scholarly journals Development of a Longitudinal Diagnosis and Prognosis in Patients with Chronic Kidney Disease: Intelligent Clinical Decision-Making Scheme

2021 ◽  
Vol 18 (23) ◽  
pp. 12807
Author(s):  
Chin-Chuan Shih ◽  
Ssu-Han Chen ◽  
Gin-Den Chen ◽  
Chi-Chang Chang ◽  
Yu-Lin Shih
Keyword(s):  
Risk Factors ◽  
Clinical Decision Making ◽  
Extended Period ◽  
Clinical Decision ◽  
Longitudinal Change ◽  
Longitudinal Assessment ◽  
Cross Sectional ◽  
Essential Information ◽  
Diagnosis And Prognosis ◽  
Testing Accuracy

Previous studies on CKD patients have mostly been retrospective, cross-sectional studies. Few studies have assessed the longitudinal assessment of patients over an extended period. In consideration of the heterogeneity of CKD progression. It’s critical to develop a longitudinal diagnosis and prognosis for CKD patients. We proposed an auto Machine Learning (ML) scheme in this study. It consists of four main parts: classification pipeline, cross-validation (CV), Taguchi method and improve strategies. This study includes datasets from 50,174 patients, data were collected from 32 chain clinics and three special physical examination centers, between 2015 and 2019. The proposed auto-ML scheme can auto-select the level of each strategy to associate with a classifier which finally shows an acceptable testing accuracy of 86.17%, balanced accuracy of 84.08%, sensitivity of 90.90% and specificity of 77.26%, precision of 88.27%, and F1 score of 89.57%. In addition, the experimental results showed that age, creatinine, high blood pressure, smoking are important risk factors, and has been proven in previous studies. Our auto-ML scheme light on the possibility of evaluation for the effectiveness of one or a combination of those risk factors. This methodology may provide essential information and longitudinal change for personalized treatment in the future.

scholarly journals Diagnósticos de enfermagem de pacientes em tratamento radioterápico

2018 ◽  
Vol 12 (11) ◽  
pp. 3060
Author(s):  
Camila Marcon ◽  
Gabriela Vicari ◽  
Patricia Poltroni ◽  
Aline Maffissoni ◽  
Kauana Dall' Agnese Caregnatto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Radiation Therapy ◽  
Skin Color ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Related Factors ◽  
Cross Sectional ◽  
Color Changes ◽  
Factores De Riesgo ◽  
Nursing Diagnoses

