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

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.

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Point-of-Care Testing-the Key in the Battle against SARS-CoV-2 Pandemic

Micromachines ◽

10.3390/mi12121464 ◽

2021 ◽

Vol 12 (12) ◽

pp. 1464

Author(s):

Florina Silvia Iliescu ◽

Ana Maria Ionescu ◽

Larisa Gogianu ◽

Monica Simion ◽

Violeta Dediu ◽

...

Keyword(s):

Clinical Decision Making ◽

Point Of Care ◽

Low Cost ◽

Diagnostic Testing ◽

Clinical Decision ◽

Rapid Screening ◽

Diagnostic Tools ◽

Point Of Care Testing ◽

Qrt Pcr ◽

User Friendly

The deleterious effects of the coronavirus disease 2019 (COVID-19) pandemic urged the development of diagnostic tools to manage the spread of disease. Currently, the “gold standard” involves the use of quantitative real-time polymerase chain reaction (qRT-PCR) for SARS-CoV-2 detection. Even though it is sensitive, specific and applicable for large batches of samples, qRT-PCR is labour-intensive, time-consuming, requires trained personnel and is not available in remote settings. This review summarizes and compares the available strategies for COVID-19: serological testing, Point-of-Care Testing, nanotechnology-based approaches and biosensors. Last but not least, we address the advantages and limitations of these methods as well as perspectives in COVID-19 diagnostics. The effort is constantly focused on understanding the quickly changing landscape of available diagnostic testing of COVID-19 at the clinical levels and introducing reliable and rapid screening point of care testing. The last approach is key to aid the clinical decision-making process for infection control, enhancing an appropriate treatment strategy and prompt isolation of asymptomatic/mild cases. As a viable alternative, Point-of-Care Testing (POCT) is typically low-cost and user-friendly, hence harbouring tremendous potential for rapid COVID-19 diagnosis.

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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

Neuro-Oncology ◽

10.1093/neuonc/noz175.823 ◽

2019 ◽

Vol 21 (Supplement_6) ◽

pp. vi197-vi198 ◽

Cited By ~ 1

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.

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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

Neuro-Oncology ◽

10.1093/neuonc/noz126.045 ◽

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.

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THE VALUE OF IN VITRO DIAGNOSTIC TESTING IN THE PROVISION OF MEDICAL CARE TO ELDERLY PATIENTS WITH CARDIOVASCULAR DISEASES

Russian Clinical Laboratory Diagnostics ◽

10.18821/0869-2084-2020-65-3-191-196 ◽

2020 ◽

Vol 65 (3) ◽

pp. 191-196

Author(s):

A. S. Pushkin ◽

O. V. Lyang ◽

T. A. Ahmedov ◽

S. A. Rukavishnikova

Keyword(s):

Decision Making ◽

Medical Care ◽

Laboratory Tests ◽

Clinical Decision Making ◽

Diagnostic Testing ◽

Clinical Decision ◽

Initial Examination ◽

Attending Physicians ◽

The Impact

In vitro diagnostics are used at all stages of patient care. The aim of this study was to assess the impact of laboratory examination on clinical decision-making in providing medical care to patients with a cardiovascular profile. We also took into account the level of financing for the laboratory industry in the Russian Federation. We divided our study on three sequential steps: literature review, survey of clinicians and test-survey of clinicians. The share of costs for the laboratory tests in 2017 amounted to about 8% of the total funding for Russian health care. About 80% (70; 90) of the visits of the attending physicians are associated with the appointment of laboratory tests. Among patients who were prescribed any laboratory test - in 62.1% (95% CI 16.9-24.9) cases, the results of these tests influenced clinical decision making related to the initiation, modification or termination of any treatment. All visits of clinicians were divided by purpose: tests were prescribed in almost 100% (90; 100) cases during the initial examination, in 40% (20; 60) cases during repeated visits, and in 40% (15; 40) cases when patients were examined before discharge. In more than half of cases (57,4%; n=31), doctors correctly assumed about the about the share of financing of the laboratory industry. The majority of respondents considered the amount of expenses adequate and recommended to maintain the current level in the future. According to attending physicians, new laboratory markers should demonstrate additional information about clinical relevance to improve patient outcomes. Thus, in current economic realities, future laboratory tests should be financially maximally available and at the same time be clinically highly effective auxiliary instruments. It creates new challenges in finding laboratory biomarkers and putting them into clinical practice.

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Correlation of Hydronephrosis Index to Society of Fetal Urology Hydronephrosis Scale

Advances in Urology ◽

10.1155/2009/960490 ◽

2009 ◽

Vol 2009 ◽

pp. 1-4 ◽

Cited By ~ 8

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.

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The ‘Number Needed to Treat’ and the ‘Adjusted NNT’ in Health Care Decision-Making

Journal of Health Services Research & Policy ◽

10.1177/135581969800300110 ◽

1998 ◽

Vol 3 (1) ◽

pp. 44-49 ◽

Cited By ~ 9

Author(s):

Jack Dowie

Keyword(s):

