Beyond the Fingerstick: Complications of Diabetes in the Acutely Ill Patient with Covid-19 with Lessons from Translation Biology and Therapeutics

The affliction that the Coronavirus Disease 2019 (COVID-19) pandemic has placed on the infrastructure of healthcare institutions across the globe permeates to the level of the provider, hampering clinical decision-making capacity and capability. Associated with the latter has been unprecedented, sweeping changes in biomedical equipment manufacturing, triage dynamics, and implementation of medical interventions in a landscape replete with clinical literature attempting to characterize features in COVID-19 patients. Preliminary assessments into the elements of the SARS-CoV-2 virus (the strain of coronavirus responsible for COVID-19) in addition to the delineation of patient flux pertaining to COVID-19 has identified diabetes as a prevalent comorbidity with increased mortality and increased disease burden in the acutely ill. The volume of patients with COVID-19 superimposed upon complicated diabetes exemplifies that insight into this association offers an expanded perspective of diabetes mellitus. Moreover, given the extensive organ compromise seen in COVID-19 in addition to the established notion that diabetes is a systemic syndrome of metabolism, an appraisal of the literature of medical management and precursory findings serve as bearings that help render clinical principles into viable treatments. In this review we investigate the array of contemporary literature surrounding COVID-19 with a perspective centered upon the management of acute diabetes complications, namely diabetic ketoacidosis and hyperosmolar hyperglycemic state, with emphases into translational biology and pharmacotherapeutics.

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Blood transfusion prescribing in the ACT: an insight into clinical decision making

Australian Health Review ◽

10.1071/ah050240 ◽

2005 ◽

Vol 29 (2) ◽

pp. 240 ◽

Cited By ~ 2

Author(s):

Philip J Crispin ◽

Bethany J Crowe ◽

Anne M McDonald

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Clinical Decision ◽

Early Discharge ◽

Organisation Of Care ◽

Metropolitan Hospital ◽

Loss Of Appetite ◽

Insight Into ◽

Structured Questionnaire

This study aimed to determine the perspectives of a group of patients categorised as ?long-stay outliers? at a large South Australian metropolitan hospital about aspects of organisation of care and the perceived impact of long-term hospitalisation. Nineteen patients were interviewed using a semi-structured questionnaire. Eighty-nine percent of participants stated that they had no knowledge of how long they were to be in hospital. Forty-two percent indicated that they did not know when they would be discharged from hospital. This was of concern, especially considering the vulnerability of this patient group and the known benefits of patient involvement in decision making and the improvements this can make to health outcomes and early discharge. Participants indicated concern about sleep deprivation, diet, ability to return to paid employment, and missing their family as the main areas of impact of their long hospitalisation. Concerns about being discharged from hospital included: apprehension as to whether they were well enough to leave; the recurrence of infection; whether they would be able to sleep well when they got home; their recent loss of appetite and associated weight loss; mobility concerns; and what supports they would have when they were discharged home. All these issues require staff to be more patient and family-centred in their approach to preparing for discharge.

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Management of Cardiac Toxicity Induced by Chemotherapy

Journal of Clinical Medicine ◽

10.3390/jcm9092885 ◽

2020 ◽

Vol 9 (9) ◽

pp. 2885 ◽

Cited By ~ 1

Author(s):

Dario Trapani ◽

Paola Zagami ◽

Eleonora Nicolò ◽

Gabriella Pravettoni ◽

Giuseppe Curigliano

Keyword(s):

Clinical Decision Making ◽

Current Knowledge ◽

Early Recognition ◽

Clinical Decision ◽

Cancer Treatments ◽

Drug Induced ◽

Medical Interventions ◽

Clinical Scenarios ◽

New Biomarkers ◽

Chemotherapy Agents

Cardiotoxicity encompasses a spectrum of adverse cardiological effects experienced by cancer patients during and after receiving antineoplastic treatments. The intersection of cancer care with the management of the multiple comorbid non-communicable diseases carried by patients or related to cancer treatments motivates the need for an integrated and multidisciplinary approach to therapeutic clinical decision-making. This present review aimed to provide a perspective and an update of the current pharmacotherapy approaches for the prevention and management of cardiotoxicity from antiblastic chemotherapy; as such, it addresses myocardial, vascular, and arrhythmic disorders associated to chemotherapy, by navigating the current knowledge and clinical indications in support of the medical interventions. Clinical scenarios of pharmacological interventions take place with patients receiving anthracycline and, by extrapolation, other agents with cardiotoxic potentials and non-chemotherapy agents, including various small molecules and immunotherapy agents. Analysis of these scenarios aims to provide practical evidence-based guidance for the management of drug-induced cardiac dysfunctions. The possible role of new biomarkers for the early recognition of cardiotoxicity is mentioned across the clinical studies, with reference to the pharmacological biomarker-driven interventions delivered. To best inform survivorship care, the management and context of cardio-oncology services are discussed within the broader network of providers and settings of care.

