Immunohistochemistry for Prostate Biopsy—Impact on Histological Prostate Cancer Diagnoses and Clinical Decision Making

Background: To test the value of immunohistochemistry (IHC) staining in prostate biopsies for changes in biopsy results and its impact on treatment decision-making. Methods: Between January 2017–June 2020, all patients undergoing prostate biopsies were identified and evaluated regarding additional IHC staining for diagnostic purpose. Final pathologic results after radical prostatectomy (RP) were analyzed regarding the effect of IHC at biopsy. Results: Of 606 biopsies, 350 (58.7%) received additional IHC staining. Of those, prostate cancer (PCa) was found in 208 patients (59.4%); while in 142 patients (40.6%), PCa could be ruled out through IHC. IHC patients harbored significantly more often Gleason 6 in biopsy (p < 0.01) and less suspicious baseline characteristics than patients without IHC. Of 185 patients with positive IHC and PCa detection, IHC led to a change in biopsy results in 81 (43.8%) patients. Of these patients with changes in biopsy results due to IHC, 42 (51.9%) underwent RP with 59.5% harboring ≥pT3 and/or Gleason 7–10. Conclusions: Patients with IHC stains had less suspicious characteristics than patients without IHC. Moreover, in patients with positive IHC and PCa detection, a change in biopsy results was observed in >40%. Patients with changes in biopsy results partly underwent RP, in which 60% harbored significant PCa.

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Causal inference for clinicians

BMJ evidence-based medicine ◽

10.1136/bmjebm-2018-111069 ◽

2019 ◽

Vol 24 (3) ◽

pp. 109-112 ◽

Cited By ~ 3

Author(s):

Steven D Stovitz ◽

Ian Shrier

Keyword(s):

Decision Making ◽

Causal Inference ◽

Clinical Decision Making ◽

Causal Effect ◽

Treatment Decision ◽

Clinical Decision ◽

Directed Acyclic Graphs ◽

Causal Effects ◽

Treatment Decision Making ◽

Inference Methods

Evidence-based medicine (EBM) calls on clinicians to incorporate the ‘best available evidence’ into clinical decision-making. For decisions regarding treatment, the best evidence is that which determines the causal effect of treatments on the clinical outcomes of interest. Unfortunately, research often provides evidence where associations are not due to cause-and-effect, but rather due to non-causal reasons. These non-causal associations may provide valid evidence for diagnosis or prognosis, but biased evidence for treatment effects. Causal inference aims to determine when we can infer that associations are or are not due to causal effects. Since recommending treatments that do not have beneficial causal effects will not improve health, causal inference can advance the practice of EBM. The purpose of this article is to familiarise clinicians with some of the concepts and terminology that are being used in the field of causal inference, including graphical diagrams known as ‘causal directed acyclic graphs’. In order to demonstrate some of the links between causal inference methods and clinical treatment decision-making, we use a clinical vignette of assessing treatments to lower cardiovascular risk. As the field of causal inference advances, clinicians familiar with the methods and terminology will be able to improve their adherence to the principles of EBM by distinguishing causal effects of treatment from results due to non-causal associations that may be a source of bias.

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ADOLESCENT PATIENTS AND THE CLINICAL DECISION ABOUT THEIR HEALTH

Revista Paulista de Pediatria ◽

10.1590/1984-0462/;2019;37;4;00011 ◽

2019 ◽

Vol 37 (4) ◽

pp. 503-509

Author(s):

Marlene Pereira Garanito ◽

Vera Lucia Zaher-Rutherford

Keyword(s):

Decision Making ◽

Latin American ◽

Clinical Decision Making ◽

Case Reports ◽

Treatment Decision ◽

Clinical Decision ◽

Electronic Library ◽

Data Synthesis ◽

Treatment Decision Making ◽

The Individual

ABSTRACT Objective: To carry out a review of the literature on adolescents’ participation in decision making for their own health. Data sources: Review in the Scientific Electronic Library Online (SciELO), Latin American and Caribbean Health Sciences Literature (LILACS) and PubMed databases. We consider scientific articles and books between 1966 and 2017. Keywords: adolescence, autonomy, bioethics and adolescence, autonomy, ethics, in variants in the English, Portuguese and Spanish languages. Inclusion criteria: scientific articles, books and theses on clinical decision making by the adolescent patient. Exclusion criteria: case reports and articles that did not address the issue. Among 1,590 abstracts, 78 were read in full and 32 were used in this manuscript. Data synthesis: The age at which the individual is able to make decisions is a matter of debate in the literature. The development of a cognitive and psychosocial system is a time-consuming process and the integration of psychological, neuropsychological and neurobiological research in adolescence is fundamental. The ability to mature reflection is not determined by chronological age; in theory, a mature child is able to consent or refuse treatment. Decision-making requires careful and reflective analysis of the main associated factors, and the approach of this problem must occur through the recognition of the maturity and autonomy that exists in the adolescents. To do so, it is necessary to “deliberate” with them. Conclusions: International guidelines recommend that adolescents participate in discussions about their illness, treatment and decision-making. However, there is no universally accepted consensus on how to assess the decision-making ability of these patients. Despite this, when possible, the adolescent should be included in a serious, honest, respectful and sincere process of deliberation.

