scholarly journals U SO CARE—The Impact of Cardiac Ultrasound during Cardiopulmonary Resuscitation: A Prospective Randomized Simulator-Based Trial

2021 ◽  
Vol 10 (22) ◽  
pp. 5218
Author(s):  
Karim Zöllner ◽  
Timur Sellmann ◽  
Dietmar Wetzchewald ◽  
Heidrun Schwager ◽  
Corvin Cleff ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Diagnostic Accuracy ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Point Of Care Ultrasound ◽  
Correct Treatment ◽  
Inappropriate Treatment ◽  
Hands On ◽  
Rhythm Analysis ◽  
The Impact

Background: Actual cardiopulmonary resuscitation (CPR) guidelines recommend point-of-care ultrasound (POCUS); however, data on POCUS during CPR are sparse and conflicting. This randomized trial investigated the effects of POCUS during CPR on team performance and diagnostic accuracy. Methods: Intensive Care and Emergency Medicine residents performed CPR with or without available POCUS in simulated cardiac arrests. The primary endpoint was hands-on time. Data analysis was performed using video recordings. Results: Hands-on time was 89% (87–91) in the POCUS and 92% (89–94) in the control group (difference 3, 95% CI for difference 2–4, p < 0.001). POCUS teams had delayed defibrillator attachments (33 vs. 26 sec, p = 0.017) and first rhythm analysis (74 vs. 52 sec, p = 0.001). Available POCUS was used in 71%. Of the POCUS teams, 3 stated a POCUS-derived diagnosis, with 49 being correct and 42 followed by a correct treatment decision. Four teams made a wrong diagnosis and two made an inappropriate treatment decision. Conclusions: POCUS during CPR resulted in lower hands-on times and delayed rhythm analysis. Correct POCUS diagnoses occurred in 52%, correct treatment decisions in 44%, and inappropriate treatment decisions in 2%. Training on POCUS during CPR should focus on diagnostic accuracy and maintenance of high-quality CPR.

scholarly journals INNV-11. GLIOBLASTOMA IN THE OLDER PERSON – HOW DO WE DECIDE ON TREATMENT?

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii118-ii118
Author(s):  
Cressida Lorimer ◽  
Anthony Chalmers ◽  
Margaret Johnson ◽  
Juliet Brock
Keyword(s):  
Screening Test ◽  
Older Patients ◽  
Performance Status ◽  
Treatment Options ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Clinical Factor ◽  
Cross Sectional ◽  
Multiple Treatment ◽  
The Impact

Abstract The incidence of glioblastoma (GBM) peaks in the 7th and 8th decades of life. Multiple treatment options exist for older patients with GBM however, the assessment of older patients prior to treatment decisions is poorly researched and lacks standardization. In order to address this issue we performed a cross-sectional electronic survey distributed to all full members of the Society for Neuro-Oncology. There were 116 respondents from a total of 1515 recipients (8% response rate). The survey was distributed during the peak of COVID-19 which undoubtedly affected response rates. 97% of respondents were clinicians with 86% academic. 72% had been in practice &gt; 10 years and the majority saw 5–10 new GBM cases per month. 95% of respondents were from the USA, with involvement from Japan, Australia, Canada and Italy. 37% of respondents routinely perform a cognitive or frailty screening test. Of these, MMSE and MoCA were the most commonly used. Of those who performed a screening test, the majority reported that the results changed their treatment decision in approximately 50% of cases. 50% of respondents have access to a multidisciplinary team during their clinic, with physical therapy being the most available. When making treatment decisions, participants ranked performance status as the most important clinical factor. Considering the heterogeneity of this patient population, we argue that performance status is a crude measure of vulnerability within this cohort. In the first survey of this kind, we have shown a disparity in assessment techniques across the international neuro-oncology field and the impact performing a cognitive screen has on decision making. Older patients with GBM represent a unique clinical scenario because of the complexity of distinguishing neuro- oncology related symptoms from general frailty. There is a need for specific geriatric assessment models tailored to the older neuro-oncology population in order to facilitate treatment decisions.