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Suicide and “do not resuscitate”: An ethical dilemma

Clinical Ethics ◽

10.1177/1477750920959555 ◽

2020 ◽

pp. 147775092095955

Author(s):

Muhammad Tariq Shakoor ◽

Abdul Ahad ◽

Samia Ayub ◽

James Kruer

Keyword(s):

Advance Directives ◽

Clinical Decision Making ◽

Clinical Decision ◽

Living Will ◽

Living Wills ◽

Do Not Resuscitate ◽

End Of Life Decisions ◽

Medical Interventions ◽

Surrogate Decision Makers ◽

Surrogate Decision

Advance directives allow people to accept or decline medical interventions and to appoint surrogate decision makers if they become incapacitated. Living wills are written in ambiguous terms and require interpretation by clinical providers. Living wills cannot cover all conceivable end-of-life decisions. There is too much variability in clinical decision making to make an all-encompassing living will possible. While there are many limitations of advance directives, this article reviews some of the most troublesome ethical dilemmas with regard to advance directives.

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Diagnostic conversations: Clinical Decision Making in surgery – Part 2

Diagnosis ◽

10.1515/dx-2014-0009 ◽

2014 ◽

Vol 1 (2) ◽

pp. 189-193 ◽

Cited By ~ 2

Author(s):

David Allan Watters ◽

Spencer Wynyard Beasley ◽

Wendy Crebbin

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Clinical Decision ◽

Learning Opportunities ◽

Clinical Decisions ◽

Decision Making Processes ◽

Royal Australasian College ◽

Insight Into ◽

Made In

AbstractProceduralists who fail to review their decision making are unlikely to learn from their experiences, irrespective of whether the operative outcome is successful or not. Teaching junior surgeons to develop ‘insight’ into their own decision making has long been a challenge. Surgeons and staff of the Royal Australasian College of Surgeons worked together to develop a model to help explain the processes around clinical decision making and incorporated this model into a Clinical Decision Making (CDM) training course. In this course, faculty apply the model to specific surgical cases, within the model’s framework of how clinical decisions are made; thus providing an opportunity to identify specific decision making processes as they occur and to highlight some of the learning opportunities they provide. The conversation in this paper illustrates the kinds of case-based interactions which typically occur in the development and teaching of the CDM course.The focus in this, the second of two papers, is on reviewing post-operative clinical decisions made in relation to one case, to improve the quality of subsequent decision making.

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FUTURES: Forecasting the Unexpected Transfer to Upgraded Resources in Sepsis

Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care ◽

10.1177/2327857919081047 ◽

2019 ◽

Vol 8 (1) ◽

pp. 187-191

Author(s):

Alexa Profozich ◽

Trevor Sytsma ◽

Ryan Arnold ◽

Kristen Miller ◽

Muge Capan

Keyword(s):

Decision Making ◽

Emergency Department ◽

Clinical Decision Making ◽

Point Of Care ◽

Initial Point ◽

Clinical Decision ◽

Sepsis Management ◽

Insight Into

Sepsis is one of the most deadly and costly diseases. The Emergency Department (ED) is the initial point of care for most patients who become hospitalized due to sepsis. Quantifying the accuracy of ED clinician forecasting regarding patients’ clinical trajectories and outcomes can provide insight into clinical decision making and inform sepsis management.

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CyberKnife stereotactic radiosurgery for the treatment of symptomatic vertebral hemangiomas: a single-institution experience

Neurosurgical FOCUS ◽

10.3171/2016.9.focus16372 ◽

2017 ◽

Vol 42 (1) ◽

pp. E13 ◽

Cited By ~ 6

Author(s):

Michael Zhang ◽

Yi-Ren Chen ◽

Steven D. Chang ◽

Anand Veeravagu

Keyword(s):

Stereotactic Radiosurgery ◽

Clinical Decision Making ◽

Clinical Decision ◽

Lesion Size ◽

Neurological Deficits ◽

Radiographic Outcomes ◽

Relative Rarity ◽

Vertebral Hemangiomas ◽

Future Patient ◽

Insight Into

OBJECTIVE Symptomatic vertebral hemangiomas (SVHs) are a very rare pathology that can present with persistent pain or neurological deficits that warrant surgical intervention. Given the relative rarity and difficulty in assessment, the authors sought to present a dedicated series of SVHs treated using stereotactic radiosurgery (SRS) to provide insight into clinical decision making. METHODS A retrospective review of a single institution's experience with hypofractionated radiosurgery for SVH from 2004 to 2011 was conducted to determine the clinical and radiographic outcomes following SRS treatment. The authors report and analyze the treatment course of 5 patients with 7 lesions, 2 of which were treated primarily by SRS. RESULTS Of the 5 patients studied, 4 presented with a chief complaint of pain refractory to conservative measures. Three patients reported dysesthesias, and 2 reported upper-extremity weakness. Following radiosurgery, 4 of 5 patients exhibited improvement in their primary symptoms (3 for pain and 1 for weakness), achieving a clinical response after a mean period of 1 year. In 2 cases there was 20%–40% reduction in lesion size in the most responsive dimension as noted on images. All treatments were well tolerated. CONCLUSIONS SRS for SVH is a safe and feasible treatment strategy, comparable to prior radiotherapy studies, and in select cases may successfully confer delayed decompressive effects. Additional investigation will determine future patient selection and how conformal SRS treatment can best be administered.

