scholarly journals Sensitivity and Specificity in Urine Bladder Cancer Markers – Is it that Simple?

2021 ◽  
pp. 1-4
Author(s):  
Florian Roghmann ◽  
Peter J. Goebell ◽  
Lars Dyrskjøt ◽  
Bas W.G. van Rhijn ◽  
Heiko U. Käfferlein ◽  
...  
Keyword(s):  
Decision Making ◽  
Bladder Cancer ◽  
Clinical Decision Making ◽  
Prospective Trial ◽  
Clinical Decision ◽  
The Past ◽  
Large Numbers ◽  
Urine Bladder ◽  
Level 1 ◽  
Current Guidelines

Marker research and, in particular urine bladder cancer marker research throughout the past three decades, devours enormous scientific resources in terms of manpower (not to mention time spent on reviewing and editorial efforts) and financial resources finally generating large numbers of manuscripts without affecting clinical decision making. This is mirrored by the fact that current guidelines do not recommend marker use due to missing level 1 evidence. Although we recognize the problems and obstacles, the authors of this commentary feel that the time has come to abandon the current procedures and move on to prospective trial designs implementing marker results into clinical decision making. Our thoughts and concerns are summarized in this comment.

When bright lines blur: Deconstructing distinctions between disorders of consciousness

2017 ◽  
Author(s):  
David B. Fischer ◽  
Robert D. Truog
Keyword(s):  
Decision Making ◽  
Diagnostic Criteria ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Disorders Of Consciousness ◽  
Ethical Management ◽  
The Past ◽  
Way Of Thinking

Disorders of consciousness are devastating to patients and present profound challenges to clinicians, scientists, philosophers, and ethicists alike. In the past, distinguishing between levels of these disorders has been vital to guiding important decisions. This chapter argues that these disorders are not sufficiently distinct, however, to dictate such decisions: diagnostic criteria are not discrete, nor do they reflect the conceptual definitions of these disorders. It argues that these non-distinct diagnostic boundaries reflect an inherent continuity between disorders of consciousness. In light of these points, a new way of thinking about disorders of consciousness is presented in the chapter to more effectively guide clinical decision-making. The chapter argues that these considerations bring clarity to disorders of consciousness and can improve the ethical management of patients suffering from these disorders.

scholarly journals Predicting Clinical Outcomes Using Molecular Biomarkers

2016 ◽  
Vol 8 ◽  
pp. BIC.S33380 ◽  
Author(s):  
Harry B. Burke
Keyword(s):  
Decision Making ◽  
Clinical Outcomes ◽  
Clinical Decision Making ◽  
Clinical Care ◽  
Clinical Decision ◽  
Molecular Biomarkers ◽  
The Past ◽  
Diagnosis And Prognosis ◽  
Molecular Therapies ◽  
Physician Patient

Over the past 20 years, there has been an exponential increase in the number of biomarkers. At the last count, there were 768,259 papers indexed in PubMed.gov directly related to biomarkers. Although many of these papers claim to report clinically useful molecular biomarkers, embarrassingly few are currently in clinical use. It is suggested that a failure to properly understand, clinically assess, and utilize molecular biomarkers has prevented their widespread adoption in treatment, in comparative benefit analyses, and their integration into individualized patient outcome predictions for clinical decision-making and therapy. A straightforward, general approach to understanding how to predict clinical outcomes using risk, diagnostic, and prognostic molecular biomarkers is presented. In the future, molecular biomarkers will drive advances in risk, diagnosis, and prognosis, they will be the targets of powerful molecular therapies, and they will individualize and optimize therapy. Furthermore, clinical predictions based on molecular biomarkers will be displayed on the clinician's screen during the physician–patient interaction, they will be an integral part of physician–patient-shared decision-making, and they will improve clinical care and patient outcomes.

scholarly journals Molecular Markers for Bladder Cancer Screening, Early Diagnosis, and Surveillance: The WHO/ICUD Consensus

2014 ◽  
Vol 94 (1) ◽  
pp. 1-24 ◽  
Author(s):  
Bernd J. Schmitz-Dräger ◽  
Michael Droller ◽  
Vinata B. Lokeshwar ◽  
Yair Lotan ◽  
M''Liss A. Hudson ◽  
...  
Keyword(s):  
Decision Making ◽  
Bladder Cancer ◽  
Molecular Markers ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Urine Cytology ◽  
Added Value ◽  
Current Status ◽  
Low Grade ◽  
Screening And Surveillance