RESUMOObjetivo: identificar a incidência dos diagnósticos de enfermagem, bem como características definidoras, fatores relacionados e fatores de risco, com base na taxonomia NANDA-I de pacientes em tratamento radioterápico. Método: trata-se de estudo quantitativo, transversal, exploratório-descritivo, realizado com 60 pacientes em um ambulatório. Resultados: identificou-se 23 Diagnósticos de Enfermagem, sendo os mais incidentes: risco de integridade da pele prejudicada (35%), mobilidade física prejudicada (15%) e eliminação urinária prejudicada (7%). As características definidoras evidenciadas foram amplitude limitada de movimentos (15,3%), incontinência e dificuldade para deglutir (7,2%). Dentre os fatores relacionados, estão dor (18,3%), desconforto (10,7%) e radiação (6%) e os fatores de risco radiação (56%), mudanças na pigmentação da pele/mudanças no turgor da pele (26,3%) e estado nutricional desequilibrado (6,3%). Conclusão: os resultados do estudo contribuem para atender às necessidades de saúde dos pacientes em tratamento radioterápico e na tomada de decisão clínica pelo enfermeiro. Descritores: Enfermagem; Oncologia; Radioterapia; Processos de Enfermagem; Diagnóstico de Enfermagem; Pesquisa em Enfermagem.ABSTRACT Objective: to identify the incidence of nursing diagnoses, as well as defining characteristics, related factors and risk factors, based on the NANDA-I taxonomy of patients undergoing radiation therapy. Method: quantitative, cross-sectional, exploratory and descriptive study, performed with 60 patients in an outpatient clinic. Results: 23 Nursing Diagnoses were identified, of which the most prevalent were risk for impaired skin integrity (35%), impaired physical mobility (15%) and impaired urinary elimination (7%). The defining characteristics were limited transfer ability (15.3%), incontinence and impaired swallowing (7.2%). The related factors were pain (18.3%), discomfort (10.7%) and radiation (6%), and the risk factors are radiation (56%), skin color changes/alteration in skin turgor (26.3%) and imbalanced nutritional state (6.3%). Conclusion: The results of the present may study contribute to meet the health needs of patients undergoing radiation therapy and clinical decision making by the nurse. Descriptors: Nursing; Oncology; Radiotherapy; Nursing Process; Nursing Diagnosis; Nursing Research.RESUMEN Objetivo: identificar la incidencia de los diagnósticos de enfermería, así como características definidoras, factores relacionados y factores de riesgo, con base en la taxonomía NANDA-I de pacientes en tratamiento radioterápico. Método: estudio cuantitativo, transversal, exploratorio-descriptivo, realizado con 60 pacientes en un ambulatorio. Resultados: se identificaron 23 Diagnósticos de Enfermería, siendo los más incidentes: riesgo de integridad de la piel perjudicada (35%), movilidad física perjudicada (15%) y eliminación urinaria perjudicada (7%). Las características definidoras evidenciadas fueron amplitud limitada de movimientos (15,3%), incontinencia y dificultad para deglutir (7,2%). Dentro de los factores relacionados, están el dolor (18,3%), el malestar (10,7%) y la radiación (6%) y los factores de riesgo radiación (56%), cambios en la pigmentación de la piel/cambios en la turgencia de la piel (26,3%) y estado nutricional desequilibrado (6,3%). Conclusión: los resultados del estudio contribuyen para atender a las necesidades de salud de los pacientes en tratamiento radioterápico y en la tomada de decisión clínica por el enfermero. Descriptores: Enfermería; Oncología Médica; Radioterapia; Proceso de Enfermería; Diagnóstico de Enfermería; Investigación en Enfermería.

scholarly journals Diagnostic accuracy of symptoms as a diagnostic tool for SARS-CoV 2 infection: a cross-sectional study in a cohort of 2,173 patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Carlos Alfonso Romero-Gameros ◽  
Tania Colin-Martínez ◽  
Salomón Waizel-Haiat ◽  
Guadalupe Vargas-Ortega ◽  
Eduardo Ferat-Osorio ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Diagnostic Tool ◽  
Clinical Decision Making ◽  
Multivariate Logistic Regression Analysis ◽  
Clinical Decision ◽  
Cross Sectional Study ◽  
World Health ◽  
Likelihood Ratios ◽  
Cross Sectional ◽  
Health Organization