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Determinants of Longitudinal Adherence in Smartphone-Based Self-Tracking for Chronic Health Conditions

Proceedings of the ACM on Interactive Mobile Wearable and Ubiquitous Technologies ◽

10.1145/3448093 ◽

2021 ◽

Vol 5 (1) ◽

pp. 1-24

Author(s):

Simon L. Jones ◽

William Hue ◽

Ryan M. Kelly ◽

Rosemarie Barnett ◽

Violet Henderson ◽

...

Keyword(s):

Clinical Decision Making ◽

Clinical Decision ◽

Health Conditions ◽

Smartphone Apps ◽

Data Logging ◽

Activity Tracker ◽

Area Of Interest ◽

Health Tracking ◽

Tracking Devices ◽

Insight Into

The use of interactive mobile and wearable technologies for understanding and managing health conditions is a growing area of interest for patients, health professionals and researchers. Self-tracking technologies such as smartphone apps and wearable devices for measuring symptoms and behaviours generate a wealth of patient-centric data with the potential to support clinical decision making. However, the utility of self-tracking technologies for providing insight into patients' conditions is impacted by poor adherence with data logging. This paper explores factors associated with adherence in smartphone-based tracking, drawing on two studies of patients living with axial spondyloarthritis (axSpA), a chronic rheumatological condition. In Study 1, 184 axSpA patients used the uMotif health tracking smartphone app for a period of up to 593 days. In Study 2, 108 axSpA patients completed a survey about their experience of using self-tracking technologies. We identify six significant correlates of self-tracking adherence, providing insight into the determinants of tracking behaviour. Specifically, our data provides evidence that adherence correlates with the age of the user, the types of tracking devices that are being used (smartphone OS and physical activity tracker), preferences for types of data to record, the timing of interactions with a self-tracking app, and the reported symptom severity of the user. We discuss how these factors may have implications for those designing, deploying or using mobile and wearable tracking technologies to support monitoring and management of chronic diseases.

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Chronic limb ischaemia: case study and clinical literature review

British Journal of Nursing ◽

10.12968/bjon.2021.30.14.846 ◽

2021 ◽

Vol 30 (14) ◽

pp. 846-851

Author(s):

Liz Farrington ◽

Gerri Mortimore

Keyword(s):

Clinical Decision Making ◽

Treatment Options ◽

Survival Rates ◽

Clinical Decision ◽

Lifestyle Changes ◽

Care Plan ◽

Limb Ischaemia ◽

Clinical Literature ◽

Artery Disease

This article will discuss chronic limb ischaemia as the result of peripheral artery disease (PAD) using a case study. The patient's concurrent diagnosis of metastases meant clinical decision making was complex and treatment options were limited. PAD is the third most common clinical presentation of atherosclerosis after coronary artery disease and stroke. Although advances in radiological technology and biochemical screening offer the potential for earlier intervention and improved survival rates for patients with PAD, a review of the evidence suggests that commitment to more conservative approaches, such as exercise therapy and health promotion, could have more sustainable, longer-term benefits for patients with chronic limb ischaemia. The therapeutic nature of the nurse–patient relationship makes nurses ideally placed for encouraging lifestyle changes and signposting to support services. Active participation from the patient is imperative for any potential modifications, which should be individualised as part of a holistic care plan, to ensure patient engagement and compliance. Therefore emphasis should remain on the management and prevention of modifiable risk factors, for which the nurse's role is an integral part to ensure success.

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Simulating Data for Clinical Research: A Tutorial

Journal of Psychoeducational Assessment ◽

10.1177/0734282917690302 ◽

2017 ◽

Vol 36 (1) ◽

pp. 7-20 ◽

Cited By ~ 5

Author(s):

A. Alexander Beaujean

Keyword(s):

Decision Making ◽

Learning Disability ◽

Simulation Study ◽

Clinical Decision Making ◽

Specific Learning Disability ◽

Clinical Decision ◽

Simulation Studies ◽

Clinical Literature ◽

Specific Learning ◽

Better Than

Simulation studies use computer-generated data to examine questions of interest that have traditionally been used to study properties of statistics and estimating algorithms. With the recent advent of powerful processing capabilities in affordable computers along with readily usable software, it is now feasible to use a simulation study to aid in clinical decision making. By simulating large quantities of data that mimic clinical situations, it is possible to understand the ramifications of different decisions better than using tangentially relevant data or intuition. In this tutorial article, I describe the general steps in conducting a simulation study with particular emphasis on clinical decision making. I conclude with a didactic example taken from clinical literature on identifying a specific learning disability.

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