scholarly journals Pharmacogenomics (PGx) Patient with Mixed Levels of Actionable Variant Evidence

2020 ◽  
Vol 11 (2) ◽  
pp. 3
Author(s):  
Michael J. Schuh ◽  
Sheena Crosby
Keyword(s):  
Clinical Decision Making ◽  
Medical Literature ◽  
Medication Management ◽  
Clinical Decision ◽  
Trial And Error ◽  
Therapeutic Outcomes ◽  
Article Type ◽  
Literature Evidence ◽  
Medication Selection

Objective: To demonstrate the types of clinical recommendations a pharmacogenomics pharmacist may make to medical clinicians with regard to medication management to improve therapeutic outcomes based on varied levels of medical literature evidence. Summary: This case demonstrates how a common type of patient seen in a pharmacist practice may present with a varied pharmacogenomic (PGx) profile, how they may benefit from PGx analysis, and how varying levels of medical literature evidence can be used with clinical decision making. Conclusion: PGx testing can help avoid adverse drug reactions (ADRs) or medication inefficacy by assisting in the adjustment of current or future medication doses. It can also help predict the best medications to use or those to avoid in advance by eliminating much of the existing dosing or medication selection method of trial and error.   Article Type: Case Study

scholarly journals Considerations over a Case of Suspected Therapeutic Failure in Pediatric Patients after Switching Valproate Manufacturers

2020 ◽  
Vol 11 (3) ◽  
pp. 10
Author(s):  
Jaqueline Kalleian Eserian ◽  
Jair Ribeiro Chagas ◽  
José Carlos Fernandes Galduróz
Keyword(s):  
Pediatric Patients ◽  
Drug Prescription ◽  
Medication Management ◽  
Therapeutic Failure ◽  
Product Switching ◽  
Therapeutic Outcomes ◽  
Article Type ◽  
Post Marketing Surveillance ◽  
Post Marketing

Introduction: Product switching followed by suspected adverse events are common and unsettling for antiepileptic drugs. The objective of this case study was to describe the investigation performed after report of suspected therapeutic failure in pediatric patients following a switch to a different valproate manufacturer and identify strategies concerning medication management for improving therapeutic outcomes. Case description: It was reported that different pediatric patients’ condition changed (agitation/ seizures) after refilling the same drug prescription (sodium valproate syrup) from a different manufacturer. Medical staff reported a suspected therapeutic failure and some units of the product batch associated with the problem were seized by the local Post-marketing Surveillance Service for investigation of potential quality deviations. The seized units were evaluated by the State’s Surveillance Laboratory, nevertheless, drug potency was found to be 98.7%. Conclusion: We consider that the reported event could be associated with aspects of medication use, i.e. potential dose measurement deviations resulting from remaining of residual liquid in the cup or eventual delay at prescription refilling process and consequential - even though brief - pharmacotherapy discontinuity. Patient education and counseling by pharmacists are essential for preventing drug-related problems and enhancing positive outcomes of pharmacotherapy.   Article Type: Case Study

Preliminary Findings on the Use of Session Questionnaires to Improve Clinician-Client Alliance With Special Consideration to Clinical Education

2015 ◽  
Vol 25 (1) ◽  
pp. 50-60
Author(s):  
Anu Subramanian
Keyword(s):  
Graduate Students ◽  
Clinical Education ◽  
Clinical Decision Making ◽  
Rating Scale ◽  
Treatment Effectiveness ◽  
Clinical Decision ◽  
Added Value ◽  
Therapeutic Outcomes ◽  
Specific Feedback ◽  
Stakeholder Perspective

ASHA's focus on evidence-based practice (EBP) includes the family/stakeholder perspective as an important tenet in clinical decision making. The common factors model for treatment effectiveness postulates that clinician-client alliance positively impacts therapeutic outcomes and may be the most important factor for success. One strategy to improve alliance between a client and clinician is the use of outcome questionnaires. In the current study, eight parents of toddlers who attended therapy sessions at a university clinic responded to a session outcome questionnaire that included both rating scale and descriptive questions. Six graduate students completed a survey that included a question about the utility of the questionnaire. Results indicated that the descriptive questions added value and information compared to using only the rating scale. The students were varied in their responses regarding the effectiveness of the questionnaire to increase their comfort with parents. Information gathered from the questionnaire allowed for specific feedback to graduate students to change behaviors and created opportunities for general discussions regarding effective therapy techniques. In addition, the responses generated conversations between the client and clinician focused on clients' concerns. Involving the stakeholder in identifying both effective and ineffective aspects of therapy has advantages for clinical practice and education.