Impact of CCP test on personalizing treatment decisions: Results from a prospective registry of newly diagnosed prostate cancer patients.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 63-63
Author(s):  
Neal D. Shore ◽  
Judd Boczko ◽  
Naveen Kella ◽  
Brian Joseph Moran ◽  
E. David Crawford ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Patient Treatment ◽  
Treatment Recommendation ◽  
Interventional Treatment ◽  
Newly Diagnosed ◽  
Actual Treatment ◽  
Therapy Recommendation ◽  
The Impact

63 Background: The cell cycle progression (CCP) test is a validated molecular assay that assesses risk of prostate cancer−specific disease progression and mortality when combined with standard clinicopathologic parameters. PROCEDE−1000 is the largest prospective registry to evaluate CCP test impact on personalizing prostate cancer treatment. Results of an interim analysis are presented. Methods: Untreated patients with newly diagnosed (≤6 months), clinically localized prostate adenocarcinoma were enrolled (n=816). The physician’s initial therapy recommendation (pre−CCP) was recorded on the first questionnaire. The CCP test was then conducted on prostate biopsy tissue. Three post−CCP questionnaires recorded the physician’s revised treatment recommendation, physician/patient treatment decision, and actual treatment administered. Changes in treatments between the pre-CCP and post−CCP questionnaires demonstrated the impact of CCP testing on treatment decisions at each stage. Results: Visual analog scale measurements indicated a significant increase (p=0.0125) in the physician’s likelihood of recommending non−interventional treatment post−CCP test; there was an increase in active surveillance from the initial interventional therapy recommendation. From pre−CCP therapy recommendation, the CCP score caused a change in actual treatment administered in 44% of patients; 72% of changes were reductions in treatment. Reductions occurred in radical prostatectomy (27%), radiation therapy (44% primary; 56% adjuvant), brachytherapy (46% interstitial; 66% HDR) and hormonal therapy (33% neoadjuvant; 68% concurrent) treatments. While 35.9% of patients were recommended for conservative management pre−CCP testing, there was a 6.5% increase in non−interventional treatments during actual follow−up. Overall, there was a significant reduction in the number of treatment options at each successive evaluation (p<0.0001). Conclusions: The CCP risk assessment score has a significant impact in helping physicians and patients reach consensus on an appropriate personalized treatment decision, often with major reductions in interventional treatment burden. Clinical trial information: NCT01954004.

scholarly journals Molecular Profiling-Selected Therapy for Treatment of Advanced Pancreaticobiliary Cancer: A Retrospective Multicenter Study

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Ron Epelbaum ◽  
Einat Shacham-Shmueli ◽  
Baruch Klein ◽  
Abed Agbarya ◽  
Baruch Brenner ◽  
...  
Keyword(s):  
Null Hypothesis ◽  
Impact Analysis ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Molecular Profiling ◽  
Outcome Analysis ◽  
Multicenter Cohort Study ◽  
Pancreaticobiliary Cancer ◽  
The Impact ◽  
Guided Therapy

This multicenter cohort study assessed the impact of molecular profiling (MP) on advanced pancreaticobiliary cancer (PBC). The study included 30 patients treated with MP-guided therapy after failing ≥1 therapy for advanced PBC. Treatment was considered as having benefit for the patient if the ratio between the longest progression-free survival (PFS) on MP-guided therapy and the PFS on the last therapy before MP was ≥1.3. The null hypothesis was that ≤15% of patients gain such benefit. Overall, ≥1 actionable (i.e., predictive of response to specific therapies) biomarker was identified/patient. Immunohistochemistry (the most commonly used method for guiding treatment decisions) identified 1–6 (median: 4) actionable biomarkers per patient. After MP, patients received 1–4 (median: 1) regimens/patient (most commonly, FOLFIRI/XELIRI). In a decision-impact analysis, of the 27 patients for whom treatment decisions before MP were available, 74.1% experienced a treatment decision change in the first line after MP. Twenty-four patients were evaluable for clinical outcome analysis; in 37.5%, the PFS ratio was ≥1.3. In one-sided exact binomial test versus the null hypothesis,P= 0.0015; therefore, the null hypothesis was rejected. In conclusion, our analysis demonstrated the feasibility, clinical decision impact, and potential clinical benefits of MP-guided therapy in advanced PBC.