Due to the lack of disease-specific symptoms, diagnosis and follow-up of bladder cancer has remained a challenge to the urologic community. Cystoscopy, commonly accepted as a gold standard for the detection of bladder cancer, is invasive and relatively expensive, while urine cytology is of limited value specifically in low-grade disease. Over the last decades, numerous molecular assays for the diagnosis of urothelial cancer have been developed and investigated with regard to their clinical use. However, although all of these assays have been shown to have superior sensitivity as compared to urine cytology, none of them has been included in clinical guidelines. The key reason for this situation is that none of the assays has been included into clinical decision-making so far. We reviewed the current status and performance of modern molecular urine tests following systematic analysis of the value and limitations of commercially available assays. Despite considerable advances in recent years, the authors feel that at this stage the added value of molecular markers for the diagnosis of urothelial tumors has not yet been identified. Current data suggest that some of these markers may have the potential to play a role in screening and surveillance of bladder cancer. Well-designed protocols and prospective, controlled trials will be needed to provide the basis to determine whether integration of molecular markers into clinical decision-making will be of value in the future.

Prediction of progression to MIBC for pT1 bladder cancer: Development of a clinical decision-making tool

2017 ◽  
Vol 16 (11) ◽  
pp. e2937
Author(s):  
M. Abufaraj ◽  
D. D’Andrea ◽  
R. Ristl ◽  
B. Foerster ◽  
C. Seitz ◽  
...  
Keyword(s):  
Decision Making ◽  
Bladder Cancer ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Cancer Development ◽  
Decision Making Tool

Considerations on implementing diagnostic markers into clinical decision making in bladder cancer

2010 ◽  
Vol 28 (4) ◽  
pp. 441-448 ◽  
Author(s):  
Yair Lotan ◽  
Shahrokh F. Shariat ◽  
Bernd J. Schmitz-Dräger ◽  
Marta Sanchez-Carbayo ◽  
Feliksas Jankevicius ◽  
...  
Keyword(s):  
Decision Making ◽  
Bladder Cancer ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Diagnostic Markers

scholarly journals Intensive care decision-making: Identifying the challenges and generating solutions to improve inter-specialty referrals to critical care

2018 ◽  
Vol 19 (4) ◽  
pp. 287-298 ◽  
Author(s):  
Nicola Power ◽  
Nicholas R Plummer ◽  
Jacqueline Baldwin ◽  
Fiona R James ◽  
Shondipon Laha
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Clinical Decision Making ◽  
Cognitive Biases ◽  
Clinical Decision ◽  
The Past ◽  
Admission Decision ◽  
Interviewing Technique ◽  
Care Decision

Introduction Decision-making regarding admission to UK intensive care units is challenging. Demand for beds exceeds capacity, yet the need to provide emergency cover creates pressure to build redundancy into the system. Guidelines to aid clinical decision-making are outdated, resulting in an over-reliance on professional judgement. Although clinicians are highly skilled, there is variability in intensive care unit decision-making, especially at the inter-specialty level wherein cognitive biases contribute to disagreement. Method This research is the first to explore intensive care unit referral and admission decision-making using the Critical Decision Method interviewing technique. We interviewed intensive care unit ( n = 9) and non-intensive care unit ( n = 6) consultants about a challenging referral they had dealt with in the past where there was disagreement about the patient’s suitability for intensive care unit. Results We present: (i) a description of the referral pathway; (ii) challenges that appear to derail referrals (i.e. process issues, decision biases, inherent stressors, post-decision consequences) and (iii) potential solutions to improve this process. Discussion This research provides a foundation upon which interventions to improve inter-specialty decision-making can be based.

Integrating Biomarkers and Targeted Therapy Into Colorectal Cancer Management

2019 ◽  
pp. 207-215 ◽  
Author(s):  
Christopher H. Lieu ◽  
Ryan B. Corcoran ◽  
Michael J. Overman
Keyword(s):  
Colorectal Cancer ◽  
Decision Making ◽  
Clinical Trials ◽  
Targeted Therapy ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Prognostic Indicators ◽  
Molecular Characteristics ◽  
Cancer Management ◽  
The Past

There have been substantial advances in the treatment of metastatic colorectal cancer (mCRC) over the past 15 years. Molecular characteristics of mCRC and identification of specific mutations can serve as predictive and prognostic indicators of disease and response to targeted therapies. When incorporated into clinical decision-making, these biomarkers can serve as critical tools in personalizing therapy to ensure the best outcomes. Additional improvements in the survival of patients with mCRC will be made possible with the identification of new predictive molecular biomarkers and their evaluation using rational and innovative clinical trials.

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