scholarly journals Right Care, First Time: Developing a Theory-Based Automated Protocol to Help Clinically Stage Young People Based on Severity and Persistence of Mental Illness

2021 ◽  
Vol 9 ◽  
Author(s):  
Frank Iorfino ◽  
Vanessa Wan Sze Cheng ◽  
Shane P. Cross ◽  
Hannah F. Yee ◽  
Tracey A. Davenport ◽  
...  
Keyword(s):  
Mental Disorders ◽  
Information Technologies ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Base ◽  
Clinical Staging ◽  
Health Information Technologies ◽  
Staging Model ◽  
Automated Protocol ◽  
First Time

Most mental disorders emerge before the age of 25 years and, if left untreated, have the potential to lead to considerable lifetime burden of disease. Many services struggle to manage high demand and have difficulty matching individuals to timely interventions due to the heterogeneity of disorders. The technological implementation of clinical staging for youth mental health may assist the early detection and treatment of mental disorders. We describe the development of a theory-based automated protocol to facilitate the initial clinical staging process, its intended use, and strategies for protocol validation and refinement. The automated clinical staging protocol leverages the clinical validation and evidence base of the staging model to improve its standardization, scalability, and utility by deploying it using Health Information Technologies (HIT). Its use has the potential to enhance clinical decision-making and transform existing care pathways, but further validation and evaluation of the tool in real-world settings is needed.

scholarly journals Computerized Clinical Decision Support: Contributions from 2014

2015 ◽  
Vol 24 (01) ◽  
pp. 119-124 ◽  
Author(s):  
V. Koutkias ◽  
J. Bouaud ◽  
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Information Technologies ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Editorial Team ◽  
Bibliographic Databases ◽  
Health Information Technologies ◽  
Selection Of

Summary Objective: To summarize recent research and propose a selection of best papers published in 2014 in the field of computerized clinical decision support for the Decision Support section of the IMIA yearbook.Method: A literature review was performed by searching two bibliographic databases for papers related to clinical decision support systems (CDSSs) and computerized provider order entry systems in order to select a list of candidate best papers to be then peer-reviewed by external reviewers. A consensus meeting between the two section editors and the editorial team was finally organized to conclude on the selection of best papers. Results: Among the 1,254 returned papers published in 2014, the full review process selected four best papers. The first one is an experimental contribution to a better understanding of unintended uses of CDSSs. The second paper describes the effective use of previously collected data to tailor and adapt a CDSS. The third paper presents an innovative application that uses pharmacogenomic information to support personalized medicine. The fourth paper reports on the long-term effect of the routine use of a CDSS for antibiotic therapy. Conclusions: As health information technologies spread more and more meaningfully, CDSSs are improving to answer users’ needs more accurately. The exploitation of previously collected data and the use of genomic data for decision support has started to materialize. However, more work is still needed to address issues related to the correct usage of such technologies, and to assess their effective impact in the long term.

Ultra-high-risk paradigm: lessons learnt and new directions

2018 ◽  
Vol 21 (4) ◽  
pp. 131-133 ◽  
Author(s):  
Patrick D McGorry ◽  
Cristina Mei
Keyword(s):  
High Risk ◽  
Mental Disorders ◽  
Psychotic Disorder ◽  
Psychotic Disorders ◽  
Evidence Base ◽  
Ultra High Risk ◽  
Underlying Mechanisms ◽  
Staging Model ◽  
Definition Of ◽  
New Generation

Within the embryonic early psychosis field in the early 1990s, the conceptualisation and definition of an at-risk or ultra-high-risk (UHR) mental state for psychosis was a breakthrough which transformed the clinical and research landscape in psychiatry. Twenty-five years later, we have a new evidence base that has illuminated the neurobiology of the onset phase of psychotic disorder, delivered Cochrane level 1 evidence showing that the onset of full-threshold sustained psychotic disorder can be at least delayed, and is paving the way to a new generation of transdiagnostic research. Here, we document the contribution of the UHR approach to understanding the underlying mechanisms of psychosis onset as well as the long-term outcomes. Particularly, we highlight that psychosis onset can be delayed in those meeting UHR criteria and that these criteria have a higher valence for subsequent psychotic disorders and some valence for persistent non-psychotic syndromes. Critiques have helped to identify some of the limitations of this paradigm, which are acknowledged. These include evidence that psychotic disorders can emerge more acutely and from other, as yet undefined, precursor states. Rather than defending, or alternatively questioning the value of, the UHR approach, we propose a broader, transdiagnostic staging model that is consistent with the pluripotent and variably comorbid trajectories for mental disorders. This approach moves beyond psychosis to capture a wider range of subthreshold symptoms and full-threshold disorders, thus enhancing prediction for the emergence and progression of a range of mental disorders, as well as providing new avenues for early intervention and prevention.

