scholarly journals Variations between two 24-hour urine collections in patients

2013 ◽  
Vol 6 (1) ◽  
pp. 30 ◽  
Author(s):  
Madhur Nayan ◽  
Mohamed A. Elkoushy ◽  
Sero Andonian
Keyword(s):  
Clinical Decision Making ◽  
Clinical Decision ◽  
Metabolic Evaluation ◽  
Normal Limits ◽  
A Value ◽  
Two Samples ◽  
History Of ◽  
The Absolute ◽  
The Difference ◽  
Urinary Parameters

Introduction: The current Canadian Urological Association (CUA)guideline recommends two 24-hour urine collections in the metabolic evaluation for patients with urolithiasis. The aim of the present study was to compare two consecutive 24-hour urine collections in patients with a history of urolithiasis presenting to a tertiary stone clinic.Methods: We retrospectively reviewed 188 patients who had two24-hour collections upon presentation between January 2010 and December 2010. Samples were collected on consecutive days and examined for the following 11 urinary parameters: volume, creatinine, sodium, calcium, uric acid, citrate, oxalate, potassium, phosphorous, magnesium and urea nitrogen. For each parameter, the absolute value of the difference between the two samples rather than the direct difference was compared with zero. Similarly, the percent difference between samples was calculated for each parameter.Results: The means of the absolute differences between the twosamples were significantly different for all 11 urinary parameters(p < 0.0001). The percent differences for all urinary parametersranged from 20.5% to 34.2%. Furthermore, 17.1% to 47.6% ofpatients had a change from a value within normal limits to anabnormal value, or vice-versa. Significance was maintained when patients with incomplete or over-collections were excluded.Conclusions: Significant variations among the two 24-hour urinecollections were observed in all of the 11 urinary parameters analyzed. This variation may change clinical decision-making in up to 47.6% of patients if only a single 24-hour urine collection is obtained. The present study supports the CUA guideline of performing two 24-hour urine collections.

Religion and Medicine

2020 ◽  
Author(s):  
Jeff Levin ◽  
Stephen G. Post
Keyword(s):  
Clinical Decision Making ◽  
Well Being ◽  
Clinical Decision ◽  
Religion And Medicine ◽  
Physical And Mental Health ◽  
Faith Based ◽  
Baylor University ◽  
Wide Range ◽  
History Of ◽  
The Impact

In Religion and Medicine, Dr. Jeff Levin, distinguished Baylor University epidemiologist, outlines the longstanding history of multifaceted interconnections between the institutions of religion and medicine. He traces the history of the encounter between these two institutions from antiquity through to the present day, highlighting a myriad of contemporary alliances between the faith-based and medical sectors. Religion and Medicine tells the story of: religious healers and religiously branded hospitals and healthcare institutions; pastoral professionals involved in medical missions, healthcare chaplaincy, and psychological counseling; congregational health promotion and disease prevention programs and global health initiatives; research studies on the impact of religious and spiritual beliefs and practices on physical and mental health, well-being, and healing; programs and centers for medical research and education within major universities and academic institutions; religiously informed bioethics and clinical decision-making; and faith-based health policy initiatives and advocacy for healthcare reform. Religion and Medicine is the first book to cover the full breadth of this subject. It documents religion-medicine alliances across religious traditions, throughout the world, and over the course of history. It summarizes a wide range of material of relevance to historians, medical professionals, pastors and theologians, bioethicists, scientists, public health educators, and policymakers. The product of decades of rigorous and focused research, Dr. Levin has produced the most comprehensive history of these developments and the finest introduction to this emerging field of scholarship.

4971Blood viscosity and its relevance to the diagnosis and management of pulmonary hypertension: a new elephant in the cathlab

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Kempny ◽  
K Dimopoulos ◽  
A E Fraisse ◽  
G P Diller ◽  
L C Price ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Cardiac Catheterization ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Pulmonary Vasculature ◽  
Pulmonary Vascular Disease ◽  
Significant Difference ◽  
The Difference ◽  
Clinically Significant ◽  
The Relationship