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A sociodental approach in prosthodontic treatment decision making

Journal of Applied Oral Science ◽

10.1590/s1678-77572004000200009 ◽

2004 ◽

Vol 12 (2) ◽

pp. 127-132 ◽

Cited By ~ 4

Author(s):

Cláudio Rodrigues Leles ◽

Maria do Carmo Matias Freire

Keyword(s):

Decision Making ◽

Clinical Practice ◽

Clinical Decision Making ◽

Treatment Decision ◽

Clinical Decision ◽

Decision Making Process ◽

Evidence Based ◽

Critical Problem ◽

Practice Model ◽

Treatment Decision Making

A critical problem in the decision making process for dental prosthodontic treatment is the lack of reliable clinical parameters. This review discusses the limits of traditional normative treatment and presents guidelines for clinical decision making. There is a need to incorporate a sociodental approach to help determine patient's needs. Adoption of the evidence-based clinical practice model is also needed to assure safe and effective clinical practice in prosthetic dentistry.

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Interactive Video Assists in Clinical Decision Making

Methods of Information in Medicine ◽

10.1055/s-0038-1634516 ◽

1998 ◽

Vol 37 (02) ◽

pp. 201-205 ◽

Cited By ~ 12

Author(s):

B. E. Waitzfelder ◽

E. P. Gramlich

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Interactive Video ◽

Clinical Decision Making ◽

Treatment Options ◽

Treatment Decision ◽

Clinical Decision ◽

Medical Decision ◽

Treatment Decision Making ◽

Interactive Videodisk

AbstractThe Hawaii Quality and Cost Consortium began a project in 1993 to implement and evaluate interactive videodisk programs to assist in clinical decision-making for breast cancer. Communication problems between physicians and patients, limitations of available outcomes data and varying preferences of individual patients can result in treatment outcomes that are less than satisfactory. Shared Decision-making Programs (SDPs) were developed by the Foundation for Informed Medical Decision Making (FIMDM) in Hanover, New Hampshire, to assist in the treatment decision-making process. Utilizing interactive videodisks, the programs provide patients with clear, unbiased information about available treatment options. With this information, patients can become more active participants in making treatment decisions. The SDPs for breast cancer were implemented at two sites in Hawaii. Evaluation data from 103 patients overwhelmingly indicate that patients find the programs clear, balanced and very good or excellent in terms of the amount of information presented and overall rating.

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The Influence of Personalised Sarcoma Care (PERSARC) Prediction Modelling on Clinical Decision Making in a Multidisciplinary Setting

Sarcoma ◽

10.1155/2021/8851354 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

H. S. Femke Hagenmaier ◽

Annelies G. K. van Beeck ◽

Rick L. Haas ◽

Veroniek M. van Praag ◽

Leti van Bodegom-Vos ◽

...

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Treatment Decision ◽

Clinical Decision ◽

Patient Centered ◽

Treatment Protocols ◽

Treatment Decision Making ◽

Heterogenous Group ◽

Centered Care ◽

Made In

Background. With soft-tissue sarcoma of the extremity (ESTS) representing a heterogenous group of tumors, management decisions are often made in multidisciplinary team (MDT) meetings. To optimize outcome, nomograms are more commonly used to guide individualized treatment decision making. Purpose. To evaluate the influence of Personalised Sarcoma Care (PERSARC) on treatment decisions for patients with high-grade ESTS and the ability of the MDT to accurately predict overall survival (OS) and local recurrence (LR) rates. Methods. Two consecutive meetings were organised. During the first meeting, 36 cases were presented to the MDT. OS and LR rates without the use of PERSARC were estimated by consensus and preferred treatment was recorded for each case. During the second meeting, OS/LR rates calculated with PERSARC were presented to the MDT. Differences between estimated OS/LR rates and PERSARC OS/LR rates were calculated. Variations in preferred treatment protocols were noted. Results. The MDT underestimated OS when compared to PERSARC in 48.4% of cases. LR rates were overestimated in 41.9% of cases. With the use of PERSARC, the proposed treatment changed for 24 cases. Conclusion. PERSARC aids the MDT to optimize individualized predicted OS and LR rates, hereby guiding patient-centered care and shared decision making.

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