the stuttering experience. Anticipation is primarily a covert phenomenon and people who stutter respond to anticipation in a variety of ways. At the same time as anticipation occurs and develops internally, for many individuals the “knowing” or “feeling” that they are about to stutter is a primary contributor to the chronicity of the disorder. In this article, we offer a roadmap for both understanding the phenomenon of anticipation and its relevance to stuttering development. We introduce the Stuttering Anticipation Scale (SAS)—a 25-item clinical tool that can be used to explore a client's internal experience of anticipation to drive goal development and clinical decision making. We ground this discussion in a hypothetical case study of “Ryan,” a 14-year-old who stutters, to demonstrate how clinicians might use the SAS to address anticipation in therapy with young people who stutter.

scholarly journals Right Care, First Time: Developing a Theory-Based Automated Protocol to Help Clinically Stage Young People Based on Severity and Persistence of Mental Illness

2021 ◽  
Vol 9 ◽  
Author(s):  
Frank Iorfino ◽  
Vanessa Wan Sze Cheng ◽  
Shane P. Cross ◽  
Hannah F. Yee ◽  
Tracey A. Davenport ◽  
...  
Keyword(s):  
Mental Disorders ◽  
Information Technologies ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Base ◽  
Clinical Staging ◽  
Health Information Technologies ◽  
Staging Model ◽  
Automated Protocol ◽  
First Time

Most mental disorders emerge before the age of 25 years and, if left untreated, have the potential to lead to considerable lifetime burden of disease. Many services struggle to manage high demand and have difficulty matching individuals to timely interventions due to the heterogeneity of disorders. The technological implementation of clinical staging for youth mental health may assist the early detection and treatment of mental disorders. We describe the development of a theory-based automated protocol to facilitate the initial clinical staging process, its intended use, and strategies for protocol validation and refinement. The automated clinical staging protocol leverages the clinical validation and evidence base of the staging model to improve its standardization, scalability, and utility by deploying it using Health Information Technologies (HIT). Its use has the potential to enhance clinical decision-making and transform existing care pathways, but further validation and evaluation of the tool in real-world settings is needed.

Integrating research and evidence-based guidance into prescribing practice

2021 ◽  
Vol 3 (3) ◽  
pp. 120-123
Author(s):  
Adam Bedson
Keyword(s):  
Decision Making ◽  
Critical Appraisal ◽  
Clinical Decision Making ◽  
Primary Source ◽  
Clinical Decision ◽  
Evidence Base ◽  
Evidence Based ◽  
Multiple Sources ◽  
Prescribing Practice ◽  
Critical Appraisal Skills

The College of Paramedics and the Royal Pharmaceutical Society are clear that they require advanced paramedics, as non-medical prescribers, to review and critically appraise the evidence base underpinning their prescribing practice. Evidence-based clinical guidance such as that published by the National Institute for Health and Care Excellence (NICE) is recommended as the primary source of evidence on which paramedics should base their prescribing decisions. NICE guidance reflects the best available evidence on which to base clinical decision-making. However, paramedics still need to critically appraise the evidence underpinning their prescribing, applying expertise and decision-making skills to inform their clinical reasoning. This is achieved by synthesising information from multiple sources to make appropriate, evidence-based judgments and diagnoses. This first article in the prescribing paramedic pharmacology series considers the importance of evidence-based paramedic prescribing, alongside a range of tools that can be used to develop and apply critical appraisal skills to support prescribing decision-making. These include critical appraisal check lists and research reporting tools

Implementation of Semantic Search to Support Clinical Decision-Making

2015 ◽  
pp. 270-286
Author(s):  
Andrew Tawfik ◽  
Karl Kochendorfer
Keyword(s):  
Human Performance ◽  
Clinical Decision Making ◽  
Information Overload ◽  
Clinical Decision ◽  
Human Performance Technology ◽  
The United States ◽  
Semantic Search ◽  
Current Case ◽  
Performance Technology

The current case study is situated within a large, land grant hospital located in the Midwestern region of the United States. Although the physicians had seen an increase in medical related human performance technology (HPTs) within the organization (e.g. computer physician ordered entry) some challenges remained as the hospital sought to improve the productivity of the electronic health record (EHRs). Specifically, physicians had difficulty finding information embedded within the chart due to usability problems and information overload. To overcome the challenges, a semantic search within the chart was implemented as a solution for physicians to retrieve relevant results given the conceptual semantic pattern. The case study will discuss many elements of the implementation based on our experience and feedback from clinicians. The case will specifically highlight the importance of training and change agents within an organization.

Leveraging Key Aspects of Collaborative Techniques to Assist Clinical Decisions

2017 ◽  
pp. 440-456
Author(s):  
Hoda Moghimi ◽  
Jonathan L. Schaffer ◽  
Nilmini Wickramasinghe
Keyword(s):  
Decision Making ◽  
Information Technologies ◽  
Clinical Decision Making ◽  
Research Question ◽  
Clinical Decision ◽  
Detection Model ◽  
Important Approach ◽  
Hip And Knee Arthroplasty ◽  
Expected Benefits ◽  
Key Aspects

Employing collaborative systems in healthcare contexts is an important approach towards designing and developing intelligent computer solutions. The objective of this study is to develop a real-time collaborative system using the Intelligent Risk Detection Model (IRD) to improve decision efficiency for the care of patients undergoing hip and knee arthroplasty (THA, TKA). Expected benefits include increasing awareness, supporting communication, improving decision making processes and also improving information sharing between surgeons, patients, families and consultants as key collaborative parties. The research question under investigation is: How can key information technologies be designed, developed and adopted to support clinical decision making in the context of THA and TKA? This research in progress has identified the value and benefit of developing a systematic and technology supported tool to facilitate the identification of various risks associated with THA and TKA.

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