scholarly journals Cell-Free microRNAs as Potential Oral Cancer Biomarkers: From Diagnosis to Therapy

Cells ◽  
2019 ◽  
Vol 8 (12) ◽  
pp. 1653 ◽  
Author(s):  
Óscar Rapado-González ◽  
Rafael López-López ◽  
José Luis López-Cedrún ◽  
Gabriel Triana-Martínez ◽  
Laura Muinelo-Romay ◽  
...  
Keyword(s):  
Oral Cancer ◽  
Clinical Decision Making ◽  
Cancer Biomarkers ◽  
Clinical Decision ◽  
Educational Interventions ◽  
New Horizons ◽  
Oral Cancer Patients ◽  
Advanced Stages ◽  
Non Coding Rnas ◽  
Noninvasive Biomarkers

Oral cavity cancer is the most frequent malignancy of the head and neck. Unfortunately, despite educational interventions for prevention and early diagnosis, oral cancer patients are often diagnosed in advanced stages associated with poor prognosis and life expectancy. Therefore, there is an urgent need to find noninvasive biomarkers to improve early detection of this tumor. Liquid biopsy has emerged as a valuable tool in medical oncology which provides new horizons for improving clinical decision making. Notably, cell-free microRNAs (miRNAs), a class of short non-coding RNAs, are emerging as novel noninvasive cancer biomarkers. Here, we provide an overview of the potential clinical application of cell-free miRNAs as diagnostic, prognostic, and therapeutic biomarkers in oral cancer.

scholarly journals Implementing Clinical Pharmacogenomics in the Classroom: Student Pharmacist Impressions of an Educational Intervention Including Personal Genotyping

Pharmacy ◽  
2018 ◽  
Vol 6 (4) ◽  
pp. 115 ◽  
Author(s):  
Amber Frick ◽  
Cristina Benton ◽  
Oscar Suzuki ◽  
Olivia Dong ◽  
Rachel Howard ◽  
...  
Keyword(s):  
Educational Intervention ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Educational Interventions ◽  
Rank Test ◽  
Drug Dosing ◽  
Signed Rank ◽  
Signed Rank Test ◽  
Students Attitudes ◽  
Personalized Approach

Pharmacogenomics provides a personalized approach to pharmacotherapy by using genetic information to guide drug dosing and selection. However, partly due to lack of education, pharmacogenomic testing has not been fully implemented in clinical practice. With pharmacotherapy training and patient accessibility, pharmacists are ideally suited to apply pharmacogenomics to patient care. Student pharmacists (n = 222) participated in an educational intervention that included voluntary personal genotyping using 23andMe. Of these, 31% of students completed both pre- and post-educational interventions to evaluate their attitudes and confidence towards the use of pharmacogenomics data in clinical decision making, and 55% of this paired subset obtained personal genotyping. McNemar’s test and the Wilcoxon signed-rank test were used to analyze responses. Following the educational intervention, students regardless of genotyping were more likely to recommend personal genotyping (36% post-educational intervention versus 19% pre-educational intervention, p = 0.0032), more confident in using pharmacogenomics in the management of drug therapy (51% post-educational intervention versus 29% pre-educational intervention, p = 0.0045), and more likely to believe that personalized genomics would have an important role in their future pharmacy career (90% post-educational intervention versus 51% pre-educational intervention, p = 0.0072) compared to before receiving the educational intervention. This educational intervention positively influenced students’ attitudes and confidence regarding pharmacogenomics in the clinical setting. Future studies will examine the use of next-generation sequencing assays that selectively examine pharmacogenes in the education of student pharmacists.

scholarly journals Circulating microRNAs as noninvasive biomarkers for canine Cushing's syndrome

2021 ◽  
Author(s):  
Karin Sanders ◽  
Anouk Veldhuizen ◽  
Hans S. Kooistra ◽  
Adri Slob ◽  
Elpetra P.M. Timmermans-Sprang ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Differentially Expressed ◽  
Circulating Mirnas ◽  
Circulating Micrornas ◽  
Blood Samples ◽  
Healthy Dogs ◽  
Noninvasive Biomarkers ◽  
One Year

