scholarly journals Second Surgery for Progressive Glioblastoma: A Multi-Centre Questionnaire and Cohort-Based Review of Clinical Decision-Making and Patient Outcomes in Current Practice

2021 ◽  
Author(s):  
Paul Brennan ◽  
R Borchert ◽  
C Coulter ◽  
G Critchley ◽  
B Hall ◽  
...  
Keyword(s):  
Decision Making ◽  
Patient Outcomes ◽  
Clinical Decision Making ◽  
Performance Status ◽  
Treatment Options ◽  
Cohort Analysis ◽  
Methylation Status ◽  
Clinical Decision ◽  
Extent Of Resection ◽  
Second Surgery

Abstract PurposeGlioblastoma prognosis is poor. Treatment options are limited at progression. Surgery may benefit, but no quality guidelines exist to inform patient selection. We sought to describe variations in surgical management at progression, highlight where further evidence is needed, and build towards a consensus strategy. MethodsCurrent practice in selection of patients with progressive GBM for second surgery was surveyed online amongst specialists in the UK and Europe. We complemented this with an assessment of practice in a retrospective cohort study from six United Kingdom neurosurgical units. We used descriptive statistics to analyse the data. Results234 questionnaire responses were received. Maintaining or improving patient quality of life was key to decision making, with variation as to whether patient age, performance status or intended extent of resection was relevant. MGMT methylation status was not important. Half considered no minimum time after first surgery. 288 patients were reported in the cohort analysis. Median time to second surgery from first surgery 390 days. Median overall survival 815 days, with no association between time to second surgery and time to death (p=0.874). ConclusionThis is the most wide-ranging examination of contemporaneous practice in management of GBM progression. Without evidence-based guidelines, the variation is unsurprising. We propose consensus guidelines for consideration, to reduce heterogeneity in decision making, support data collection and analysis of factors influencing outcomes, and to inform clinical trials to establish whether second surgery improves patient outcomes, or simply selects to patients already performing well.

scholarly journals Second surgery for progressive glioblastoma: a multi‐centre questionnaire and cohort‐based review of clinical decision‐making and patient outcomes in current practice

2021 ◽  
Author(s):  
P. M. Brennan ◽  
R. Borchert ◽  
C. Coulter ◽  
G. R. Critchley ◽  
B. Hall ◽  
...  
Keyword(s):  
Decision Making ◽  
Patient Outcomes ◽  
Current Practice ◽  
Clinical Decision Making ◽  
Performance Status ◽  
Treatment Options ◽  
Cohort Analysis ◽  
Methylation Status ◽  
Clinical Decision ◽  
Second Surgery

Abstract Purpose Glioblastoma prognosis is poor. Treatment options are limited at progression. Surgery may benefit, but no quality guidelines exist to inform patient selection. We sought to describe variations in surgical management at progression, highlight where further evidence is needed, and build towards a consensus strategy. Methods Current practice in selection of patients with progressive GBM for second surgery was surveyed online amongst specialists in the UK and Europe. We complemented this with an assessment of practice in a retrospective cohort study from six United Kingdom neurosurgical units. We used descriptive statistics to analyse the data. Results 234 questionnaire responses were received. Maintaining or improving patient quality of life was key to decision making, with variation as to whether patient age, performance status or intended extent of resection was relevant. MGMT methylation status was not important. Half considered no minimum time after first surgery. 288 patients were reported in the cohort analysis. Median time to second surgery from first surgery 390 days. Median overall survival 815 days, with no association between time to second surgery and time to death (p = 0.874). Conclusions This is the most wide-ranging examination of contemporaneous practice in management of GBM progression. Without evidence-based guidelines, the variation is unsurprising. We propose consensus guidelines for consideration, to reduce heterogeneity in decision making, support data collection and analysis of factors influencing outcomes, and to inform clinical trials to establish whether second surgery improves patient outcomes, or simply selects to patients already performing well.

scholarly journals Composer—Visual Cohort Analysis of Patient Outcomes

2019 ◽  
Vol 10 (02) ◽  
pp. 278-285 ◽  
Author(s):  
Jen Rogers ◽  
Nicholas Spina ◽  
Ashley Neese ◽  
Rachel Hess ◽  
Darrel Brodke ◽  
...  
Keyword(s):  
Decision Making ◽  
Patient Outcomes ◽  
Visual Analysis ◽  
Treatment Options ◽  
Cohort Analysis ◽  
Analysis Tool ◽  
Electronic Health Record Data ◽  
Patient Cohort ◽  
Orthopedic Surgeons ◽  
Patient Reported