Improving the quality of breast cancer surgical treatment decisions.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6024-6024
Author(s):  
Steven J. Katz ◽  
Jennifer J. Griggs ◽  
Nancy K. Janz ◽  
Sarah T. Hawley
Keyword(s):  
Breast Cancer ◽  
Surgical Treatment ◽  
Early Stage ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Breast Cancer Patients ◽  
Chi Square ◽  
Treatment Decision Making ◽  
Strongly Agree ◽  
The Impact

6024 Background: Ensuring breast cancer treatment decisions are high quality (i.e., informed and preference-concordant) is a key component of patient centered care. Methods: A web-based decision tool, including an interactive preference clarification exercise, was developed over a one-year period with input from health communication experts, clinicians, and women with breast cancer. Newly diagnosed early stage breast cancer patients from two cancer centers were recruited and randomized to view the tool before or after completing a survey. Mean scores for key outcome measures, including surgical treatment knowledge (4 true/false questions), decision satisfaction (12 questions each with a 5-point Likert scale from strongly agree to strongly disagree), and preference-concordant decisions, were compared between the groups using t-tests. Concordance between preferences and surgical choices was evaluated using the chi-square test. Results: 110 subjects were recruited and 105 completed the study. Their mean age was 57 years, 60% had a college degree or more, and 81% were white. Those viewing the website first had higher scores on several decision outcomes than those taking the survey first (Table). Knowledge scores were also higher among those viewing the website before the survey (3.0 vs. 2.61, p=.23). The risk of recurrence was the most important treatment attribute, followed by retaining the natural breast, in both groups. Concordance between treatment choice and computer generated treatment was 65% for website first and 61% for survey first groups. Conclusions: A tool focused on improving knowledge and preference-concordant decisions produced positive results on breast cancer surgical treatment decision making. Further work should assess the impact of the tool in larger and more diverse populations. [Table: see text]

scholarly journals Analysis of an obstetrics point-of-care ultrasound training program for healthcare practitioners in Zanzibar, Tanzania

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Elizabeth A. Hall ◽  
Danielle Matilsky ◽  
Rachel Zang ◽  
Naomasa Hase ◽  
Ali Habibu Ali ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Training Program ◽  
Point Of Care ◽  
Course Completion ◽  
Point Of Care Ultrasound ◽  
Care Providers ◽  
Final Exam ◽  
Training Requirements ◽  
Hands On ◽  
The Impact

Abstract Background A point-of-care ultrasound education program in obstetrics was developed to train antenatal healthcare practitioners in rural Zanzibar. The study group consisted of 13 practitioners with different training backgrounds: physicians, clinical officers, and nurse/midwives. Trainees received an intensive 2-week antenatal ultrasound course consisting of lectures and hands-on practice followed by 6 months of direct supervision of hands-on scanning and bedside education in their clinical practice environments. Trainees were given a pre-course written exam, a final exam at course completion, and practical exams at 19 and 27 weeks. Trainees were expected to complete written documentation and record ultrasound images of at least 75 proctored ultrasounds. The objective of this study was prospectively to analyze the success of a longitudinal point-of-care ultrasound training program for antepartum obstetrical care providers in Zanzibar. Results During the 6-month course, trainees completed 1338 ultrasound exams (average 99 exams per trainee with a range of 42–128 and median of 109). Written exam scores improved from a mean of 33.7% (95% CI 28.6–38.8%) at pre-course assessment to 77.5% (95% CI 71–84%) at course completion (P < 0.0001). Practical exam mean scores improved from 71.2% at course midpoint (95% CI 62.3–80.1%) to 84.7% at course completion (95% Cl 78.5–90.8%) (P < 0.0005). Eight of the 13 trainees completed all training requirements including 75 proctored ultrasound exams. Conclusion Trainees improved significantly on all measures after the training program. 62% of the participants completed all requirements. This relatively low completion rate reflects the challenges of establishing ultrasound capacity in this type of setting. Further study is needed to determine trainees’ long-term retention of ultrasound skills and the impact of the program on clinical practice and health outcomes.

scholarly journals Randomized study of effectiveness of computerized ultrasound simulators for an introductory course for residents in Brazil