Canine Cushing′s syndrome (hypercortisolism) can be caused by a pituitary tumor (pituitary-dependent hypercortisolism; PDH) or a cortisol-secreting adrenocortical tumor (csACT). For both cases, noninvasive biomarkers that could pre-operatively predict the risk of recurrence after surgery would greatly impact clinical decision making. The aim of this study was to determine whether circulating microRNAs (miRNAs) can be used as noninvasive biomarkers for canine Cushing′s syndrome. After a pilot study with 40 miRNAs in blood samples of healthy dogs (n = 3), dogs with PDH (n = 3) and dogs with a csACT (n = 4), we selected a total of 20 miRNAs for the definitive study. In the definitive study, these 20 miRNAs were analyzed in blood samples of healthy dogs (n = 6), dogs with PDH (n = 19, pre- and post-operative samples) and dogs with a csACT (n = 26, pre-operative samples). In dogs with PDH, six miRNAs (miR-122-5p, miR-126-5p, miR-141-3p, miR-222-3p, miR-375-3p and miR-483-3p) were differentially expressed compared to healthy dogs. Of one miRNA, miR-122-5p, the expression levels did not overlap between healthy dogs and dogs with PDH (p = 2.9x10-4), significantly decreased after hypophysectomy (p = 0.013), and were significantly higher (p = 0.017) in dogs with recurrence (n = 3) than in dogs without recurrence for at least one year after hypophysectomy (n = 7). In dogs with csACTs, two miRNAs (miR-483-3p and miR-223-3p) were differentially expressed compared to healthy dogs. Additionally, miR-141-3p was expressed significantly lower (p = 0.009) in dogs with csACTs that had a histopathological Utrecht score of ≥ 11 compared to those with a score of < 11. These results indicate that circulating miRNAs have the potential to be noninvasive biomarkers in dogs with Cushing′s syndrome that may contribute to clinical decision-making.

scholarly journals The Quality of Evidence-Based Morning Reports with an Interactive and Consultative Approach in the Viewpoint of Clinical Faculties and Residents: A Qualitative Study

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Saeideh Daryazadeh ◽  
Payman Adibi
Keyword(s):  
Qualitative Study ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Educational Interventions ◽  
Influential Factors ◽  
Faculty Members ◽  
Evidence Based ◽  
Structured Interviews ◽  
Quality Of Evidence

Background: Morning reports are important training programs (especially for residents) as they enhance clinical decision-making skills, social interactions, and participatory learning. Given the need to eliminate the educational gap and provide optimal conditions, educational interventions regarding morning reports are often implemented in the form of evidence-based morning reports with an interactive and consultative approach. Objectives: The present study aimed to evaluate the quality of evidence-based morning reports using an interactive and consultative approach. Methods: This qualitative study was conducted with an inductive approach in 2019 in Iran. Changes were made to develop an evidence-based morning report and create a friendly educational environment between faculty members and residents, as well as interactive learning among the residents. The intervention was assessed through explaining the experiences of 16 participants via individual semi-structured interviews. Purposive sampling continued until data saturation. Data analysis was performed in the MAXQDA10 software. Results: In total, 153 codes, two main categories (education and dimensions of change), six categories (educational deficiencies, influential factors in the quality of education, requirements, barriers, benefits, and response to change), and 20 subcategories were extracted. Conclusions: According to the results, the residents were satisfied with the changes, while the faculty members needed more justification and motivation. The strengths and weaknesses identified in the intervention could lay the groundwork for broader changes in the same clinical fields.

scholarly journals 1636. Variation in Clinical Practice Patterns Among Infectious Diseases Faculty at a Large Academic Institution

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S44-S44
Author(s):  
Varun K Phadke ◽  
Jennifer O Spicer
Keyword(s):  
Clinical Practice ◽  
Clinical Decision Making ◽  
Practice Patterns ◽  
Clinical Care ◽  
Clinical Decision ◽  
Educational Interventions ◽  
Fixed Dose ◽  
Published Data ◽  
Routine Practice ◽  
Clinical Practice Patterns

Abstract Background Clinical practice patterns vary between providers, but few studies have examined this variation among infectious disease (ID) physicians. Characterizing these differences in practice can help identify areas where targeted educational interventions or further research are needed to improve clinical decision-making. We describe a faculty survey conducted at our institution designed to identify clinical practice variation within a large academic ID division. Methods In January 2017, an electronic survey was distributed to all clinical ID faculty at our institution. The survey collected baseline demographic information as well as responses to 28 common clinical dilemmas encountered in routine practice. Descriptive statistics were performed. Results Twenty-four (44%) of 54 active clinical ID faculty (12 assistant professors, 6 associate professors, and 6 professors) completed the survey. Examples of clinical dilemmas with &gt;80% agreement among faculty included: (1) S. aureus bacteremia should be a mandatory ID consult (88%) and (2) lumbar puncture should be performed for all patients with suspected ocular syphilis (88%). The majority of clinical dilemmas had less than 80% agreement, and these spanned the range of routine ID practice. Examples included: (1) use of ceftriaxone for outpatient antibiotic therapy for nonbacteremic invasive methicillin-susceptible S. aureus infections (58% agree), (2) length of treatment for guideline-defined uncomplicated S. aureus bacteremia (50% 2 weeks, 50% 4 weeks), (3) use of fixed-dose dolutegravir/abacavir/lamivudine as a single-drug regimen for an HIV-infected patient with an M184V mutation (42% agree), and (4) benefit of routine anal Pap smears among HIV-infected men who have sex with men (50% agree). Conclusion Practice patterns vary between ID physicians within our institution, particularly for clinical dilemmas for which there is insufficient or conflicting published data. Further studies to examine practice pattern variation among ID physicians across institutions and geographic regions could identify areas where further research or educational interventions are needed to enhance clinical care. Disclosures All authors: No reported disclosures.