Integrating research and evidence-based guidance into prescribing practice

2021 ◽  
Vol 3 (3) ◽  
pp. 120-123
Author(s):  
Adam Bedson
Keyword(s):  
Decision Making ◽  
Critical Appraisal ◽  
Clinical Decision Making ◽  
Primary Source ◽  
Clinical Decision ◽  
Evidence Base ◽  
Evidence Based ◽  
Multiple Sources ◽  
Prescribing Practice ◽  
Critical Appraisal Skills

The College of Paramedics and the Royal Pharmaceutical Society are clear that they require advanced paramedics, as non-medical prescribers, to review and critically appraise the evidence base underpinning their prescribing practice. Evidence-based clinical guidance such as that published by the National Institute for Health and Care Excellence (NICE) is recommended as the primary source of evidence on which paramedics should base their prescribing decisions. NICE guidance reflects the best available evidence on which to base clinical decision-making. However, paramedics still need to critically appraise the evidence underpinning their prescribing, applying expertise and decision-making skills to inform their clinical reasoning. This is achieved by synthesising information from multiple sources to make appropriate, evidence-based judgments and diagnoses. This first article in the prescribing paramedic pharmacology series considers the importance of evidence-based paramedic prescribing, alongside a range of tools that can be used to develop and apply critical appraisal skills to support prescribing decision-making. These include critical appraisal check lists and research reporting tools

Leveraging Key Aspects of Collaborative Techniques to Assist Clinical Decisions

2017 ◽  
pp. 440-456
Author(s):  
Hoda Moghimi ◽  
Jonathan L. Schaffer ◽  
Nilmini Wickramasinghe
Keyword(s):  
Decision Making ◽  
Information Technologies ◽  
Clinical Decision Making ◽  
Research Question ◽  
Clinical Decision ◽  
Detection Model ◽  
Important Approach ◽  
Hip And Knee Arthroplasty ◽  
Expected Benefits ◽  
Key Aspects

Employing collaborative systems in healthcare contexts is an important approach towards designing and developing intelligent computer solutions. The objective of this study is to develop a real-time collaborative system using the Intelligent Risk Detection Model (IRD) to improve decision efficiency for the care of patients undergoing hip and knee arthroplasty (THA, TKA). Expected benefits include increasing awareness, supporting communication, improving decision making processes and also improving information sharing between surgeons, patients, families and consultants as key collaborative parties. The research question under investigation is: How can key information technologies be designed, developed and adopted to support clinical decision making in the context of THA and TKA? This research in progress has identified the value and benefit of developing a systematic and technology supported tool to facilitate the identification of various risks associated with THA and TKA.

scholarly journals Prospective assessment of NGS-detectable mutations in CML patients with nonoptimal response: the NEXT-in-CML study

Blood ◽  
2020 ◽  
Vol 135 (8) ◽  
pp. 534-541 ◽  
Author(s):  
Simona Soverini ◽  
Luana Bavaro ◽  
Caterina De Benedittis ◽  
Margherita Martelli ◽  
Alessandra Iurlo ◽  
...  
Keyword(s):  
Clinical Relevance ◽  
Kinase Inhibitors ◽  
Clinical Decision Making ◽  
Mutation Screening ◽  
Clinical Decision ◽  
Kinase Domain ◽  
Low Level ◽  
Prospective Assessment ◽  
Next Generation Sequencing Ngs ◽  
First Time