Clinical decision making in spastic bilateral CP – Planning interventions using clinical gait analysis: A case study

2015 ◽  
Vol 42 ◽  
pp. S37
Author(s):  
M. Alvela ◽  
M. Bergmann ◽  
M.-L. Ööpik ◽  
Ü. Kruus ◽  
K. Englas ◽  
...  
Keyword(s):  
Decision Making ◽  
Gait Analysis ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Clinical Gait Analysis

Exploring hospital nurses’ transitional medication management for older patients with multi-morbidity: An ethnographic study

2021 ◽  
pp. 205715852110617
Author(s):  
Mette Geil Kollerup ◽  
Birgitte Schantz Laursen
Keyword(s):  
Older Patients ◽  
Communication Systems ◽  
Clinical Decision Making ◽  
Medication Management ◽  
Clinical Decision ◽  
Ethnographic Study ◽  
University Hospital ◽  
Hospital Nurses ◽  
Assessment Skills ◽  
Field Notes

Transitional medication management, in which individual needs are balanced against organizational priorities, is crucial for safe discharge processes. The aim of this study was to explore hospital nurses’ transitional medication management in the discharge of older patients with multi-morbidity. Using an ethnographic approach the data were collected through participant observations at a mixed medical ward at a Danish university hospital for two weeks. The participants were five registered nurses, responsible for nursing care of 23 patients with multi-morbidity and planned for discharge. The data comprised field notes that were analysed using iterative processes of domain, taxonomic and component analysis. The reporting adhered to the COREQ checklist. Hospital nurses’ transitional medication management was characterized by unpredictability and inconsistency in patient situations, fragmentation and discontinuity in working processes and complexity in communication systems. Special attention to nurses’ needs assessment skills and clinical decision making in caring for patients with multi-morbidity in a single focused healthcare system is required.

scholarly journals My Client Knows That He's About to Stutter: How Can We Address Stuttering Anticipation during Therapy with Young People Who Stutter?

2018 ◽  
Vol 39 (04) ◽  
pp. 356-370 ◽  
Author(s):  
Hope Gerlach ◽  
Naomi Rodgers ◽  
Patricia Zebrowski ◽  
Eric Jackson
Keyword(s):  
Decision Making ◽  
Young People ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Hypothetical Case ◽  
Clinical Tool ◽  
Goal Development ◽  
Internal Experience

AbstractStuttering anticipation is endorsed by many people who stutter as a core aspect of the stuttering experience. Anticipation is primarily a covert phenomenon and people who stutter respond to anticipation in a variety of ways. At the same time as anticipation occurs and develops internally, for many individuals the “knowing” or “feeling” that they are about to stutter is a primary contributor to the chronicity of the disorder. In this article, we offer a roadmap for both understanding the phenomenon of anticipation and its relevance to stuttering development. We introduce the Stuttering Anticipation Scale (SAS)—a 25-item clinical tool that can be used to explore a client's internal experience of anticipation to drive goal development and clinical decision making. We ground this discussion in a hypothetical case study of “Ryan,” a 14-year-old who stutters, to demonstrate how clinicians might use the SAS to address anticipation in therapy with young people who stutter.

Implementation of Semantic Search to Support Clinical Decision-Making

2015 ◽  
pp. 270-286
Author(s):  
Andrew Tawfik ◽  
Karl Kochendorfer
Keyword(s):  
Human Performance ◽  
Clinical Decision Making ◽  
Information Overload ◽  
Clinical Decision ◽  
Human Performance Technology ◽  
The United States ◽  
Semantic Search ◽  
Current Case ◽  
Performance Technology

The current case study is situated within a large, land grant hospital located in the Midwestern region of the United States. Although the physicians had seen an increase in medical related human performance technology (HPTs) within the organization (e.g. computer physician ordered entry) some challenges remained as the hospital sought to improve the productivity of the electronic health record (EHRs). Specifically, physicians had difficulty finding information embedded within the chart due to usability problems and information overload. To overcome the challenges, a semantic search within the chart was implemented as a solution for physicians to retrieve relevant results given the conceptual semantic pattern. The case study will discuss many elements of the implementation based on our experience and feedback from clinicians. The case will specifically highlight the importance of training and change agents within an organization.

scholarly journals Strategies in Abduction: Generating and Selecting Diagnostic Hypotheses

2020 ◽  
Vol 45 (2) ◽  
pp. 159-178
Author(s):  
Donald E Stanley ◽  
Rune Nyrup
Keyword(s):  
Medical Diagnosis ◽  
Clinical Case ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Hypothesis Generation ◽  
Clinical Case Study ◽  
Diagnostic Hypothesis ◽  
Threshold Approach ◽  
Selection Of

Abstract We distinguish three aspects of medical diagnosis: generating new diagnostic hypotheses, selecting hypotheses for further pursuit, and evaluating their probability in light of the available evidence. Drawing on Peirce’s account of abduction, we argue that hypothesis generation is amenable to normative analysis: physicians need to make good decisions about when and how to generate new diagnostic hypothesis as well as when to stop. The intertwining relationship between the generation and selection of diagnostic hypotheses is illustrated through the analysis of a detailed clinical case study. This interaction is not adequately captured by the existing probabilistic, decision-theoretic models of the threshold approach to clinical decision-making. Instead, we propose to conceptualize medical diagnosis in terms of strategic reasoning.

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