Abstract Background Pulmonary vascular resistance (PVR) is an essential parameter assessed during cardiac catheterization. It is used to confirm pulmonary vascular disease, to assess response to targeted pulmonary hypertension (PH) therapy and to determine the possibility of surgery, such as closure of intra-cardiac shunt or transplantation. While PVR is believed to mainly reflect the properties of the pulmonary vasculature, it is also related to blood viscosity (BV). Objectives We aimed to assess the relationship between measured (mPVR) and viscosity-corrected PVR (cPVR) and its impact on clinical decision-making. Methods We assessed consecutive PH patients undergoing cardiac catheterization. BV was assessed using the Hutton method. Results We included 465 patients (56.6% female, median age 63y). The difference between mPVR and cPVR was highest in patients with abnormal Hb levels (anemic patients: 5.6 [3.4–8.0] vs 7.8Wood Units (WU) [5.1–11.9], P<0.001; patients with raised Hb: 10.8 [6.9–15.4] vs. 7.6WU [4.6–10.8], P<0.001, respectively). Overall, 33.3% patients had a clinically significant (>2.0WU) difference between mPVR and cPVR, and this was more pronounced in those with anemia (52.9%) or raised Hb (77.6%). In patients in the upper quartile for this difference, mPVR and cPVR differed by 4.0WU [3.4–5.2]. Adjustment of PVR required Conclusions We report, herewith, a clinically significant difference between mPVR and cPVR in a third of contemporary patients assessed for PH. This difference is most pronounced in patients with anemia, in whom mPVR significantly underestimates PVR, whereas in most patients with raised Hb, mPVR overestimates it. Our data suggest that routine adjustment for BV is necessary.

Clinical Problem Solving: Decreased Level of Consciousness and Unexplained Hydrocephalus

2022 ◽  
pp. 194187442110567
Author(s):  
Naomi Niznick ◽  
Ronda Lun ◽  
Daniel A. Lelli ◽  
Tadeu A. Fantaneanu
Keyword(s):  
Decision Making ◽  
Differential Diagnosis ◽  
Clinical Decision Making ◽  
Clinical Problem ◽  
Clinical Decision ◽  
Decision Making Process ◽  
Clinical Problem Solving ◽  
Level Of Consciousness ◽  
History Of

We present a clinical reasoning case of 42-year-old male with a history of type 1 diabetes who presented to hospital with decreased level of consciousness. We review the approach to coma including initial approach to differential diagnosis and investigations. After refining the diagnostic options based on initial investigations, we review the clinical decision-making process with a focus on narrowing the differential diagnosis, further investigations, and treatment.

Predictive Analytics to Support Clinical Decision Making

2020 ◽  
pp. 271-281
Author(s):  
Nilmini Wickramasinghe
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Predictive Analytics ◽  
Complete Information ◽  
Clinical Decision ◽  
Decision Making Process ◽  
The Difference

A key activity in healthcare is clinical decision making. This decision making typically has to be made rapidly and often without complete information. Moreover, the consequences of these decisions could be far reaching including the difference between life or death. Today analytics can assist in clinical decision making as the following chapter highlights. However, to gain the most from any type of analytics, it is first necessary to fully understand the dynamics around the clinical decision making process.

scholarly journals Gaitography on lower-limb amputees: Repeatability and between-methods agreement

2018 ◽  
Vol 43 (1) ◽  
pp. 71-79 ◽  
Author(s):  
Celine Timmermans ◽  
Andrea G. Cutti ◽  
Hester van Donkersgoed ◽  
Melvyn Roerdink
Keyword(s):  
Clinical Decision Making ◽  
Center Of Pressure ◽  
Clinical Decision ◽  
Repeated Measurements ◽  
Test Results ◽  
Foot Placement ◽  
Gait Characteristics ◽  
Gait Parameters ◽  
Two Samples ◽  
Systematic Biases

Background: Gaitography is gait parametrization from center-of-pressure trajectories of walking on an instrumented treadmill. Gaitograms may be useful for prosthetic gait analyses, as they can be rapidly and unobtrusively collected over multiple gait cycles without constraining foot placement. However, its reliability must still be established for prosthetic gait. Objectives: To evaluate (a) within-method test–retest repeatability and (b) between-methods agreement for temporal gait events (foot contact, foot off) and gait characteristics (e.g. step times, single-support duration). Study design: Cohort study with repeated measurements. Methods: Ten male proficient prosthetic walkers with a unilateral trans-femoral or trans-tibial amputation were equipped with a pressure-insole system and were invited to walk on separate days on an instrumented treadmill. Results: We found better between-methods reproducibility than within-method repeatability in temporal gait characteristics. Step times, stride times, and foot-contact events matched well between the two methods. In contrast, insole-based foot-off events were detected one-to-two samples earlier. Likewise, a similar bias was observed for temporal gait characteristics that incorporated foot-off events. Conclusion: Notwithstanding small systematic biases, the good between-methods agreement indicates that temporal gait characteristics may be determined interchangeably with gaitograms and insoles in persons with a prosthesis. However, the relatively poorer test–retest repeatability hinders longitudinal assessments with either method. Clinical relevance: Clinical practice could potentially benefit from gaitography as an efficient, unobtrusive, easy to use, automatized, and patient-friendly means to objectively parametrize prosthetic gait, with immediate availability of test results allowing for prompt clinical decision-making. Temporal gait parameters demonstrate good between-methods agreement, but poorer within-method repeatability hinders detecting prosthetic gait changes.

