Digital Pain Drawings Can Improve Doctors’ Understanding of Acute Pain Patients: Survey and Pain Drawing Analysis (Preprint)

BACKGROUND Pain drawings (PDs) are an important tool to evaluate, communicate, and objectify pain. In the past few years, there has been a shift toward tablet-based acquisition of PDs, and several studies have been conducted to test the usefulness, reliability, and repeatability of electronic PDs. However, to our knowledge, no study has investigated the potential role of electronic PDs in the clinical assessment and treatment of inpatients in acute pain situations. OBJECTIVE The aim of this study was to evaluate whether knowledge of the patients’ electronic PD has the potential to improve the doctors’ understanding of their patients and to influence their clinical decision making. Furthermore, we sought to identify differences between electronic PDs of patients and their treating pain specialists in an acute pain situation and to find those specific characteristics derived from the PDs that had the largest impact on doctors’ understanding. METHODS We obtained electronic PDs from 47 inpatients in acute pain situations before their consultation with a pain specialist on a tablet personal computer with a stylus. Before looking at their patients’ drawings, these specialists drew their own conception of the patients’ pain after anamnesis and physical examination. Patients’ drawings were then revealed to the doctors, and they were asked to evaluate how much the additional information improved their understanding of the case and how much it influenced their clinical decision on an 11-point Likert scale (0=“not at all” and 10=“very much”). Similarities and differences of patients’ and doctors’ PDs were assessed by visual inspection and by calculating Jaccard index and intraclass correlation coefficient (ICC) of the pain area and the number of pain clusters. Exploratory analyses were conducted by means of correlation tables to identify specific factors that influenced doctors’ understanding. RESULTS Patients’ PDs significantly improved the doctors’ understanding (mean score 4.81, SD 2.60, P<.001) and to a lesser extent their clinical decision (mean 2.68, SD 1.18, P<.001). Electronic PDs of patients and doctors showed fair to good similarity for pain extent (r=.454, P=.001) and widespreadness (P=.447, r=.002) were important factors helping doctors to understand their patients. CONCLUSIONS In a clinical setting, electronic PDs can improve doctors’ understanding of patients in acute pain situations. The ability of electronic PDs to visualize differences between doctors’ and patients’ conception of pain has the potential to improve doctor-patient communication.

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Transitioning towards official clinical guidelines for the diagnostics and treatment of severe behavioural problems in children across Europe: current state and future directions.

10.31234/osf.io/8hsmy ◽

2017 ◽

Author(s):

Alexandra-Raluca Gatej ◽

Audri Lamers ◽

Robert Vermeiren ◽

Lieke van Domburgh

Keyword(s):

Mental Health ◽

Clinical Guidelines ◽

Clinical Decision Making ◽

Daily Practice ◽

Clinical Decision ◽

European Guidelines ◽

Current State ◽

Assessment And Treatment ◽

Evidence Based Treatments ◽

Multifactorial Approach

Severe behaviour problems (SBPs) in early childhood include oppositional and aggressive behaviours and predict negative mental health outcomes later in life. Although effective treatments for this group are available and numerous clinical practice guidelines have been developed to facilitate the incorporation of evidence-based treatments in clinical decision-making (NICE, 2013), many children with SBPs remain unresponsive to treatment (Lahey & Waldman, 2012). At present, it is unknown how many countries in Europe possess official clinical guidelines for SBPs diagnosis and treatment and what is their perceived utility. The aim was to create an inventory of clinical guidelines (and associated critical needs) for the diagnostics and treatment of SBPs in youth mental health across Europe according to academic experts and mental health clinicians’ opinions. To investigate the aim, two separate online semi-structured questionnaires were used, one directed at academics (N=28 academic experts; 23 countries), and the other at clinicians (N=124 clinicians; 24 countries). Three key results were highlighted. First, guidelines for SBPs are perceived as beneficial by both experts and clinicians. However, their implementation needs to be reinforced and content better adapted to daily practice. Improvements may include taking a multifactorial approach to assessment and treatment, involving the systems around the child, and multidisciplinary collaboration. Second, academic experts and clinicians support the need for further developing national / European guidelines. Finally, future guidelines should address current challenges identified by clinicians to be more applicable to daily practice.

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Structured Reporting of Rectal Cancer Staging and Restaging: A Consensus Proposal

Cancers ◽

10.3390/cancers13092135 ◽

2021 ◽

Vol 13 (9) ◽

pp. 2135

Author(s):

Vincenza Granata ◽

Damiano Caruso ◽

Roberto Grassi ◽

Salvatore Cappabianca ◽

Alfonso Reginelli ◽

...

