The junior doctor's virtual consulting room

2007 ◽  
Vol 13 (1_suppl) ◽  
pp. 65-67 ◽  
Author(s):  
Eleanor Wood ◽  
Alexandra Rankin ◽  
Pasquale Berlingieri ◽  
Owen Epstein
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Management Plan ◽  
Direct Access ◽  
Knowledge Use ◽  
Patient Journey ◽  
Web Based ◽  
Final Destination ◽  
Specialist Knowledge

We assessed the usability of the Virtual Consulting Room (VCR), a Web-based guidance application providing direct access to specialist knowledge. The VCR guides the user through the patient journey from first presentation to final destination. Four pre-registration house officers (PRHOs) were informed of the availability of the VCR which was accessible from all ward computers at the Royal Free Hospital. During a six-week study, 52 patients were assessed by four PRHOs. The VCR was accessed for all 52 patients. A questionnaire was completed in 49 cases (94%). In 43 of the 49 cases (88%), the PRHOs reported that the VCR supported clinical decision-making, and in 46 cases (94%) it improved their knowledge. Use of the VCR altered the PRHOs investigations in 24 cases (49%), changed the management plan in 18 cases (37%) and the decision to refer in 10 cases (20%). The present study showed that the VCR was easy to use, educational, supported clinical decision-making and affected patient management.

A validated web-based nomogram for predicting positive surgical margins following breast-conserving surgery as a preoperative tool for clinical decision-making

The Breast ◽  
2013 ◽  
Vol 22 (5) ◽  
pp. 773-779 ◽  
Author(s):  
Rick G. Pleijhuis ◽  
Annemiek B.G. Kwast ◽  
Liesbeth Jansen ◽  
Jakob de Vries ◽  
Rosanne Lanting ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Breast Conserving Surgery ◽  
Surgical Margins ◽  
Web Based ◽  
Positive Surgical Margins

scholarly journals Correlation of clinical decision-making with probability of disease: A web-based study among general practitioners

PLoS ONE ◽  
2020 ◽  
Vol 15 (10) ◽  
pp. e0241210
Author(s):  
Lionel De Alencastro ◽  
Isabella Locatelli ◽  
Carole Clair ◽  
Mark H. Ebell ◽  
Nicolas Senn
Keyword(s):  
Decision Making ◽  
General Practitioners ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Web Based

Multidisciplinary cancer care

2016 ◽  
pp. 196-208
Author(s):  
David N. Church ◽  
Rachel Kerr ◽  
David J. Kerr
Keyword(s):  
Decision Making ◽  
Patient Outcomes ◽  
Multidisciplinary Team ◽  
Cancer Care ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Healthcare Systems ◽  
Management Plan ◽  
Therapeutic Options ◽  
Western World

Over the last two decades, multidisciplinary team (MDT) working has become an integral part of cancer care in many healthcare systems in the Western world. MDT meetings were established as part of an effort to reduce the fragmented provision of cancer care, and to ensure that each patient receives a management plan based on expert consensus following consideration of all appropriate therapeutic options. Although limited, the available evidence indicates that MDT working is associated with improved patient outcomes, though the associated costs are significant. MDTs are likely to evolve over the coming years through the development of specific software tools to aid clinical decision-making, and through the incorporation of tumour genomics and the personalization of therapy this enables.

scholarly journals Analysis of an inter-centre, web-based radiation oncology peer-review case conference

2015 ◽  
Vol 14 (2) ◽  
pp. 135-142
Author(s):  
Chamunyonga Crispen ◽  
Osama M. Kellini ◽  
Milind Kumar
Keyword(s):  
Decision Making ◽  
Peer Review ◽  
Radiation Oncology ◽  
Professional Growth ◽  
Clinical Decision Making ◽  
Good Practice ◽  
Clinical Decision ◽  
Case Conference ◽  
Web Based ◽  
The Web

AbstractPurposePeer-review programmes in radiation oncology are used to facilitate the process and evaluation of clinical decision-making. However, web-based peer-review methods are still uncommon. This study analysed an inter-centre, web-based peer-review case conference as a method of facilitating the decision-making process in radiation oncology.MethodologyA benchmark form was designed based on the American Society for Radiation Oncology targets for radiation oncology peer review. This was used for evaluating the contents of the peer-review case presentations on 40 cases, selected from three participating radiation oncology centres. A scoring system was used for comparison of data, and a survey was conducted to analyse the experiences of radiation oncology professionals who attended the web-based peer-review meetings in order to identify priorities for improvement.ResultsThe mean scores for the evaluations were 82·7, 84·5, 86·3 and 87·3% for cervical, prostate, breast and head and neck presentations, respectively. The survey showed that radiation oncology professionals were confident about the role of web-based peer-reviews in facilitating sharing of good practice, stimulating professionalism and promoting professional growth. The participants were satisfied with the quality of the audio and visual aspects of the web-based meeting.ConclusionThe results of this study suggest that simple inter-centre web-based peer-review case conferences are a feasible technique for peer review in radiation oncology. Limitations such as data security and confidentiality can be overcome by the use of appropriate structure and technology. To drive the issues of quality and safety a step further, small radiotherapy departments may need to consider web-based peer-review case conference as part of their routine quality assurance practices.