Health Care ◽

Decision Making ◽

Evidence Based Medicine ◽

Clinical Decision Making ◽

Treatment Options ◽

Clinical Decision ◽

Population Based ◽

Number Needed To Treat ◽

Evidence Based ◽

Based Medicine

Within ‘evidence-based medicine and health care’ the ‘number needed to treat’ (NNT) has been promoted as the most clinically useful measure of the effectiveness of interventions as established by research. Is the NNT, in either its simple or adjusted form, ‘easily understood’, ‘intuitively meaningful’, ‘clinically useful’ and likely to bring about the substantial improvements in patient care and public health envisaged by those who recommend its use? The key evidence against the NNT is the consistent format effect revealed in studies that present respondents with mathematically-equivalent statements regarding trial results. Problems of understanding aside, trying to overcome the limitations of the simple (major adverse event) NNT by adding an equivalent measure for harm (‘number needed to harm’ NNH) means the NNT loses its key claim to be a single yardstick. Integration of the NNT and NNH, and attempts to take into account the wider consequences of treatment options, can be attempted by either a ‘clinical judgement’ or an analytical route. The former means abandoning the explicit and rigorous transparency urged in evidence-based medicine. The attempt to produce an ‘adjusted’ NNT by an analytical approach has succeeded, but the procedure involves carrying out a prior decision analysis. The calculation of an adjusted NNT from that analysis is a redundant extra step, the only action necessary being comparison of the results for each option and determination of the optimal one. The adjusted NNT has no role in clinical decision-making, defined as requiring patient utilities, because the latter are measurable only on an interval scale and cannot be transformed into a ratio measure (which the adjusted NNT is implied to be). In any case, the NNT always represents the intrusion of population-based reasoning into clinical decision-making.

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Genomic screening and genomic diagnostic testing—two very different kettles of fish

Genome Medicine ◽

10.1186/s13073-019-0696-9 ◽

2019 ◽

Vol 11 (1) ◽

Cited By ~ 2

Author(s):

Leslie G. Biesecker

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Diagnostic Testing ◽

Clinical Decision ◽

Bayes Theorem ◽

Genomic Testing ◽

Test Results ◽

Correct Interpretation ◽

Genomic Test ◽

Genomic Screening

AbstractGenomic testing can be misunderstood as being determinative, when in reality it is the same as all other tests and context is essential for its correct interpretation. Two hypothetical cases of testing for Marfan syndrome demonstrate how clinicians should contextualize genomic test results and the implementation of Bayes theorem in clinical decision-making.

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Clinical Decision Making on Extensive Molar Restorations

Operative Dentistry ◽

10.2341/13-069-c ◽

2014 ◽

Vol 39 (6) ◽

pp. E231-E240 ◽

Cited By ~ 11

Author(s):

T Laegreid ◽

NR Gjerdet ◽

A Johansson ◽

A-K Johansson

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Dietary Habits ◽

Influencing Factor ◽

Treatment Options ◽

Clinical Decision ◽

Background Information ◽

Molar Teeth ◽

Logistic Regressions ◽

Indirect Technique

SUMMARY Extensive loss of posterior tooth substance, which traditionally was restored with amalgam or indirect restorations, is more commonly being restored with resin-based composite restorations. Using a questionnaire, we aimed to survey dentists' clinical decision making when restoring extensive defects in posterior molar teeth. The questionnaire, which included questions on background information from the dentists, clinical cases with treatment options, and general questions about restoring extensive posterior defects, was sent to 476 dentists. The response rate was 59%. Multiple logistic regressions were used to investigate the different associations. Most of the respondents preferred a direct composite restoration when one cusp was missing, while indirect restorations were most preferred when replacing three or four cusps. Younger dentists and dentists working in the private sector had a greater tendency to choose an indirect technique compared with older colleagues. Generally, the most important influencing factor in clinical decision making was the amount of remaining tooth substance. Factors that appeared to be less important were dental advertisements, use of fluoride, and dietary habits. Female dentists perceived factors such as oral hygiene, patient requests, and economy to be more important than did their male colleagues.

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Exploring patient satisfaction of a joint-consultation clinic for trigeminal neuralgia: Enabling improved decision-making

British Journal of Pain ◽

10.1177/20494637211045877 ◽

2021 ◽

pp. 204946372110458

Author(s):

Jolyon Poole ◽

Valeria Mercadante ◽

Sanjeet Singhota ◽

Karim Nizam ◽

Joanna M Zakrzewska

Keyword(s):

Decision Making ◽

Trigeminal Neuralgia ◽

Clinical Decision Making ◽

Response Rate ◽

Treatment Options ◽

Rare Condition ◽

Clinical Decision ◽

Consultation Clinic ◽

Level Of Satisfaction ◽

Paper Survey

Background Trigeminal neuralgia (TN) is a relatively rare condition which has a profound impact not only on the patient but also on those around them. There is no cure for TN, and the management of the condition is complex. The most effective forms of treatment are either through medication, neurosurgery, or combination of the two. Each option has risks and implications for the patient. As with all clinical decisions, it is important for patients to understand and be fully informed of the treatments available to them. A London UK unit adopted a joint-consultation clinic approach where the patient meets with both physician and neurosurgeon at the same time to discuss treatment options. The purpose of this evaluation is to understand patients’ level of satisfaction with the joint-consultation clinic and evaluate utilisation of a clinical decision-making tool. Method Patients who had attended the joint-consultation clinic over a period of 12 months were invited to participate in a telephone or paper survey (N = 55). Responses were analysed using descriptive statistics and thematic analysis. Results Forty-one patients (77% response rate) participated in the survey, and the results were overwhelmingly positive for the joint-consultation clinic regarding satisfaction. The benefits were broad ranging including increased understanding, collaboration and confidence in decision-making. Conclusions A joint-consultation clinic comprising a neurosurgeon and a physician for the treatment of TN is valued by patients who become better informed and able to make decisions about their care. Positive application of clinical decision-making aids in this situation offers potential across specialities.

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