Abstract Background The SARS-CoV-2 pandemic continues to be a priority health problem; According to the World Health Organization data from October 13, 2020, 37,704,153 confirmed COVID-19 cases have been reported, including 1,079,029 deaths, since the outbreak. The identification of potential symptoms has been reported to be a useful tool for clinical decision-making in emergency departments to avoid overload and improve the quality of care. The aim of this study was to evaluate the performances of symptoms as a diagnostic tool for SARS -CoV-2 infection. Methods An observational, cross-sectional, prospective and analytical study was carried out, during the period of time from April 14 to July 21, 2020. Data (demographic variables, medical history, respiratory and non-respiratory symptoms) were collected by emergency physicians. The diagnosis of COVID-19 was made using SARS-CoV-2 RT-PCR. The diagnostic accuracy of these characteristics for COVID-19 was evaluated by calculating the positive and negative likelihood ratios. A Mantel-Haenszel and multivariate logistic regression analysis was performed to assess the association of symptoms with COVID-19. Results A prevalence of 53.72% of SARS-CoV-2 infection was observed. The symptom with the highest sensitivity was cough 71%, and a specificity of 52.68%. The symptomatological scale, constructed from 6 symptoms, obtained a sensitivity of 83.45% and a specificity of 32.86%, taking ≥2 symptoms as a cut-off point. The symptoms with the greatest association with SARS-CoV-2 were: anosmia odds ratio (OR) 3.2 (95% CI; 2.52–4.17), fever OR 2.98 (95% CI; 2.47–3.58), dyspnea OR 2.9 (95% CI; 2.39–3.51]) and cough OR 2.73 (95% CI: 2.27–3.28). Conclusion The combination of ≥2 symptoms / signs (fever, cough, anosmia, dyspnea and oxygen saturation < 93%, and headache) results in a highly sensitivity model for a quick and accurate diagnosis of COVID-19, and should be used in the absence of ancillary diagnostic studies. Symptomatology, alone and in combination, may be an appropriate strategy to use in the emergency department to guide the behaviors to respond to the disease. Trial registration Institutional registration R-2020-3601-145, Federal Commission for the Protection against Sanitary Risks 17 CI-09-015-034, National Bioethics Commission: 09 CEI-023-2017082.

Standardized Synoptic Cancer Pathology Reports — So What and Who Cares?: A Population-Based Satisfaction Survey of 970 Pathologists, Surgeons, and Oncologists

2013 ◽  
Vol 137 (11) ◽  
pp. 1599-1602 ◽  
Author(s):  
Sara Lankshear ◽  
John Srigley ◽  
Thomas McGowan ◽  
Marta Yurcan ◽  
Carol Sawka
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Physician Satisfaction ◽  
Cross Sectional ◽  
Cancer Pathology ◽  
Report Turnaround Time ◽  
Significant Difference ◽  
Pathology Reporting ◽  
The Impact

Context.—Cancer Care Ontario implemented synoptic pathology reporting across Ontario, impacting the practice of pathologists, surgeons, and medical and radiation oncologists. The benefits of standardized synoptic pathology reporting include enhanced completeness and improved consistency in comparison with narrative reports, with reported challenges including increased workload and report turnaround time. Objective.—To determine the impact of synoptic pathology reporting on physician satisfaction specific to practice and process. Design.—A descriptive, cross-sectional design was utilized involving 970 clinicians across 27 hospitals. An 11-item survey was developed to obtain information regarding timeliness, completeness, clarity, and usability. Open-ended questions were also employed to obtain qualitative comments. Results.—A 51% response rate was obtained, with descriptive statistics reporting that physicians perceive synoptic reports as significantly better than narrative reports. Correlation analysis revealed a moderately strong, positive relationship between respondents' perceptions of overall satisfaction with the level of information provided and perceptions of completeness for clinical decision making (r = 0.750, P &lt; .001) and ease of finding information for clinical decision making (r = 0.663, P &lt; .001). Dependent t tests showed a statistically significant difference in the satisfaction scores of pathologists and oncologists (t169 = 3.044, P = .003). Qualitative comments revealed technology-related issues as the most frequently cited factor impacting timeliness of report completion. Conclusion.—This study provides evidence of strong physician satisfaction with synoptic cancer pathology reporting as a clinical decision support tool in the diagnosis, prognosis, and treatment of cancer patients.

scholarly journals Factors Influencing Physicians' Clinical Decision-making at Upazila Health Complexes in Bangladesh

2020 ◽  
Vol 3 (4) ◽  
pp. 125-133
Author(s):  
M. Aminul Islam ◽  
M. Abdul Awal
Keyword(s):  
Decision Making ◽  
Social Networks ◽  
Clinical Decision Making ◽  
Average Length ◽  
Clinical Decision ◽  
Primary Data ◽  
Decision Making Process ◽  
Cross Sectional ◽  
The Right ◽  
Consultation Session