Combined Evaluation of Matrix Metalloproteinases and their Inhibitors has Better Clinical Utility in Oral Cancer

2011 ◽  
Vol 26 (1) ◽  
pp. 27-36 ◽  
Author(s):  
Ragini D. Singh ◽  
Haridas Nilayangode ◽  
Jayendra B. Patel ◽  
Franky D. Shah ◽  
Shilin N. Shukla ◽  
...  
Keyword(s):  
Oral Cancer ◽  
Diagnostic Accuracy ◽  
Cancer Patients ◽  
Sensitivity And Specificity ◽  
Clinical Decision Making ◽  
Health Hazard ◽  
Plasma Concentrations ◽  
Cervical Lymph Node Metastasis ◽  
Incidence And Mortality ◽  
Oral Cancer Patients

Background Oral cancer is a major health hazard worldwide with increasing incidence and mortality. Cervical lymph node metastasis is a major determinant of outcome in oral cancer. The matrix metalloproteinase (MMP) system is critically involved in invasion and metastasis. Assessment of MMPs and tissue inhibitors of MMPs (TIMPs) in certain combinations might have better clinical efficacy given their potential role in the metastatic process. Aim Plasma concentrations of MMP-2, MMP-9, TIMP-1 and TIMP-2 in 50 controls and 75 oral cancer patients (nonmetastatic, n=54; metastatic, n=21) were evaluated to assess their investigative value and role in predicting the behavior of this malignancy. Methods The plasma concentrations of MMP-2, MMP-9, TIMP-1 and TIMP-2 were quantified by ELISA. The best 2- and 3-marker combinations were calculated using the statistical software mROC. The diagnostic values for all the biomolecules as single markers and their combinations were estimated using the measures of diagnostic accuracy, i.e. the area under the ROC curve and the sensitivity and specificity at cutoff limits with the highest diagnostic accuracy and at the 95% limits of sensitivity and specificity, respectively. Results MMP-9, TIMP-1 and TIMP-2 were significantly elevated (p=0.000, p=0.013 and p=0.005, respectively) in oral cancer patients. MMP-9 emerged as the best single statistically significant marker in plasma for oral cancer detection. It showed an increase in diagnostic performance when tested in combination with MMP-2 and TIMP-2. The median plasma MMP-9 levels were elevated in both the metastatic and nonmetastatic groups compared with controls (p<0.004 and p<0.007, respectively). Conclusion The results indicated that plasma MMP and TIMP levels in relevant combinations may facilitate clinical decision-making for improved management of oral cancer patients and may provide important data for selecting patients for treatment with drugs that interfere with MMP and TIMP activities.

scholarly journals Vigilance in Iranian Nurses Working in Intensive Care Units

2021 ◽  
Author(s):  
Mojgan Najafi ◽  
Mehdi Ajri ◽  
Mansoureh Karimollahi
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Clinical Decision Making ◽  
Essential Element ◽  
Clinical Decision ◽  
Educational Interventions ◽  
Demographic Characteristics ◽  
Cross Sectional ◽  
The Mean

Abstract Background and aim: Vigilance is an essential element in intensive care nursing. This study was conducted to determine nursing vigilance in nurses working in the intensive care units of educational and medical centers in Ardabil, IranMethods: This was a cross-sectional descriptive-analytical study with 192 ICU nurses as the participants. The data were obtained through questionnaires regarding demographic characteristics and nursing vigilance. SPSS software version 24 was used for the statistical analysis.Results: The mean total vigilance score was 3.86 ± 0.23 of 5. The mean scores of the timely diagnosis of changes, pattern recognition, and clinical decision-making subscales were 4.07 ± 0.26, 04.04 ± 0.41, and 3.44 ± 0.25, respectively. No significant relationships were observed between the total or subscale vigilance scores and other demographic characteristics.Conclusion: We assessed ICU nurses’ vigilance behaviors and found that their mean vigilance score was higher than the expected average, indicating our participants had a high level of clinical vigilance. These results suggest a need for effective educational interventions to boost clinical decision-making skills in ICU nurses, especially younger nurses.