scholarly journals Influence of psychiatric or social backgrounds on clinical decision making: a randomized, controlled multi-centre study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Yosuke Yamauchi ◽  
Takashi Shiga ◽  
Kiyoshi Shikino ◽  
Takahiro Uechi ◽  
Yasuaki Koyama ◽  
...  
Keyword(s):  
Decision Making ◽  
Repeated Measures ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Background Information ◽  
Accuracy Score ◽  
Multi Centre Study ◽  
Additional Information ◽  
Free Care ◽  
History Of

Abstract Background Frequent and repeated visits from patients with mental illness or free medical care recipients may elicit physicians’ negative emotions and influence their clinical decision making. This study investigated the impact of the psychiatric or social background of such patients on physicians’ decision making about whether to offer recommendations for further examinations and whether they expressed an appropriate disposition toward the patient. Methods A randomized, controlled multi-centre study of residents in transitional, internal medicine, or emergency medicine was conducted in five hospitals. Upon randomization, participants were stratified by gender and postgraduate year, and they were allocated to scenario set 1 or 2. They answered questions pertaining to decision-making based on eight clinical vignettes. Half of the eight vignettes presented to scenario set 1 included additional patient information, such as that the patient had a past medical history of schizophrenia or that the patient was a recipient of free care who made frequent visits to the doctor (biased vignettes). The other half included no additional information (neutral vignettes). For scenario set 2, the four biased vignettes presented to scenario set 1 were neutralized, and the four neutral vignettes were rendered biased by providing additional information. After reading, participants answered decision-making questions regarding diagnostic examination, interventions, or patient disposition. The primary analysis was a repeated-measures ANOVA on the mean management accuracy score, with patient background information as a within-subject factor (no bias, free care recipients, or history of schizophrenia). Results A total of 207 questionnaires were collected. Repeated-measures ANOVA showed that additional background information had influence on mean accuracy score (F(7, 206) = 13.84, p <  0.001 partial η2 = 0.063). Post hoc pairwise multiple comparison test, Sidak test, showed a significant difference between schizophrenia and no bias condition (p <  0.05). The ratings for patient likability were lower in the biased vignettes compared to the neutral vignettes, which was associated with the lower utilization of medical resources by the physicians. Conclusions Additional background information on past medical history of schizophrenia increased physicians’ mistakes in decision making. Patients’ psychiatric backgrounds should not bias physicians’ decision-making. Based on these findings, physicians are recommended to avoid being influenced by medically unrelated information.

scholarly journals How Much? How Frequent? How Long? A Clinical Guide to New Therapies in Myelodysplastic Syndromes

Hematology ◽  
2010 ◽  
Vol 2010 (1) ◽  
pp. 314-321 ◽  
Author(s):  
William Blum
Keyword(s):  
Quality Of Life ◽  
Myelodysplastic Syndromes ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Clinical Decision ◽  
Clinical Results ◽  
Improve Quality ◽  
Substantial Impact ◽  
History Of

AbstractAdvances in the treatment of myelodysplastic syndromes (MDSs) over the last decade have given patients and their hematologists a multitude of treatment options. Therapeutic options now exist that reduce disease-related symptoms, improve quality of life, and alter the natural history of the disease. Three drugs are now specifically Food and Drug Administration-approved for treatment of MDS: (1) azacitidine, (2) decitabine, and (3) lenalidomide. Clinical results with each of these agents, plus results with immunosuppressive therapy, are reviewed to guide clinical decision making. Although each therapy has made a substantial impact in improving the care of patients with MDS, unfortunately MDS treatment in 2010 ultimately fails in most patients, but these therapies provide a foundation on which we can build to further improve outcomes.