2016 ◽  
Vol 13 ◽  
pp. 16 ◽  
Author(s):  
Jack Philip Silva ◽  
Trevor Plescia ◽  
Nathan Molina ◽  
Ana Claudia de Oliveira Tonelli ◽  
Mark Langdorf ◽  
...  
Keyword(s):  
Point Of Care ◽  
Image Acquisition ◽  
Simulator Training ◽  
Point Of Care Ultrasound ◽  
Ultrasound Simulation ◽  
Live Model ◽  
Hands On ◽  
Model Training ◽  
The Impact ◽  
Experimental Group

Purpose: This study aimed to assess the impact of ultrasound simulation (SonoSim) on educational outcomes of an introductory point-of-care ultrasound course compared to hands-on training with live models alone. Methods: Fifty-three internal medicine residents without ultrasound experience were randomly assigned to control or experimental groups. They participated in an introductory point-of-care ultrasound course covering eight topics in eight sessions from June 23, 2014 until July 18, 2014. Both participated in lecture and hands-on training, but experimental group received an hour of computerized simulator training instead of a second hour of hands-on training. We assessed clinical knowledge and image acquisition with written multiple-choice and practical exams, respectively. Of the 53 enrolled, 40 participants (75.5%) completed the course and all testing. Results: For the 30-item written exam, mean score of the experimental group was 23.1±3.4 (n=21) vs. 21.8±4.8 (n=19), (P>0 .05). For the practical exam, mean score for both groups was 8.7 out of 16 (P>0 .05). Conclusion: The substitution of eight hours of ultrasound simulation training for live model scanning in a 24 hour training course did not enhance performance on written and image acquisition tests in an introductory ultrasound course for residents. This result suggests that ultrasound simulation technology used as a substitute for live model training on an hour-for-hour basis, did not improve learning outcomes. Further investigation into simulation as a total replacement for live model training will provide a clearer picture of the efficacy of ultrasound simulators in medical education.

scholarly journals The impact of a multidisciplinary small renal mass clinic on patient treatment decisions

2021 ◽  
Vol 16 (2) ◽  
Author(s):  
Danielle Earis ◽  
Chris Wall ◽  
Nicolette Sinclair ◽  
Trustin Domes ◽  
Kunal Jana
Keyword(s):  
Decision Making ◽  
Watchful Waiting ◽  
Irreversible Electroporation ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Patient Treatment ◽  
Control Group ◽  
Treatment Decision Making ◽  
The Impact ◽  
Historic Cohort

Introduction: Small renal masses (SRMs) are managed with active surveillance (AS), thermal ablation (TA), irreversible electroporation (IRE), or surgery, depending on patient and tumor factors. A novel SRM multidisciplinary clinic (SRMC), involving urologists and interventional radiologists, was established to provide patients with information on treatments options. The objective of this study was to evaluate the impact of the SRMC on treatment decision-making Methods: Demographics, tumor characteristics, and treatment decisions were prospectively collected on patients (n=216) attending the SRMC between 2016 and 2019. A retrospective historic cohort (n=238) seen by urologists was used as a control group. Key variables were analyzed and compared. Patient satisfaction (n=27) was surveyed and responses were summarized and explored. Results: Mean age, tumor size, and pathology was similar between groups; however, the SRMC cohort had more male patients (65.7% vs. 53.8%, p=0.009). Chosen treatment modality differed significantly between cohorts (p<0.0001). Patients in the historic cohort were treated by AS (41.5%), surgery (37.9%), TA (11.9%), watchful waiting (7.9%), and IRE (0.8%). SRMC patients were treated by TA (42.2%), AS (26.7%), surgery (21.3%), IRE (7.6%), and watchful waiting (2.2%). Post-hoc analysis revealed statistically significant differences in proportions of AS, TA, IRE, and surgery between cohorts. Patients reported high satisfaction with the collaborative approach. Conclusions: A multidisciplinary approach may have an impact on patient treatment decision-making for SRMs. Consultations involving a urologist and an interventional radiologist resulted in more TA and IRE and less AS and surgery. Future studies should evaluate if these findings occur in other centers.

