scholarly journals Health emergencies and interoceptive sensibility modulate the perception of non-evidence-based drug use: Findings from the COVID-19 outbreak

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256806
Author(s):  
Gerardo Salvato ◽  
Daniela Ovadia ◽  
Alessandro Messina ◽  
Gabriella Bottini
Keyword(s):  
Decision Making ◽  
Individual Characteristics ◽  
Decision Making Process ◽  
Evidence Based ◽  
Care Providers ◽  
Therapeutic Decision ◽  
Therapeutic Approaches ◽  
Experimental Drugs ◽  
Therapeutic Decisions ◽  
Therapeutic Decision Making

Scientific evidence plays an important role in the therapeutic decision-making process. What happens when physicians are forced to make therapeutic decisions under uncertainty? The absence of scientific guidelines at the beginning of a pandemic due to an unknown virus, such as COVID-19, could influence the perceived legitimacy of the application of non-evidence-based therapeutic approaches. This paper reports on a test of this hypothesis, in which we administered an ad hoc questionnaire to a sample of 64 Italian physicians during the first wave of the COVID-19 pandemic in Italy (April 2020). The questionnaire statements regarding the legitimacy of off-label or experimental drugs were framed according to three different scenarios (Normality, Emergency and COVID-19). Furthermore, as the perception of internal bodily sensations (i.e., interoception) modulates the decision-making process, we tested participants’ interoceptive sensibility using the Multidimensional Assessment of Interoceptive Awareness (MAIA). The results showed that participants were more inclined to legitimate non-evidence-based therapeutic approaches in the COVID-19 and Emergency scenarios than the Normality scenario. We also found that scores on the MAIA Trusting subscale positively predicted this difference. Our findings demonstrate that uncertain medical scenarios, involving a dramatic increase in patient volume and acuity, can increase risk-taking in therapeutic decision-making. Furthermore, individual characteristics of health care providers, such as interoceptive ability, should be taken into account when constructing models to prevent the breakdown of healthcare systems in cases of severe emergency.

scholarly journals Spectrum of Neurologic Complications in COVID-19: An Evidence-Based Review

2020 ◽  
Vol 07 (02) ◽  
pp. 062-066
Author(s):  
Soumya Sarkar ◽  
Puneet Khanna ◽  
Surya K. Dube
Keyword(s):  
Decision Making ◽  
Severe Acute Respiratory Syndrome ◽  
Respiratory Tract ◽  
Individualized Treatment ◽  
Evidence Based ◽  
Neurologic Complications ◽  
Neurologic Manifestations ◽  
Therapeutic Decision ◽  
The World ◽  
Therapeutic Decision Making

AbstractThe world is facing an unprecedented crisis due to the pandemic of current coronavirus disease 2019 (COVID-19). Coronavirus (CoVs) infections not only are always involving the respiratory tract but also possess significant neuroinvasive potential. The literature regarding neuropathogenic potential of human CoVs is sparse. Thus, the number of COVID-19–related neurologic complications is likely to be underestimated. Awareness regarding the possible spectrum of neurologic complications is essential for therapeutic decision-making and individualized treatment and thereby limiting the COVID-19–related morbidity and mortality. The aim of this review is to address the neurologic manifestations of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).

Bone marrow examination (BMex) in staging of SCLC after implementation of PET/CT scan.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e20014-e20014
Author(s):  
Karin Holmskov Hansen ◽  
Mette Boes Eriksen ◽  
Tine Schytte ◽  
Olfred Hansen
Keyword(s):  
Decision Making ◽  
Ct Scan ◽  
Bone Metastases ◽  
Bone Lesions ◽  
Therapeutic Decision ◽  
Therapeutic Decisions ◽  
Pet Ct ◽  
Therapeutic Decision Making ◽  
The Impact ◽  
Pet Ct Scan

e20014 Background: Correct staging of small cell lung cancer (SCLC) in limited disease (LD) or extensive disease (ED) is crucial as it has an impact on the therapeutic decision-making. The staging procedures in SCLC in the late 1990s included chest X-ray, blood samples, abdominal ultrasonography (UL), and iliac crest BMex. The aim of this study was to evaluate the continued eligibility of performing BMex in patients (ptt) with SCLC as a routine staging procedure, and to see how often therapeutic decisions were influenced by a positive BM before and after the PET/CT scan era. Methods: All diagnostic and staging procedures were registered in ptt with SCLC referred to our department from 1995 to 1999 in cohort 1 (C1). Cohort 2 (C2) included SCLC patients referred from 2009 to 2013. In C2 results of PET/CT in terms of bone metastases were related to results of BMex. Results: In C1 194 ptt was referred with 136 (70%) having ED. BMex was omitted in 32 (17%) fragile ptt having known ED while all LD ptt underwent BMex. BM involvement was seen in 37 (23%) of all 162 BMex and 36% of the 104 ED ptt examined. When BM was negative the staging of ED was due to other imaging. The BM had an impact on therapeutic decision-making in 5 (4%) of 136 having ED and 5 (3%) of 162 BMex. In C2 211 ptt of 292 (72%) had ED and 203 (70%) of all ptt underwent BMex. BM biopsy was done in 137 (65 %) ED and in 66 (69 %) LD. Of 137 ED ptt BM involvement was found in 31 (23 %) cases. A PET/CT scan was performed in 13 (42 %) of these ptt of which bone metastases was found in 12 (92 %). One patient (8%) had a PET/CT without bone lesions. Bone metastases were seen at PET/CT scan in 61 ptt in C2, of these 22 (36%) had negative BM, whereas 12 (20%) had BM involvement and in 3 ptt (5%) BMex were inconclusive. No BMex was performed in 24 ptt (39%). BMex had an impact on therapeutic decision-making in 3 (1.4%) of 211 having ED and 5 (2.5%) of 203 BMex. Conclusions: Due to staging by PET/CT and CT scan in SCLC ptt the impact of BMex in the therapeutic decision-making has decreased and fewer ptt are undergoing BMex. Though a negative PET/CT cannot exclude BM involvement BMex may be considered omitted.