scholarly journals Circulating Long Non-Coding RNAs as Novel Potential Biomarkers for Osteogenic Sarcoma

Cancers ◽  
2021 ◽  
Vol 13 (16) ◽  
pp. 4214
Author(s):  
Sutpirat Moonmuang ◽  
Parunya Chaiyawat ◽  
Salinee Jantrapirom ◽  
Dumnoensun Pruksakorn ◽  
Luca Lo Piccolo
Keyword(s):  
Clinical Decision Making ◽  
Expression Patterns ◽  
Osteogenic Sarcoma ◽  
Clinical Decision ◽  
Diagnostic Tools ◽  
Liquid Biopsies ◽  
Specific Expression ◽  
Altered Expression ◽  
Novel Biomarkers ◽  
Non Coding Rnas

Circulating cell-free nucleic acids recently became attractive targets to develop non-invasive diagnostic tools for cancer detection. Along with DNA and mRNAs, transcripts lacking coding potential (non-coding RNAs, ncRNAs) directly involved in the process of tumor pathogenesis have been recently detected in liquid biopsies. Interestingly, circulating ncRNAs exhibit specific expression patterns associated with cancer and suggest their role as novel biomarkers. However, the potential of circulating long ncRNAs (c-lncRNAs) to be markers in osteosarcoma (OS) is still elusive. In this study we performed a systematic review to identify thirteen c-lncRNAs whose altered expression in blood associate with OS. We herein discuss the potential impact that these c-lncRNAs may have on clinical decision-making in the management of OS. Overall, we aimed to provide novel insights that can contribute to the development of future precision medicine in oncology.

scholarly journals Treatment of AML in Older Patients

2021 ◽  
Author(s):  
Jacobien Hilberink ◽  
Gerwin Huls
Keyword(s):  
Treatment Option ◽  
Older Patients ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Patient Characteristics ◽  
Clinical Decision ◽  
New Drugs ◽  
Advanced Stages ◽  
Allogeneic Haematopoietic Cell Transplantation ◽  
Treatment Tolerance

Acute myeloid leukaemia (AML) is a disease mostly diagnosed in older adults. Treatment of older patients with AML remains challenging with higher rates of intrinsic chemotherapeutic resistance and decreased treatment tolerance. Indeed AML in older patients has different clinical and biologic characteristics compared to younger patients. Several treatment options are available for treatment of AML in older patients, namely conventional intensive chemotherapy (‘3 + 7’), low-dose cytarabine, and hypomethylating agents. Combinations with new drugs have been recently approved or are in advanced stages of clinical testing, namely venetoclax, midostaurin, glasdegib. Clinical decision making should take into account disease characteristics (e.g. cytogenetic and molecular abnormalities, white blood cell count), patient characteristics (e.g. performance, comorbidities, geriatric assessment) and patients’ preference when considering which treatment option is most suitable for the older patient. Allogeneic haematopoietic cell transplantation (HCT) as post-remission strategy should also be considered for older patients with AML. Allogeneic HCT following reduced-intensity conditioning or non-myeloablative conditioning has made this treatment option more suitable for older patients with a reduction in treatment-related mortality.

scholarly journals Circulating Non-Coding RNAs in Head and Neck Cancer: Roles in Diagnosis, Prognosis, and Therapy Monitoring

Cells ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 48
Author(s):  
Araceli Diez-Fraile ◽  
Joke De Ceulaer ◽  
Charlotte Derpoorter ◽  
Christophe Spaas ◽  
Tom De Backer ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Clinical Decision Making ◽  
Therapy Monitoring ◽  
Clinical Decision ◽  
Upper Aerodigestive Tract ◽  
Non Coding Rna ◽  
Non Coding Rnas ◽  
Trna Halves

Head and neck cancer (HNC), the seventh most common form of cancer worldwide, is a group of epithelial malignancies affecting sites in the upper aerodigestive tract. The 5-year overall survival for patients with HNC has stayed around 40–50% for decades, with mortality being attributable mainly to late diagnosis and recurrence. Recently, non-coding RNAs, including tRNA halves, YRNA fragments, microRNAs (miRNAs), and long non-coding RNAs (lncRNAs), have been identified in the blood and saliva of patients diagnosed with HNC. These observations have recently fueled the study of their potential use in early detection, diagnosis, and risk assessment. The present review focuses on recent insights and the potential impact that circulating non-coding RNA evaluation may have on clinical decision-making in the management of HNC.

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