Radiation concerns in frequent flyer patients: Should imaging history influence decisions about recurrent imaging?

2021 ◽  
pp. 20210543
Author(s):  
Aaron D Sodickson
Keyword(s):  
Diagnostic Imaging ◽  
Low Dose ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Underlying Disease ◽  
Medical Practitioners ◽  
Dose Threshold ◽  
Radiation Risks ◽  
Disease States ◽  
Frequent Flyer

Radiation risks from diagnostic imaging have captured the attention of patients and medical practitioners alike, yet it remains unclear how these considerations can best be incorporated into clinical decision making. This manuscript presents a framework to consider these issues in a potentially at-risk population, the so called “frequent flyer” patients undergoing a large amount of recurrent imaging over time. Radiation risks from the low-dose exposures of diagnostic imaging are briefly reviewed, as applied to recurrent exposures. Some scenarios are then explored in which it may be helpful to incorporate knowledge of a patient’s imaging history. There is no simple or uniformly applicable approach to these challenging and often nuanced clinical decisions. The complexity and variability of the underlying disease states and trajectories argues against alerting mechanisms based on a simple cumulative dose threshold. Awareness of imaging history may instead be beneficial in encouraging physicians and patients to take the long view, and to identify those populations of frequent flyers that might benefit from alternative imaging strategies.

Anemia and fatigue in cancer patients

1998 ◽  
Vol 4 (4_suppl) ◽  
pp. S5-S11
Author(s):  
Terri G Davidson
Keyword(s):  
Clinical Decision Making ◽  
Clinical Decision ◽  
Underlying Disease ◽  
Disease Treatment ◽  
Anemia Of Chronic Disease ◽  
Cancer Related Fatigue ◽  
Lack Of Exercise ◽  
Cancer Related Anemia ◽  
The Relationship ◽  
Adequate Tissue

Although strong evidence indicates that fatigue can be caused by anemia, little is known about the relationship between the extent and rate of hemoglobin loss and the development of fa tigue. Anemia, an insufficiency of red blood cells to maintain adequate tissue oxygenation, is the most common hematologic abnormality associ ated with cancer. It usually results from a de crease in red blood cell production, resulting from either direct tumor invasion of bone mar row or the anemia of chronic disease. Fatigue is a subjective sensation, often described as tired ness, exhaustion, lethargy, or malaise. The mechanism that precipitates or sustains fatigue is probably multifactorial and includes the re lease of inflammatory cytokines and the onset of the acute-phase inflammatory response. Other factors that contribute to cancer-related fatigue include the underlying disease, treatment of the disease, intercurrent systemic illnesses, sleep disorders, immobility and lack of exercise, chronic pain, and psychosocial factors. A review of cancer-related anemia and fatigue is pre sented, which focuses on the clinical decision- making process regarding the management of these syndromes when they exist concurrently.

Local Ablative Therapies in Oligometastatic NSCLC: New Data and New Directions

2020 ◽  
Vol 41 (03) ◽  
pp. 369-376
Author(s):  
Pencilla Lang ◽  
Daniel R. Gomez ◽  
David A. Palma
Keyword(s):  
Clinical Decision Making ◽  
Treatment Phase ◽  
Progression Free Survival ◽  
Clinical Decision ◽  
Stereotactic Ablative Radiotherapy ◽  
Free Survival ◽  
Fractionated Radiotherapy ◽  
Disease States ◽  
Ablative Therapies ◽  
Clinical Scenarios

AbstractThe oligometastatic and oligoprogressive disease states have been recently recognized as common clinical scenarios in the management of non-small cell lung cancer (NSCLC). As a result, there has been increasing interest in treating these patients with locally ablative therapies including surgery, conventionally fractionated radiotherapy, stereotactic ablative radiotherapy, and radiofrequency ablation. This article provides an overview of oligometastatic and oligoprogressive disease in the setting of NSCLC and reviews the evidence supporting ablative treatment. Phase II randomized controlled trials and retrospective series suggest that ablative treatment of oligometastases may substantially improve progression-free survival and overall survival, and additional large randomized studies testing this hypothesis in a definitive context are ongoing. However, several challenges remain, including quantifying the possible benefits of ablative therapies for oligoprogressive disease and developing prognostic and predictive models to assist in clinical decision making.