Abstract In chronic myeloid leukemia (CML) patients, tyrosine kinase inhibitors (TKIs) may select for drug-resistant BCR-ABL1 kinase domain (KD) mutants. Although Sanger sequencing (SS) is considered the gold standard for BCR-ABL1 KD mutation screening, next-generation sequencing (NGS) has recently been assessed in retrospective studies. We conducted a prospective, multicenter study (NEXT-in-CML) to assess the frequency and clinical relevance of low-level mutations and the feasibility, cost, and turnaround times of NGS-based BCR-ABL1 mutation screening in a routine setting. A series of 236 consecutive CML patients with failure (n = 124) or warning (n = 112) response to TKI therapy were analyzed in parallel by SS and NGS in 1 of 4 reference laboratories. Fifty-one patients (22 failure, 29 warning) who were negative for mutations by SS had low-level mutations detectable by NGS. Moreover, 29 (27 failure, 2 warning) of 60 patients who were positive for mutations by SS showed additional low-level mutations. Thus, mutations undetectable by SS were identified in 80 out of 236 patients (34%), of whom 42 (18% of the total) had low-level mutations somehow relevant for clinical decision making. Prospective monitoring of mutation kinetics demonstrated that TKI-resistant low-level mutations are invariably selected if the patients are not switched to another TKI or if they are switched to a inappropriate TKI or TKI dose. The NEXT-in-CML study provides for the first time robust demonstration of the clinical relevance of low-level mutations, supporting the incorporation of NGS-based BCR-ABL1 KD mutation screening results in the clinical decision algorithms.

scholarly journals Green walking groups: A mixed-methods review of the mental health outcomes for adults with mental health problems

2019 ◽  
Vol 83 (3) ◽  
pp. 162-171
Author(s):  
Tom Swinson ◽  
Jennifer Wenborn ◽  
Paul Sugarhood
Keyword(s):  
Mental Health ◽  
Mixed Methods ◽  
Health Outcomes ◽  
Clinical Decision Making ◽  
Mental Health Problems ◽  
Clinical Decision ◽  
Evidence Base ◽  
Health Problems ◽  
Mental Health Outcomes ◽  
Natural Environments

Introduction Evidence suggests group walking in natural environments is more beneficial to the general population’s mental health than walking indoors, in urban environments, and alone. Such ‘green walking groups’ have been suggested as an occupational therapy intervention that could be suitable for adults with mental health problems. However, there have been no reviews of the mental health outcomes of participating in green walking groups for this population. Method A mixed-methods literature review was conducted. A range of databases was systematically searched electronically. Papers that met pre-defined inclusion criteria were selected, critically appraised, and qualitative and quantitative data were extracted. Thematic analysis was used to identify key qualitative outcomes. Findings Six papers were included and eight mental health outcomes identified. The evidence suggests participants can experience connections with other people, connections with nature, and a sense of freedom. There is some limited evidence to support improvements to mood, self-esteem, reflection on life tasks, and symptoms of depression, with mixed evidence for experiencing a sense of achievement. Conclusion This review can be used to build the evidence base for the link between occupation and mental health, and inform the clinical decision-making of occupational therapists, who are well-placed to design and implement green walking groups.

Management of severe stifle trauma: 2. Periarticular fractures

2019 ◽  
Vol 21 (7) ◽  
pp. 633-644
Author(s):  
Alessandro Conte ◽  
Elena Addison
Keyword(s):  
Clinical Decision Making ◽  
Proximal Tibia ◽  
Clinical Decision ◽  
Evidence Base ◽  
Deciduous Teeth ◽  
Published Data ◽  
Close Attention ◽  
Stifle Joint ◽  
Pin Fixation ◽  
Adult Cats

Practical relevance: Periarticular stifle fractures are uncommon but challenging injuries to treat. There may be concurrent damage to the ligaments and stabilising structures of the stifle joint itself, which should also be evaluated (see Part 1 of this article series). Improved knowledge of the fixation options and biomechanical challenges of these injuries will aid clinical decision-making and effective repair. Clinical challenges: Due to their nature, periarticular fractures may have small juxta-articular fragments, which require additional thought to address during stabilisation. In juvenile animals, these fractures typically involve the physis and often can be managed with cross pin fixation. In adult cats, locking fixation, specialised plates or external skeletal fixators can be utilised to address the juxta-articular fragments. Readers should also be aware of patellar fracture and dental anomaly syndrome (PADS), where cats develop insufficiency fractures affecting the patella and proximal tibia. A careful oral examination should be performed in affected patients, as these cats may have persistent deciduous teeth. Close attention should be paid to preoperative radiographs for evidence of chronicity of the injury including sclerosis of the patella, remodelling and blunting of the fracture lines. Aims: The aims of the article are to review the current literature surrounding periarticular fractures of the stifle joint and to summarise the diagnosis, treatment, outcome and complications of each fracture type. As well as discussing general fracture fixation and biomechanical principles applicable to both dogs and cats, information is provided on specific issues facing cats, such as PADS. Evidence base: Published data is limited, with reports including only a small number of cats. The information and recommendations in this article have therefore been drawn from a combination of the available literature and the authors’ clinical experience.