Implementation of malignant bowel obstruction multidisciplinary case conferences (MCCs) to improve clinical decision making in malignant bowel obstruction (MBO) in gynecologic oncology.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18322-e18322
Author(s):  
Gita Bhat ◽  
Ainhoa Madariaga ◽  
Luisa Bonilla ◽  
Yeh Chen Lee ◽  
Neesha C. Dhani ◽  
...  
Keyword(s):  
Decision Making ◽  
Interventional Radiology ◽  
Bowel Obstruction ◽  
Clinical Management ◽  
Clinical Decision Making ◽  
Gynecologic Oncology ◽  
Clinical Decision ◽  
Management Plan ◽  
Malignant Bowel Obstruction ◽  
Cancer Centre

e18322 Background: Though patients (pts) with gynecological cancer are at higher risk of MBO, clinical management is not well defined. We implemented a coordinated team approach to evaluate MBO at Princess Margaret Cancer Centre. The Princess Margaret Cancer Centre inter-professional MBO management program includes nurse led ambulatory symptom management, inpatient treatment algorithm, patient directed bowel management education & MCCs. This study evaluates the utility of MBO MCC on clinical decision making in gynecologic oncology. Methods: Monthly MBO MCCs are conducted to discuss complex clinical management issues. A clinical summary is presented prior to the discussion with each case incorporating radiology review followed by interdisciplinary discussion. In this study, the initial management plan was compared to post-MCC consensus. A change in plan was defined as a consensus plan different from the pre-MCC plan or no definite plan prior to MCC. Barriers to implementation of the consensus were analyzed. Results: From December 2016 to November 2018, 90 pts were discussed in 22 MCCs. Of these, 60 had high grade serous ovarian carcinoma (67%) & 64 had small bowel obstruction (71%). Discussion in MCCs lead to a change in management plan in 49 cases(54%). These changes included recommendations for palliative surgery (25%) or radiation (10%), interventional radiology (23%), pharmacologic management alone (14%), imaging studies (4%) & total parenteral nutrition (TPN) (4%). Chemotherapy continuation, break or regimen changes were recommended in 20%. MCC consensus plan could not be implemented in 11 cases (23%). The barriers were refusal of surgery (8%), interventional radiology procedures (2%), TPN (4%) by patients, functional decline (6%) & inability to create a colostomy due to dense adhesions (2%). During MCC referrals to the dietitian & palliative care team were planned for 16 (18%) & 22 (24%) pts respectively. Conclusions: Interdisciplinary MBO MCCs have a significant impact on decision making in complex MBO cases. Radiology review & group discussion facilitates greater clarity in formulation of a management plan.

scholarly journals the Use of Tailored Feedback to Improve Hematologist Competence and Clinical Decision Making for the Treatment of Patients with Multiple Myeloma: a Novel Web-Based Educational Solution

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3570-3570
Author(s):  
Patricia Repetto ◽  
Noopur S. Raje ◽  
Sara R Fagerlie
Keyword(s):  
Decision Making ◽  
Multiple Myeloma ◽  
Effect Size ◽  
Clinical Decision Making ◽  
Conflicts Of Interest ◽  
Clinical Problem ◽  
Clinical Decision ◽  
Patient Specific ◽  
Web Based ◽  
Based Instruction

Abstract Introduction/Background: Recent advances in the understanding and treatment of multiple myeloma (MM) have led to improvements in patient management, including stratifying patients according to disease- and patient-specific risk factors, identifying appropriate patients for autologous stem cell transplantation, selecting treatment and incorporating new therapies into practice, and managing adverse effects. Materials and Methods: An online educational program using clinical problem-based instruction methodology was developed for hematologists and posted November 30, 2015 (http://www.medscape.org/viewarticle/853712). Each patient case included interactivity in the form of clinical decision questions and knowledge assessmentquestions. Tailored feedback and potential consequences in response to clinical decision questions was provided to each learner. Learners who answered a question incorrectly on the first attempt were provided feedback without revealing the correct answer and given the opportunity to answer the question again (second attempt) [Figure 1]. To determine measurable improvements in competence and clinical decision making, first and second attempt answer choices were evaluated for the clinical decision questions. Overall effect size was calculated using Cohen's d to show the magnitude and strength of the consequence-based feedback learning method. Data were collected through February 17, 2016. Results: A total of 404 hematologists participated in the activity during the study period, and responses from 129 (those who completed all clinical decision questions) were assessed. Responses to the 6 clinical decision questions show that a range of 28% to 67% of learners answered a question correctly on the first attempt. After receiving feedback specific to each incorrect answer, there was an overall 71% relative improvement in hematologists/oncologists who answered a question correctly on the second attempt [Figure 2]. The consequence-based feedback had a large impact on hematologists' ability to make clinical decisions correctly as demonstrated by the overall effect size of d=.94. Conclusions: This study demonstrated the success of a web-based CME activity with tailored feedback to learners' responses. Participation in this activity led to large improvements in clinician knowledge and the ability to select appropriate evidence- based practice choices, which may ultimately improve outcomes of patients being treated for multiple myeloma. Disclosures No relevant conflicts of interest to declare.

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