scholarly journals Precision medicine in inflammatory bowel disease: concept, progress and challenges

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 54 ◽  
Author(s):  
Simon P. Borg-Bartolo ◽  
Ray Kiran Boyapati ◽  
Jack Satsangi ◽  
Rahul Kalla
Keyword(s):  
Precision Medicine ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Underlying Disease ◽  
Response To Therapy ◽  
Current Evidence ◽  
Disease Biology ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
The Individual

Crohn’s disease and ulcerative colitis are increasingly prevalent, relapsing and remitting inflammatory bowel diseases (IBDs) with variable disease courses and complications. Their aetiology remains unclear but current evidence shows an increasingly complex pathophysiology broadly centring on the genome, exposome, microbiome and immunome. Our increased understanding of disease pathogenesis is providing an ever-expanding arsenal of therapeutic options, but these can be expensive and patients can lose response or never respond to certain therapies. Therefore, there is now a growing need to personalise therapies on the basis of the underlying disease biology and a desire to shift our approach from “reactive” management driven by disease complications to “proactive” care with an aim to prevent disease sequelae. Precision medicine is the tailoring of medical treatment to the individual patient, encompassing a multitude of data-driven (and multi-omic) approaches to foster accurate clinical decision-making. In IBD, precision medicine would have significant benefits, enabling timely therapy that is both effective and appropriate for the individual. In this review, we summarise some of the key areas of progress towards precision medicine, including predicting disease susceptibility and its course, personalising therapies in IBD and monitoring response to therapy. We also highlight some of the challenges to be overcome in order to deliver this approach.

scholarly journals Increasing Neonatal Healthcare Productivity using Clinical Reasoning Coaching Tools

2020 ◽  
Vol 18 (2) ◽  
Author(s):  
Mossad AbdelHak Shaban Mohamed ◽  
Taher Halawa ◽  
Taufiq Hidayat ◽  
Asrar Abu Bakar ◽  
Azamin Anuar ◽  
...  
Keyword(s):  
Clinical Reasoning ◽  
Clinical Decision Making ◽  
Research Question ◽  
Control Policy ◽  
Clinical Decision ◽  
Medical Practitioners ◽  
Continuous Contact ◽  
Diagnostic Skills ◽  
Medical Subspecialty ◽  
Diagnostic Thinking

Introduction: Productivity in medical field has inherent value in terms of improving our lives, which can expand our economies. Productivity in medicine has many aspects including improving clinical diagnostic skills, safety, and quality and quantity care. This study will assess whether early exposure to structured clinical reasoning coaching tools would improve their clinical decision making and productivity. Research question: Does clinical reasoning coaching tools Increase neonatal healthcare productivity? Materials and method: Medical practitioners recently joined neonatal units will participate over 2 years in an innovative series of clinical reasoning coaching sessions blended with virtual patients. Practitioners will be exposed to many teaching methods during the neonatal training that includes lectures, bedside teaching sessions and small group discussions beside website continuous contact for learning and chairing skills. Teaching series scope should cover resuscitating sick neonates, handling ventilators either conventional or high frequency, practicing common neonatal procedures, dealing with common neonatal scenarios, infection control policy and, effective communication skills The evaluation sessions will be introduced at the beginning of their training, during the course and at the end of the clerkship to assess their improving productivity, using diagnostic thinking inventory(DTI). Selection of the medical practitioners will be based on either on stratified random sampling or cohort control depending on the funding and logistic. All items will be analysed advanced statistical analysis methods. Results: The coaching tool may yield dramatic impact, allowing the innovators to be more productive. Suggesting widely utilize it for nurses, undergraduate and postgraduate medical Subspecialty. Conclusion: The research hypothesis is assuming that DTI scores and productivity will be higher after the coaching sessions as rated by the candidate’s performance.