ABSTRACT Introduction Selecting the most appropriate treatment for each patient is the key activity in patient-physician encounters and providing healthcare services. Achieving desirable clinical goals mostly depends on making the right decision at the right time in any healthcare setting. But little is known about physicians' clinical decision-making in the primary care setting in Bangladesh. Therefore, this study explored the factors that influence decisions about prescribing medications, ordering pathologic tests, counseling patients, average length of patient visits in a consultation session, and referral of patients to other physicians or hospitals by physicians at Upazila Health Complexes (UHCs) in the country. It also explored the structure of physicians' social networks and their association with the decision-making process. Methods This was a cross-sectional descriptive study that used primary data collected from 85 physicians. The respondents, who work at UHCs in the Rajshahi Division, were selected purposively. The collected data were analyzed with descriptive statistics including frequency, percentage, one-way analysis of variance, and linear regression to understand relationships among the variables. Results The results of the study reveal that multiple factors influence physicians' decisions about prescribing medications, ordering pathologic tests, length of visits, counseling patients, and referring patients to other physicians or hospitals at the UHCs. Most physicians prescribe drugs to their patients, keeping in mind their purchasing capacity. Risk of violence by patients' relatives and better management are the two key factors that influence physicians' referral decisions. The physicians' professional and personal social networks also play an influential role in the decision-making process. It was found that physicians dedicate on average 16.17 minutes to a patient in a consultation session. The length of visits is influenced by various factors including the distance between the physicians' residence and their workplace, their level of education, and the number of colleagues with whom they have regular contact and from whom they can seek help. Conclusion The results of the study have yielded some novel insights about the complexity of physicians' everyday tasks at the UHCs in Bangladesh. The results would be of interest to public health researchers and policy makers.

scholarly journals Relationships between emotional schemas, mindfulness, self-compassion and unconditional self-acceptance on the regulation of psychological needs

2020 ◽  
Vol 23 (2) ◽  
Author(s):  
Bruno Faustino ◽  
António Branco Vasco ◽  
Ana Nunes Silva ◽  
Telma Marques
Keyword(s):  
Experiential Avoidance ◽  
Clinical Decision Making ◽  
Psychological Symptoms ◽  
Well Being ◽  
Clinical Decision ◽  
Psychological Needs ◽  
Self Report ◽  
Cross Sectional ◽  
Self Compassion ◽  
Self Acceptance

Emotional schemas are pervasive mental structures associated with a wide array of psychological symptoms, while mindfulness, self-compassion, and self-acceptance are viewed as adaptive psychological constructs. Psychological needs may be described as the cornerstone of mental health and well-being. However, a study of the relationships between emotional schemas, mindfulness, self-compassion, and self-acceptance with psychological needs was not performed. For this purpose, 250 subjects (M=20.67, SD=4.88, Male=33, Female=217), were evaluated through self-report questionnaires, in a cross-sectional design. Negative correlations were found between emotional schemas, mindfulness, self-compassion, unconditional self-acceptance, and psychological needs. Symptomatology was positively correlated with emotional schemas. Mindfulness, self-compassion, and unconditional self-acceptance predicted the regulation of psychological needs and mediated the relationship between emotional schemas and psychological needs. Emotional schemas may be associated with a tendency for experiential avoidance of internal reality, self-rejection/shame and self-criticism which may impair the regulation of psychological needs. These variables may be targets of integrative case conceptualization and clinical decision making focused on patient’s timings, styles of communication and needs.

scholarly journals Impact of 123I-MIBG Scintigraphy on Clinical Decision-Making in Pheochromocytoma and Paraganglioma

2019 ◽  
Vol 104 (9) ◽  
pp. 3812-3820 ◽  
Author(s):  
Dipti Rao ◽  
Anouk van Berkel ◽  
Ianthe Piscaer ◽  
William F Young ◽  
Lucinda Gruber ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Diagnostic Value ◽  
Mibg Scintigraphy ◽  
Cross Sectional ◽  
First Choice ◽  
Cross Sectional Imaging ◽  
The Cost ◽  
The Impact