scholarly journals Therapeutic decision making in autoimmune and inflammatory disorders of the central nervous system in children

2016 ◽  
Author(s):  
Russell Clive Dale
Keyword(s):  
Decision Making ◽  
Central Nervous System ◽  
Nervous System ◽  
Fatal Outcome ◽  
Decision Making Process ◽  
Therapeutic Decision ◽  
Inflammatory Disorders ◽  
Sydenham Chorea ◽  
The Central Nervous System ◽  
Therapeutic Decision Making

Autoimmune and inflammatory disorders of the central nervous system can result in significant morbidity and mortality. Through the recognition of syndromes using diagnostic biomarkers, the clinician is now able to use immune suppressive therapies to improve outcomes. However, the therapeutic decision-making process is complex. The clinician has to balance the risk of disease, with the risk of treatment side effects. To achieve this balance, it is important to understand the natural history of disease, the risk of residual disability, the risk of relapse, and risk of a fatal outcome. It is also important to have some understanding of the pathological processes, as some of the entities have more reversible processes, whereas others have destructive processes. This review will assess the dynamic nature of this decision-making process, and compare some of the more severe diseases such as neuromyelitis optica, anti-N-methyl-D-aspartate receptor encephalitis and opsoclonus myoclonus ataxia syndrome, with disorders with more favourable outcomes such as Sydenham chorea and post-infectious cerebellar ataxia. 

scholarly journals Empowering Patients in the Therapeutic Decision-Making Process: A Glance Into Behçet's Syndrome

2021 ◽  
Vol 8 ◽  
Author(s):  
Diana Marinello ◽  
Federica Di Cianni ◽  
Alessandra Del Bianco ◽  
Irene Mattioli ◽  
Jurgen Sota ◽  
...  
Keyword(s):  
Decision Making ◽  
Psychological Status ◽  
Care Process ◽  
Decision Making Process ◽  
Behçet’S Syndrome ◽  
Therapeutic Decision ◽  
Behçet's Syndrome ◽  
Behcet’S Syndrome ◽  
Therapeutic Decision Making ◽  
Behcet's Syndrome

Behçet's syndrome (BS) represents a challenging condition, characterized by a variable spectrum of disease profile and associated with a significant limitation of the daily activities as well as a potential negative impact on relationships and psychological status. Considering also the complexity of the therapeutic management of BS, that often includes biological off-label treatments, the participation in the therapeutic decision-making process of the BS patients is essential to ensure the integration of the care process into the life of the patient. For this reason, the empowerment of BS patients represents a crucial need and the present work is aimed at fully exploring all the potential variables implicated in the BS patient empowerment, also highlighting major points to consider and concrete actions to be planned in the immediate future in order to implement a pragmatic facilitation of the patients' empowerment.

scholarly journals Patients’ demographic and socioeconomic characteristics influence the therapeutic decision-making process in psoriasis

PLoS ONE ◽  
2020 ◽  
Vol 15 (8) ◽  
pp. e0237267 ◽  
Author(s):  
Emanuele Scala ◽  
Matteo Megna ◽  
Paolo Amerio ◽  
Giuseppe Argenziano ◽  
Graziella Babino ◽  
...  
Keyword(s):  
Decision Making ◽  
Decision Making Process ◽  
Therapeutic Decision ◽  
Socioeconomic Characteristics ◽  
Therapeutic Decision Making

scholarly journals Spinal arteriovenous malformation

2018 ◽  
Vol 21 (3) ◽  
pp. 172-174
Author(s):  
Elton Gomes Da Silva ◽  
Vinícius Teixeira Ribeiro ◽  
Juliana ' Rebechi Zuiani ◽  
Ronie Leo Piske ◽  
Helder Tedeschi
Keyword(s):  
Decision Making ◽  
Arteriovenous Malformation ◽  
Decision Making Process ◽  
Therapeutic Decision ◽  
Spinal Arteriovenous Malformation ◽  
Therapeutic Decision Making ◽  
Complex Lesions

Spinal AVMs are complex lesions that can present as a nidus or more often as fistulae. Diagnosis is usually made by angiography and the treatment of election in most cases is embolization being surgery reserved for selected cases. In this report the classification of such lesions and their treatment are discussed. We also present a case that was submitted to surgery. Although usually managed by embolization, surgery of spinal AVMs also has a role in the treatment, bringing to evidence the necessity for a multidisciplinary discussion in the therapeutic decision making process.

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