Objective Visual cohort analysis utilizing electronic health record data has become an important tool in clinical assessment of patient outcomes. In this article, we introduce Composer, a visual analysis tool for orthopedic surgeons to compare changes in physical functions of a patient cohort following various spinal procedures. The goal of our project is to help researchers analyze outcomes of procedures and facilitate informed decision-making about treatment options between patient and clinician. Methods In collaboration with orthopedic surgeons and researchers, we defined domain-specific user requirements to inform the design. We developed the tool in an iterative process with our collaborators to develop and refine functionality. With Composer, analysts can dynamically define a patient cohort using demographic information, clinical parameters, and events in patient medical histories and then analyze patient-reported outcome scores for the cohort over time, as well as compare it to other cohorts. Using Composer's current iteration, we provide a usage scenario for use of the tool in a clinical setting. Conclusion We have developed a prototype cohort analysis tool to help clinicians assess patient treatment options by analyzing prior cases with similar characteristics. Although Composer was designed using patient data specific to orthopedic research, we believe the tool is generalizable to other healthcare domains. A long-term goal for Composer is to develop the application into a shared decision-making tool that allows translation of comparison and analysis from a clinician-facing interface into visual representations to communicate treatment options to patients.

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

1998 ◽  
Vol 3 (1) ◽  
pp. 44-49 ◽  
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.

Clinical Decision Making on Extensive Molar Restorations

2014 ◽  
Vol 39 (6) ◽  
pp. E231-E240 ◽  
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.

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

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.

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

2021 ◽  
pp. 194187442110395
Author(s):  
Ayse Altintas ◽  
Ayca Ersen Danyeli ◽  
Subutay Berke Bozkurt ◽  
Sanem Pinar Uysal ◽  
Sergin Akpek ◽  
...  
Keyword(s):  
Decision Making ◽  
Urinary Retention ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Diagnostic Testing ◽  
Clinical Decision ◽  
Diagnostic Tools ◽  
Progressive Weakness ◽  
Over Time

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.

scholarly journals Observational Study of the Multisciplinaryteam role (MDT) on Healthcare Management of Cancer Patients: Benefits and Barriers, AbuDhabi 2017

2019 ◽  
Vol 61 (1) ◽  
pp. 18-24
Author(s):  
Ibtisam Hussein Al Obaidi
Keyword(s):  
Decision Making ◽  
Cancer Patients ◽  
Patient Outcomes ◽  
Health Care Professionals ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Healthcare Management ◽  
Survey Study ◽  
Multidisciplinary Teams ◽  
The Impact

Background: Multidisciplinary team meetings (MDTs) are designed to optimize patient outcomes. It appears intuitive that MDTs are essential to clinical decision - making and patient management; however, it is unclear whether that belief is supported by evidence. With regard to cancer patients, studies demonstrated that  treatment plans made by interacting health care professionals are more effective than those made by individual practitioners. Objectives: To assess the impact of multidisciplinary teams (MDTs) on clinical decision - making and  patient outcomes. Methods: We follow a descriptive questionnaire survey study design and created a (10) sections  surveymonkey that was distributed via email to (150) experts in surgical oncology, general surgery, oncology, radiation oncology, pathologists, and administrative staff. Fourty (40) completed responses were collected to ensure a statistical basis on which to draw sound conclusions. The remaining 110 staff have submitted incomplete answers. Answers were discussed in a separate MDT meeting with most of the  participants.The survey was followed by an interpretation of the respondents’ results and comparison with literatures.  Results: 75% of the participants chose” Agree and strongly agree”, supporting the hypothesis that MDT  meetings ensure an effective and up-to- date management guidelines. This means that the risk of not  discussing a cancer patient cannot be neglected any longer. So the hypothesis statement (H0) is rejected and the alternative statement (Ha) is accepted. Conclusions: The majority of participants saw the value in the MDT process and expressed support for its implementation locally and nationally; however, feedback about the most appropriate format is yet to be established. The clinicians identified the need for agreed standards in MDT performance

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