Abstract Context Cross-sectional imaging with CT or MRI is regarded as a first-choice modality for tumor localization in patients with pheochromocytoma and paraganglioma (PPGL). 123I-labeled metaiodobenzylguanidine (123I-MIBG) is widely used for functional imaging but the added diagnostic value is controversial. Objective To establish the virtual impact of adding 123I-MIBG scintigraphy to CT or MRI on diagnosis and treatment of PPGL. Design International multicenter retrospective study. Intervention None. Patients Two hundred thirty-six unilateral adrenal, 18 bilateral adrenal, 48 unifocal extra-adrenal, 12 multifocal, and 26 metastatic PPGL. Main Outcome Measures Patients underwent both anatomical imaging (CT and/or MRI) and 123I-MIBG scintigraphy. Local imaging reports were analyzed centrally by two independent observers who were blinded to the diagnosis. Imaging-based diagnoses determined by CT/MRI only, 123I-MIBG only, and CT/MRI combined with 123I-MIBG scintigraphy were compared with the correct diagnoses. Results The rates of correct imaging-based diagnoses determined by CT/MRI only versus CT/MRI plus 123I-MIBG scintigraphy were similar: 89.4 versus 88.8%, respectively (P = 0.50). Adding 123I-MIBG scintigraphy to CT/MRI resulted in a correct change in the imaging-based diagnosis and ensuing virtual treatment in four cases (1.2%: two metastatic instead of nonmetastatic, one multifocal instead of single, one unilateral instead of bilateral adrenal) at the cost of an incorrect change in seven cases (2.1%: four metastatic instead of nonmetastatic, two multifocal instead of unifocal and one bilateral instead of unilateral adrenal). Conclusions For the initial localization of PPGL, the addition of 123I-MIBG scintigraphy to CT/MRI rarely improves the diagnostic accuracy at the cost of incorrect interpretation in others, even when 123I-MIBG scintigraphy is restricted to patients who are at risk for metastatic disease. In this setting, the impact of 123I-MIBG scintigraphy on clinical decision-making appears very limited.

Reversibility of Delirium in Palliative Care (DRAFT)

2018 ◽  
Author(s):  
Tiffany Shaw ◽  
Eric Prommer
Keyword(s):  
Risk Factors ◽  
Decision Making ◽  
Palliative Care ◽  
Clinical Case ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Factors Associated ◽  
Frequent Event ◽  
Study Intervention

Delirium is a frequent event in patients with advanced cancer. Untreated delirium affects assessment of symptoms, impairs communication including participation in clinical decision-making. This study used specific diagnostic criteria for delirium and prospectively identified precipitating causes of delirium. The study identified factors associated with reversible and irreversible delirium. Impact of delirium on prognosis was evaluated. This chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case. Topics covered include delirium, neoplasms, palliative care, polypharmacy, risk factors, and therapeutics.

scholarly journals Host Inflammatory Biomarkers of Disease Severity in Pediatric Community-Acquired Pneumonia: A Systematic Review and Meta-analysis

2019 ◽  
Vol 6 (12) ◽  
Author(s):  
Catarina D Fernandes ◽  
María B Arriaga ◽  
Maria Carolina M Costa ◽  
Maria Clara M Costa ◽  
Maria Heloina M Costa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Disease Severity ◽  
Clinical Decision Making ◽  
Meta Analysis ◽  
Clinical Decision ◽  
Serum Levels ◽  
Community Acquired Pneumonia ◽  
Inflammatory Biomarkers ◽  
Cross Sectional ◽  
Cell Counts