How to Decide Whether to Offer and Use “Nonstandard” Therapies in Patients with Advanced Sarcomas and Gastrointestinal Stromal Tumors: Global Variations in Clinical Practice, Assessment, and Access to Therapies in Diseases with Limited Incidence and Data

2012 ◽  
pp. 645-650 ◽  
Author(s):  
Stefan Sleijfer ◽  
Ian Judson ◽  
George D. Demetri
Keyword(s):  
Clinical Practice ◽  
Rare Diseases ◽  
Clinical Benefit ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Base ◽  
Stromal Tumors ◽  
Appropriate Care ◽  
Social Interests ◽  
Practice Assessment

Overview: As cancer is more generally recognized as a collection of various rare diseases rather than a homogeneous illness, sarcomas have become a model for the manner in which data can and cannot be used to drive clinical decision making. In this article, we explore the limitations of data generated in rare diseases such as sarcomas to provide an evidence base for clinical practice. How should patients be treated if there is no “standard” that offers “proof” of clinical benefit? By asking this question, we also raise the issue of what constitutes “clinical benefit”—and how to measure that—for patients with sarcomas and other rare diseases. As physicians become more accountable for decisions—and yet are always accountable to the patients and families who rely on them to provide the best and most appropriate care—oncologists must be cognizant of the limitations of data in rare diseases and be ready to justify actions that are in the best medical and social interests of patients.

Integrating research and evidence-based guidance into prescribing practice

2021 ◽  
Vol 13 (1) ◽  
pp. 10-13
Author(s):  
Adam Bedson
Keyword(s):  
Decision Making ◽  
Critical Appraisal ◽  
Clinical Decision Making ◽  
Primary Source ◽  
Clinical Decision ◽  
Evidence Base ◽  
Evidence Based ◽  
Multiple Sources ◽  
Prescribing Practice ◽  
Critical Appraisal Skills

The College of Paramedics and the Royal Pharmaceutical Society are clear that they require advanced paramedics, as non-medical prescribers, to review and critically appraise the evidence base underpinning their prescribing practice. Evidence-based clinical guidance such as that published by the National Institute for Health and Care Excellence (NICE) is recommended as the primary source of evidence on which paramedics should base their prescribing decisions. NICE guidance reflects the best available evidence on which to base clinical decision-making. However, paramedics still need to critically appraise the evidence underpinning their prescribing, applying expertise and decision-making skills to inform their clinical reasoning. This is achieved by synthesising information from multiple sources to make appropriate, evidence-based judgments and diagnoses. This first article in the prescribing paramedic pharmacology series considers the importance of evidence-based paramedic prescribing, alongside a range of tools that can be used to develop and apply critical appraisal skills to support prescribing decision-making. These include critical appraisal checklists and research reporting tools.

scholarly journals Developing supervisory competence: preliminary data on the impact of CBT supervision training

2012 ◽  
Vol 5 (4) ◽  
pp. 83-92 ◽  
Author(s):  
Katherine Newman Taylor ◽  
Kenneth Gordon ◽  
Simon Grist ◽  
Charlotte Olding
Keyword(s):  
Clinical Supervision ◽  
Repeated Measures ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Base ◽  
Preliminary Evaluation ◽  
Repeated Measures Design ◽  
Supervision Training ◽  
Psychological Therapies ◽  
The Impact

AbstractClinical supervision is key to the delivery and governance of effective psychological work. We place increasing emphasis on the evidence base in our clinical decision making, and yet there is no comparable body of information to inform our supervisory practice. This is a serious problem for psychological therapists; there is an urgent need for theoretically driven and empirically evaluated approaches to supervision, and the training of such skills. This preliminary evaluation examined the impact of a 5-day training designed for Improving Access to Psychological Therapies (IAPT) supervisors new to the role. A within-subject, repeated-measures design was used to compare self-assessed supervision competencies over the course of training. Twenty-eight IAPT supervisors completed 5 days’ training based on the Supervision Competencies Framework and IAPT Supervision Guidance. Significant improvements were found in ratings of generic, specific, applied and meta-supervision competencies, as well as overall competency. This evaluation gives preliminary support for the impact of training on supervisory competencies. There are clear limitations, particularly the lack of objective measures and comparison training. Nevertheless, in the context of a very limited evidence base to date, the study contributes to a more robust approach to developing supervisory competence in clinical practice.

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