DECISION MAKING IN PEDIATRIC SPINAL DEFORMITY

Neurosurgery ◽  
2008 ◽  
Vol 63 (suppl_3) ◽  
pp. A54-A68 ◽  
Author(s):  
Justin S. Smith ◽  
Christopher I. Shaffrey ◽  
Mark F. Abel ◽  
Christopher P. Ames
Keyword(s):  
Decision Making ◽  
Spinal Deformity ◽  
Pediatric Patients ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Nonoperative Treatment ◽  
Treatment Modalities ◽  
Decision Making Process ◽  
History Of ◽  
Diagnosis And Classification

ABSTRACT OBJECTIVE To review the concepts involved in the decision-making process for management of pediatric patients with spinal deformity. METHODS The literature was reviewed in reference to pediatric deformity evaluation and management. RESULTS Pediatric spinal deformity includes a broad range of disorders with differing causes, natural histories, and treatments. Appropriate categorization of pediatric deformities is an important first step in the clinical decision-making process. An understanding of both nonoperative and operative treatment modalities and their indications is requisite to providing treatment for pediatric patients with spinal deformity. The primary nonoperative treatment modalities include bracing and casting, and the primary operative treatments include nonfusion instrumentation and fusion with or without instrumentation. In this article, we provide a review of pediatric spinal deformity classification and an overview of general treatment principles. CONCLUSION The decision-making process in pediatric deformity begins with appropriate diagnosis and classification of the deformity. Treatment decisions, both nonoperative and operative, are often predicated on the basis of the age of the patient and the natural history of the disorder.

Reirradiation and/or surgery for locoregionally recurrent rectal cancer: A systemic review and meta-analyses.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15159-e15159
Author(s):  
Chai Hong Rim ◽  
Jeongshim Lee
Keyword(s):  
Rectal Cancer ◽  
Clinical Decision Making ◽  
Late Complication ◽  
Clinical Decision ◽  
Late Complications ◽  
Local Control Rate ◽  
Systemic Review ◽  
Cochrane Library ◽  
The Difference ◽  
Grade 3

e15159 Background: Locoregional recurrence of rectal cancer (LRRC) might be occurred even after combination treatments including surgery and pelvic radiotherapy. Re-irradiation might provide the control of recurrence and/or symptomatic palliation, but possible complications are fearful hindrances. This study is to integrate information from various clinical studies, regarding re-irradiation and/or surgery of LRRC, and to provide practical information for clinical decision making. Methods: We searched four databases including pubmed, MEDLINE, Cochrane library, and Embase. The primary endpoint was overall survival (OS), and secondary endpoints were complications of grade ≥3, local control rate (LC), and symptomatic palliation rate. Results: A total of 17 studies, involving 18 cohorts and 744 patients with LRRC were included. Median OS among included studies ranged from 10 to 45 months (median: 24.5 months). Pooled 1-, 2-, and 3- year OS rates for all LRRC patients were 76.1% [95% confidence interval (CI): 61.7-86.3], 49.1% (38.5-59.7), and 38.3% (30.2-47.2), respectively. For patients who underwent re-irradiation and surgery (OP group), pooled 1-, 2-, and 3- year OS rates were 85.9% (95% CI: 74.0-92.9), 71.8% (54.6-84.4), and 51.7% (39.4-63.8). For patients who underwent re-irradiation but not surgery (non-OP group), pooled 1-, 2-, and 3-year OS rates were 63.5% (95% CI: 51.1-74.4), 34.2% (20.4-51.2), and 23.8% (15.4-34.8). The difference between two subgroups were significant for all 3 years analyses. Pooled 1-, 2-, and 3- year LC rates for OP group were 84.4% (95% CI: 75.5-90.4), 63.8% (55.2-71.5), and 46.9% (39.6-54.4), and for non-OP group were 72.0% (95% CI: 48.8-87.4), 54.8% (28.6-78.5), and 44.6% (16.6-76.5). The difference between subgroups were not statistically significant for all 3 years analyses. Pooled overall grade ≥3 acute complication rate was 11.7% (95% CI: 6.7-19.5), and for late complication was 25.5% (95% CI: 16.7-40.0). Patients who underwent surgery had a higher risk of grade ≥3 late complications (OR: 6.39, 95% CI: 3.2-12.7). Pooled symptomatic palliation rate was 75.2% (95% CI: 67.3-81.8). Conclusions: Re-irradiation and/or surgery might be an option with oncologic and palliative efficacies, where combined surgery provided more favorable survival outcome. However, late complication should be carefully considered especially when combined with surgery.

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