Keyword(s):

Rectal Cancer ◽

Correlation Coefficient ◽

Clinical Decision Making ◽

Intraclass Correlation ◽

Clinical Decision ◽

Cancer Staging ◽

Structured Reporting ◽

Quality Analysis ◽

Promising Tool ◽

Structured Reports

Background: Structured reporting (SR) in oncologic imaging is becoming necessary and has recently been recognized by major scientific societies. The aim of this study was to build MRI-based structured reports for rectal cancer (RC) staging and restaging in order to provide clinicians all critical tumor information. Materials and Methods: A panel of radiologist experts in abdominal imaging, called the members of the Italian Society of Medical and Interventional Radiology, was established. The modified Delphi process was used to build the SR and to assess the level of agreement in all sections. The Cronbach’s alpha (Cα) correlation coefficient was used to assess the internal consistency of each section and to measure the quality analysis according to the average inter-item correlation. The intraclass correlation coefficient (ICC) was also evaluated. Results: After the second Delphi round of the SR RC staging, the panelists’ single scores and sum of scores were 3.8 (range 2–4) and 169, and the SR RC restaging panelists’ single scores and sum of scores were 3.7 (range 2–4) and 148, respectively. The Cα correlation coefficient was 0.79 for SR staging and 0.81 for SR restaging. The ICCs for the SR RC staging and restaging were 0.78 (p < 0.01) and 0.82 (p < 0.01), respectively. The final SR version was built and included 53 items for RC staging and 50 items for RC restaging. Conclusions: The final version of the structured reports of MRI-based RC staging and restaging should be a helpful and promising tool for clinicians in managing cancer patients properly. Structured reports collect all Patient Clinical Data, Clinical Evaluations and relevant key findings of Rectal Cancer, both in staging and restaging, and can facilitate clinical decision-making.

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Quantifying the Impact of Patient-Specific Factors and Disease Severity on Clinical Decision Making in Cuff Tear Arthropathy: A Case-Based Survey

HSS Journal ® ◽

10.1007/s11420-019-09695-x ◽

2019 ◽

Vol 15 (3) ◽

pp. 276-285

Author(s):

Adam P. Schumaier ◽

Yehia H. Bedeir ◽

Joshua S. Dines ◽

Keith Kenter ◽

Lawrence V. Gulotta ◽

...

Keyword(s):

Decision Making ◽

Disease Severity ◽

Clinical Decision Making ◽

Clinical Decision ◽

Patient Specific ◽

Cuff Tear Arthropathy ◽

Cuff Tear ◽

Specific Factors ◽

The Impact ◽

Case Based

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Clinical Decision Making in the ICU: Dysphagia Screening, Assessment, and Treatment

Seminars in Speech and Language ◽

10.1055/s-0039-1688980 ◽

2019 ◽

Vol 40 (03) ◽

pp. 170-187 ◽

Cited By ~ 4

Author(s):

Martin B. Brodsky ◽

Emily B. Mayfield ◽

Roxann Diez Gross

Keyword(s):

Intensive Care Unit ◽

Decision Making ◽

Intensive Care ◽

Clinical Decision Making ◽

Clinical Care ◽

Clinical Decision ◽

Level Of Care ◽

Assessment And Treatment ◽

Proper Training ◽

Screening Assessment

AbstractClinicians often perceive the intensive care unit as among the most intimidating environments in patient care. With the proper training, acquisition of skill, and approach to clinical care, feelings of intimidation may be overcome with the great rewards this level of care has to offer. This review—spanning the ages of birth to senescence and covering oral/nasal endotracheal intubation and tracheostomy—presents a clinically relevant, directly applicable review of screening, assessment, and treatment of dysphagia in the patients who are critically ill for clinical speech–language pathologists and identifies gaps in the clinical peer-reviewed literature for researchers.

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Influence of psychiatric or social backgrounds on clinical decision making: a randomized, controlled multi-centre study

BMC Medical Education ◽

10.1186/s12909-019-1897-z ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Yosuke Yamauchi ◽

Takashi Shiga ◽

Kiyoshi Shikino ◽

Takahiro Uechi ◽

Yasuaki Koyama ◽

...

Keyword(s):