Comprehensive On-site Medical and Public Health Training for Local Medical Practitioners in a Refugee Setting

2013 ◽  
Vol 7 (1) ◽  
pp. 82-88 ◽  
Author(s):  
Ramin Asgary ◽  
Karen Jacobson
Keyword(s):  
Public Health ◽  
Clinical Decision Making ◽  
Health Workers ◽  
Medical Personnel ◽  
Clinical Decision ◽  
Medical Providers ◽  
Medical Practitioners ◽  
Use Of Resources ◽  
Public Health Training ◽  
Site Training

AbstractObjectivesIn refugee settings, local medical personnel manage a broad range of health problems but commonly lack proper skills and training, which contributes to inefficient use of resources. To fill that gap, we designed, implemented, and evaluated a curriculum for a comprehensive on-site training for medical providers.MethodsThe comprehensive teaching curriculum provided ongoing on-site training for medical providers (4 physicians, 7 medical officers, 15 nurses and nurse aids, and 30 community health workers) in a sub-Saharan refugee camp. The curriculum included didactic sessions, inpatient and outpatient practice-based teaching, and case-based discussions, which included clinical topics, refugee public health, and organizational skills. The usefulness and efficacy of the training were evaluated through pretraining and posttraining tests, anonymous self-assessment surveys, focus group discussions, and direct clinical observation.ResultsPhysicians had a 50% (95% CI 17%-82%; range, 25%-75%) improvement in knowledge and skills. They rated the quality and usefulness of lectures 4.75 and practice-based teaching 5.0 on a 5-point scale (1=poor to 5=excellent). Evaluation of medical officers’ knowledge revealed improvements in (1) overall test scores (52% [SD 8%] to 80% [SD 5%]; P < .0001); (2) pediatric infectious diseases (44% [SD 9%] to 79% [SD 7%]; P < .001); and (3) noninfectious diseases (57% [SD 16%] to 81% [SD 10%] P < .01). Main barriers to effective learning were lack of training prioritization, time constraints, and limited ancillary support.ConclusionsA long-term, ongoing training curriculum for medical providers initiated by aid agencies but integrated into horizontal peer-to-peer education is feasible and effective in refugee settings. Such programs need prioritizing, practice and system-based personnel training, and a comprehensive curriculum to improve clinical decision making.(Disaster Med Public Health Preparedness. 2013;7:82-88)

Integrative workflows for network analysis

2018 ◽  
Vol 62 (4) ◽  
pp. 549-561
Author(s):  
Faiz M. Khan ◽  
Shailendra K. Gupta ◽  
Olaf Wolkenhauer
Keyword(s):  
Regulatory Networks ◽  
Clinical Decision Making ◽  
Epithelial Mesenchymal Transition ◽  
Therapeutic Targets ◽  
Clinical Decision ◽  
Underlying Disease ◽  
Biological Information ◽  
Dynamical Analysis ◽  
Mesenchymal Transition ◽  
Optimization Function

Due to genetic heterogeneity across patients, the identification of effective disease signatures and therapeutic targets is challenging. Addressing this challenge, we have previously developed a network-based approach, which integrates heterogeneous sources of biological information to identify disease specific core-regulatory networks. In particular, our workflow uses a multi-objective optimization function to calculate a ranking score for network components (e.g. feedback/feedforward loops) based on network properties, biomedical and high-throughput expression data. High ranked network components are merged to identify the core-regulatory network(s) that is then subjected to dynamical analysis using stimulus–response and in silico perturbation experiments for the identification of disease gene signatures and therapeutic targets. In a case study, we implemented our workflow to identify bladder and breast cancer specific core-regulatory networks underlying epithelial–mesenchymal transition from the E2F1 molecular interaction map. In this study, we review our workflow and described how it has developed over time to understand the mechanisms underlying disease progression and prediction of signatures for clinical decision making.

scholarly journals Use of Dyna-CT Angiography in Neuroendovascular Decision-Making

2009 ◽  
Vol 15 (1) ◽  
pp. 67-72 ◽  
Author(s):  
K. Namba ◽  
Y. Niimi ◽  
J.K. Song ◽  
A. Berenstein
Keyword(s):  
Decision Making ◽  
Ct Angiography ◽  
Low Dose ◽  
Clinical Decision Making ◽  
Three Dimensional ◽  
Clinical Decision ◽  
Timely Manner ◽  
Anatomical Structures ◽  
Rescue Technique ◽  
Endovascular Devices