Abstract Background Community-acquired pneumonia (CAP) is the leading cause of death in children. Identification of reliable biomarkers offers the potential to develop a severity quantitative score to assist in clinical decision-making and improve outcomes. Methods A systematic review and meta-analysis was performed in PubMed and EMBASE on November 13, 2018, to examine the association between host inflammatory biomarkers and CAP severity in children. The inclusion criteria were case–control, cross-sectional, and cohort studies that examined candidate serum biomarkers. We extracted outcomes of interest, means, and standardized mean differences (SMDs) of plasma and serum levels of biomarkers together with information on disease severity. Meta-analysis was performed. This review was registered in the PROSPERO international registry (CRD42019123351). Results Two hundred seventy-two abstracts were identified, and 17 studies were included. Among the biomarkers evaluated, levels of C-reactive protein (CRP; SMD, 0.63; 95% confidence interval [CI], 0.35 to 0.91), interleukin (IL)-6 (SMD, 0.46; 95% CI, 0.25 to 0.66), IL-8 (SMD, 0.72; 95% CI, 0.15 to 1.29), neutrophil count (SMD, 0.27; 95% CI, 0.07 to 0.47), and procalcitonin (SMD, 0.68; 95% CI, 0.20 to 1.15) were substantially increased in severe CAP. In contrast, IL-2 concentrations (SMD, –0.24; 95% CI, –0.45 to –0.03) were higher in nonsevere CAP. Study heterogeneity was reported to be high (I2 &gt; 75%), except for IL-2, IL-5, IL-6, and IL-12p70, which were classified as moderate (I2 = 50%–74%). Only neutrophil and white blood cell counts were described by studies exhibiting a low level of heterogeneity. Conclusions Our results suggest that host biomarkers, and especially CRP, IL-6, IL-8, and procalcitonin levels, have the potential to predict severe CAP in pediatric populations.

A comparison of patients' and physicians' expectations regarding precision oncology tests.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 1568-1568
Author(s):  
Navdeep Dehar ◽  
Tasnima Abedin ◽  
Patricia A. Tang ◽  
D. Gwyn Bebb ◽  
Winson Y. Cheung
Keyword(s):  
Decision Making ◽  
Genetic Testing ◽  
Cancer Biology ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Survey Study ◽  
Precision Oncology ◽  
Diagnosis And Prognosis ◽  
Genetic Test Results ◽  
Survey Responses

1568 Background: With the increasing number and frequency of biomarker and genetic tests that are offered to patients with cancer, it is important to ensure that they fully understand the implications of these tests. In this survey study, we aimed to compare the attitudes and expectations of patients and cancer physicians about the role of biomarker and genetic testing in clinical decision-making. Methods: Two separate, complimentary, self-administered questionnaires for cancer patients and their physicians, respectively, were collected in Calgary, Alberta, Canada. Survey responses from patients were subsequently matched with those of their corresponding oncologists to form patient–oncologist dyads. We determined the concordance rates between responses of patients and those of their oncologists. Results: A total of 113 patients and 15 physicians participated in the study from July to September 2019. Patients demonstrated good understanding of general cancer biology (79%) and diagnostic processes (91%) associated with precision oncology. About 70% patients were willing to undergo minor procedures, and participate in research involving biomarker or genetic testing; however, this was over-estimated by their physicians in 82% of cases. Many patients felt that their tumor should be tested to guide treatment (70%) and were not bothered by potential delays in treatment due to testing (23%). These views from patients were largely shared by their oncologists (concordance 64%). While only 28% patients thought that they had enough knowledge to make informed decisions, majority (68%) said that they needed more information. Importantly, knowledge and expectations regarding the applications of biomarker or genetic test results on actual diagnosis and prognosis were grossly discrepant between patients and their oncologists (concordance 26% and 36%, respectively). Conclusions: Patients and cancer physicians tend to be aware of the advances in precision oncology and are willing to participate in biomarker and genetic testing and research. However, they do not consistently agree about the roles and applications of these tests, which may result in misplaced expectations. Strategies to improve education and communication are needed to align these expectations and improve the quality of clinical decision-making.

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