Decision Making ◽

Repeated Measures ◽

Clinical Decision Making ◽

Clinical Decision ◽

Background Information ◽

Accuracy Score ◽

Multi Centre Study ◽

Additional Information ◽

Free Care ◽

History Of

Abstract Background Frequent and repeated visits from patients with mental illness or free medical care recipients may elicit physicians’ negative emotions and influence their clinical decision making. This study investigated the impact of the psychiatric or social background of such patients on physicians’ decision making about whether to offer recommendations for further examinations and whether they expressed an appropriate disposition toward the patient. Methods A randomized, controlled multi-centre study of residents in transitional, internal medicine, or emergency medicine was conducted in five hospitals. Upon randomization, participants were stratified by gender and postgraduate year, and they were allocated to scenario set 1 or 2. They answered questions pertaining to decision-making based on eight clinical vignettes. Half of the eight vignettes presented to scenario set 1 included additional patient information, such as that the patient had a past medical history of schizophrenia or that the patient was a recipient of free care who made frequent visits to the doctor (biased vignettes). The other half included no additional information (neutral vignettes). For scenario set 2, the four biased vignettes presented to scenario set 1 were neutralized, and the four neutral vignettes were rendered biased by providing additional information. After reading, participants answered decision-making questions regarding diagnostic examination, interventions, or patient disposition. The primary analysis was a repeated-measures ANOVA on the mean management accuracy score, with patient background information as a within-subject factor (no bias, free care recipients, or history of schizophrenia). Results A total of 207 questionnaires were collected. Repeated-measures ANOVA showed that additional background information had influence on mean accuracy score (F(7, 206) = 13.84, p < 0.001 partial η2 = 0.063). Post hoc pairwise multiple comparison test, Sidak test, showed a significant difference between schizophrenia and no bias condition (p < 0.05). The ratings for patient likability were lower in the biased vignettes compared to the neutral vignettes, which was associated with the lower utilization of medical resources by the physicians. Conclusions Additional background information on past medical history of schizophrenia increased physicians’ mistakes in decision making. Patients’ psychiatric backgrounds should not bias physicians’ decision-making. Based on these findings, physicians are recommended to avoid being influenced by medically unrelated information.

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Total Amylase and Pancreatic Isoamylase in Serum and Urine: Considerations from Data on Biological Variation

Annals of Clinical Biochemistry International Journal of Laboratory Medicine ◽

10.1177/000456328902600407 ◽

1989 ◽

Vol 26 (4) ◽

pp. 335-340 ◽

Cited By ~ 6

Author(s):

Steven T Cummings ◽

Callum G Fraser

Keyword(s):

Clinical Decision Making ◽

Amylase Activity ◽

Clinical Decision ◽

Population Based ◽

Reference Intervals ◽

Similar Data ◽

Creatinine Ratio ◽

Additional Information ◽

Pancreatic Isoamylase ◽

Urine Amylase

The analytical, within-subject and between-subject components of variation were estimated for amylase activity and pancreatic isoamylase activity in serum measured using newer analytical methods. Desirable analytical imprecisions based on within-subject variation were CV ≤ 4·4% and CV ≤ 7·0%, respectively. Conventional population-based reference intervals were not useful because of marked individuality; clinical decision-making points should be derived from the desired sensitivity and specificity. Serial results must change more than about 30% and 40% respectively before significance (P ≤ 0·05) can be claimed. Similar data on total amylase and pancreatic isoamylase activities in random and first morning urines showed that the use of conventional reference intervals was appropriate. Very large changes (> 100%) were required before a difference in serial results was significant. Calculation of the urine amylase/creatinine ratio appeared to confer no advantage. Derivation of the ratio of pancreatic isoamylase to total amylase activity in serum or urine was unlikely to provide additional information of value in either diagnosis or monitoring.

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Utility and Acceptability of Influenza Surveillance amongst Emergency Providers

Online Journal of Public Health Informatics ◽

10.5210/ojphi.v7i1.5737 ◽

2015 ◽

Vol 7 (1) ◽

Author(s):

Andrea F. Dugas ◽

Howard Burkom ◽

Anna L. DuVal ◽

Richard Rothman

Keyword(s):

Decision Making ◽

Emergency Department ◽

Real Time ◽

Clinical Decision Making ◽

Clinical Decision ◽

Surveillance Data ◽

Influenza Surveillance ◽

Additional Information ◽

Provider Surveys

We provided emergency department providers with a real-time laboratory-based influenza surveillance tool, and evaluated the utility and acceptability of the surveillance information using provider surveys. The majority of emergency department providers found the surveillance data useful and indicated the additional information impacted their clinical decision making regarding influenza testing and treatment.

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Using daily monitoring of psychiatric symptoms to evaluate hospital length of stay

BJPsych Open ◽

10.1192/bjpo.bp.116.003814 ◽

2016 ◽

Vol 2 (6) ◽

pp. 341-345 ◽

Cited By ~ 7

Author(s):

Andrew C. Page ◽

Nadia K. Cunningham ◽

Geoffrey R. Hooke

Keyword(s):

Hospital Stay ◽

Clinical Decision Making ◽

Psychiatric Symptoms ◽

Clinical Decision ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Significant Treatment ◽

Daily Monitoring ◽

Additional Information ◽

Clinically Significant

BackgroundRoutine symptom monitoring and feedback improves out-patient outcomes, but the feasibility of its use to inform decisions about discharge from in-patient care has not been explored.AimsTo examine the potential value to clinical decision-making of monitoring symptoms during psychiatric in-patient hospitalisation.MethodA total of 1102 in-patients in a private psychiatric hospital, primarily with affective and neurotic disorders, rated daily distress levels throughout their hospital stay. The trajectories of patients who had, and had not, met a criterion of clinically significant improvement were examined.ResultsTwo-thirds of patients (n=604) met the clinically significant improvement criterion at discharge, and three-quarters (n=867) met the criterion earlier during their hospital stay. After meeting the criterion, the majority (73.2%) showed stable symptoms across the remainder of their hospital stay, and both classes showed substantially lower symptoms than at admission.ConclusionsMonitoring of progress towards this criterion provides additional information regarding significant treatment response that could inform clinical decisions around discharge readiness.