A successful neuroendovascular procedure depends on accurate anatomical understanding of a target vessel in relation to surrounding anatomical structures or endovascular devices, such as coils and stents. During an endovascular procedure, with conventional or three dimensional (3D) rotational angiography, this type of information is extremely difficult to obtain in a timely manner. To overcome this drawback, a DynaCT was combined with low dose contrast injection to create CT angiography (CTA)-like images (DynaCTA). The images obtained were similar to those of conventional CTA but with better quality in analyzing vessels to surrounding anatomical structures and endovascular devices while the patient was on the table. The authors present three illustrative cases in which information added by the DynaCTA helped improve understanding of anatomy, and affected our clinical decision-making. Although better quality images may be obtained by other imaging modalities or careful angiographic interpretations, DynaCTA can be an easy and effective rescue technique worth keeping in mind in clarifying the relation of a vessel to surrounding anatomy.

scholarly journals Wikipedia as Informal Self-Education for Clinical Decision-Making in Medical Practice

2017 ◽  
Vol 4 (1) ◽  
pp. 15-25 ◽  
Author(s):  
David Matheson ◽  
Catherine Matheson-Monnet
Keyword(s):  
Decision Making ◽  
Informal Education ◽  
Clinical Decision Making ◽  
Medical Profession ◽  
Empirical Studies ◽  
Clinical Decision ◽  
Small Scale ◽  
Medical Practitioners ◽  
Health Related ◽  
Quality And Reliability

Background:For almost any topic, a Wikipedia page will appear among the first ten items of a search online. Wikipedia is also a site whose quality and reliability has been called into question.Methods:In this paper, we aim to discuss medical practitioners’ use of Wikipedia, what this consists of and what it might be. We consider the context and history of Wikipedia before discussing the relationship between Wikipedia and the medical profession. In so doing, we will consider Wikipedia as a means of informal self-education and the extent to which it might inform clinical decision-making. We compare with the existing literature results from our two small-scale empirical studies of Wikipedia and clinical decision-making.Results:Notwithstanding issues over quality and reliability, Wikipedia’s rules on verifiability are such that its articles are very heavily referenced, and this is just as true of health-related articles. The Cochrane/Wikipedia Initiative in improving the quality and reliability of medical and health pages in Wikipedia is significant in increasing reliability. Our respondents largely concurred with the results from earlier studies on the use of Wikipedia by medical practitioners.Conclusion:Perhaps the very doubt over Wikipedia’s accuracy is its greatest strength as a means of informal education of doctors. That medical and health articles on Wikipedia can be so fully referenced and still be doubted is arguably a good thing and one whose effects may be spread into other, more trusted, publications. Hence, one might envisage a future where no one source is taken automatically on trust.

scholarly journals Bayesian network modelling for early diagnosis and prediction of Endometriosis

2020 ◽  
Author(s):  
Rachel Collins ◽  
Norman Fenton
Keyword(s):  
Early Diagnosis ◽  
Graphical Models ◽  
Observational Studies ◽  
Clinical Decision Making ◽  
Causal Structure ◽  
Clinical Decision ◽  
Underlying Disease ◽  
Model Parameters ◽  
Network Modelling ◽  
The Impact

AbstractBayesian networks (BNs) are graphical models that can combine knowledge with data to represent the causal probabilistic relationships between a set of variables and provide insight into the processes underlying disease progression, closely resembling clinical decision-making. This paper describes a BN causal model for the early diagnosis and prediction of endometriosis. The causal structure of the BN model is developed using an idioms-based approach and the model parameters are derived from the data reported in multiple medical observational studies and trials. The BN incorporates the impact of errors and omissions in reporting endometriosis, and the distinction between assumed and actual cases. Hence, it is also able to explain both flawed and counterintuitive results of observational studies.

Sign in / Sign up

Export Citation Format

Share Document