Information Behavior Factors Related to Satisfaction with Treatment Decisions in Parents of Children with Cancer (Preprint)

2018 ◽  
Author(s):  
Makiko Watanabe
Keyword(s):  
Health Literacy ◽  
Information Sources ◽  
Information Behavior ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Medical Institution ◽  
Information Utilization ◽  
Critical Health Literacy ◽  
Satisfaction With Treatment ◽  
Attending Physician

BACKGROUND Information behavior studies in modern medicine are indispensable not only for medical professionals but also in considering health outcomes for patients and health consumers. However, quantitative surveys do not provide sufficient information, and the medical information available on the Internet has not been analyzed in detail. OBJECTIVE The purpose of this study was to examine the relationship between information behavior and satisfaction with treatment decisions in patients and their family members and explore the characteristics of information behavior involved in treatment decisions. METHODS A retrospective, cross-sectional survey was conducted using a questionnaire (58 respondents, response rate 59.2%) for 105 parents of children with cancer at a children’s hospital in Japan. Multiple regression analysis was performed to determine whether information behavior influenced satisfaction with treatment decisions, and correlation analysis was performed to examine the relationships between information behaviors. The analysis included 15 information sources and information behavior measured as the communicative health literacy, critical health literacy, and Shared Decision Making measured using the Functional, Communicative and Critical Health Literacy Scale and the Treatment Decision Satisfaction Scale consisting of 6 items. RESULTS The results regarding the RQ1 showed that the attending physician (P = .044), medical institution websites (P = .038), medical books/scientific papers (including those published in English; P = .020), and communicative health literacy (which reflects information utilization capability; P = .048), influenced satisfaction with treatment decisions. The results regarding the RQ2 showed that parents who used the attending physician as an information source did not receive information from other sources apart from a hospital medical professional. On the other hand, parents who used medical institution websites as information sources received various descriptive information. CONCLUSIONS We identified Internet-based information sources that influenced satisfaction with treatment decisions. We identified that the parent's information behavior tended to have a positive influence on the treatment decision when the attending physician and the medical institution’s Health Practitioner, HP, were the information sources, or when they recognized that there was a high communicative HL and utilized the information. Furthermore, the variables used to measure information behavior were divided into several groups based on association. Regarding satisfaction with treatment decisions correlating with each other, information behavior reflected the possibility of establishing links with information sources with direct influence, related information sources, and information utilization capability.

scholarly journals The role of point-of-care ultrasound in the diagnosis of pericardial effusion: a single academic center retrospective study

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Matthew G. Hanson ◽  
Barry Chan
Keyword(s):  
Pericardial Effusion ◽  
Point Of Care ◽  
Physical Exam ◽  
Right Atrial ◽  
Point Of Care Ultrasound ◽  
X Ray ◽  
Average Systolic Blood Pressure ◽  
Time To Diagnosis ◽  
Clinically Significant ◽  
The Impact

Abstract Background Symptomatic pericardial effusion (PCE) presents with non-specific features and are often missed on the initial physical exam, chest X-ray (CXR), and electrocardiogram (ECG). In extreme cases, misdiagnosis can evolve into decompensated cardiac tamponade, a life-threatening obstructive shock. The purpose of this study is to evaluate the impact of point-of-care ultrasound (POCUS) on the diagnosis and therapeutic intervention of clinically significant PCE. Methods In a retrospective chart review, we looked at all patients between 2002 and 2018 at a major Canadian academic hospital who had a pericardiocentesis for clinically significant PCE. We extracted the rate of presenting complaints, physical exam findings, X-ray findings, ECG findings, time-to-diagnosis, and time-to-pericardiocentesis and how these were impacted by POCUS. Results The most common presenting symptom was dyspnea (64%) and the average systolic blood pressure (SBP) was 120 mmHg. 86% of people presenting had an effusion > 1 cm, and 89% were circumferential on departmental echocardiogram (ECHO) with 64% having evidence of right atrial systolic collapse and 58% with early diastolic right ventricular collapse. The average time-to-diagnosis with POCUS was 5.9 h compared to > 12 h with other imaging including departmental ECHO. Those who had the PCE identified by POCUS had an average time-to-pericardiocentesis of 28.1 h compared to > 48 h with other diagnostic modalities. Conclusion POCUS expedites the diagnosis of symptomatic PCE given its non-specific clinical findings which, in turn, may accelerate the time-to-intervention.

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