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Review of Systematic Reviews on Acute Procedural Pain in Children in the Hospital Setting

Pain Research and Management ◽

10.1155/2008/465891 ◽

2008 ◽

Vol 13 (1) ◽

pp. 51-57 ◽

Cited By ~ 53

Author(s):

Jennifer Stinson ◽

Janet Yamada ◽

Alison Dickson ◽

Jasmine Lamba ◽

Bonnie Stevens

Keyword(s):

Systematic Reviews ◽

Acute Pain ◽

Clinical Decision Making ◽

Hospital Setting ◽

Clinical Decision ◽

Future Research ◽

Hospitalized Children ◽

Assessment Measure ◽

Cochrane Database ◽

Meta Analyses

BACKGROUND: Acute pain is a common experience for hospitalized children. Despite mounting research on treatments for acute procedure-related pain, it remains inadequately treated.OBJECTIVE: To critically appraise all systematic reviews on the effectiveness of acute procedure-related pain management in hospitalized children.METHODS: Published systematic reviews and meta-analyses on pharmacological and nonpharmacological management of acute procedure-related pain in hospitalized children aged one to 18 years were evaluated. Electronic searches were conducted in the Cochrane Database of Systematic Reviews, Medline, EMBASE, the Cumulative Index to Nursing and Allied Health Literature and PsycINFO. Two reviewers independently selected articles for review and assessed their quality using a validated seven-point quality assessment measure. Any disagreements were resolved by a third reviewer.RESULTS: Of 1469 published articles on interventions for acute pain in hospitalized children, eight systematic reviews met the inclusion criteria and were included in the analysis. However, only five of these reviews were of high quality. Critical appraisal of pharmacological pain interventions indicated that amethocaine was superior to EMLA (AstraZeneca Canada Inc) for reducing needle pain. Distraction and hypnosis were nonpharmacological interventions effective for management of acute procedure-related pain in hospitalized children.CONCLUSIONS: There is growing evidence of rigorous evaluations of both pharmacological and nonpharmacological strategies for acute procedure-related pain in children; however, the evidence underlying some commonly used strategies is limited. The present review will enable the creation of a future research plan to facilitate clinical decision making and to develop clinical policy for managing acute procedure-related pain in children.

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Standardized method for the measurement of Grabb’s line and clival-canal angle

Journal of Neurosurgery Pediatrics ◽

10.3171/2017.5.peds17181 ◽

2017 ◽

Vol 20 (4) ◽

pp. 352-356 ◽

Cited By ~ 4

Author(s):

Jonathan E. Martin ◽

Markus Bookland ◽

Douglas Moote ◽

Catherine Cebulla

Keyword(s):

Measurement Technique ◽

Clinical Decision Making ◽

Measurement Techniques ◽

Intraclass Correlation ◽

Clinical Decision ◽

Radiographic Measurement ◽

Pediatric Radiologist ◽

Intrarater Reliability ◽

Measurement Protocol ◽

Standardized Measurement

OBJECTIVEGrabb’s line—the perpendicular distance from the basion-C2 line (pB-C2)—is a widely used radiographic measurement with significant clinical implications in patients with a complex Chiari malformation. Rigorous demonstration of the reproducibility of this measurement has not previously been reported. The authors report a standardized measurement technique with excellent inter- and intrarater reliability on T1-weighted sagittal MRI.METHODSThe authors developed a standardized measurement technique that included specifications of midline slice selection, landmark and reference line definitions, and measurement technique on T1-weighted sagittal images. Twenty MR images were reviewed by 2 pediatric neurosurgeons, 1 pediatric radiologist, and 1 undergraduate student. Measurements were performed using the technique specified on 2 separate occasions. Intrarater and interrater reliabilities were calculated using the intraclass correlation coefficient.RESULTSA combined interrater reliability of 0.879 was achieved for the pB-C2, and 0.916 for the clival-canal angle, another measure of interest in patients with complex Chiari malformations. Intrarater reliability for these measurements exceeded 0.858 for all 4 reviewers.CONCLUSIONSGrabb’s line—the pB-C2—can be measured with excellent reliability using a standardized measurement protocol. Individual clinicians and collaborative databases should consider using validated measurement techniques to guide clinical decision making in patients with craniocervical junction pathology.

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