Search results for "Clinical Decision-Making"
showing 10 items of 56 documents
Clinical Decision-Making when Treating Diabetic Macular Edema Patients with Dexamethasone Intravitreal Implants.
2017
Diabetes mellitus (DM) is a metabolic disease frequently associated with comorbidities that include diabetic macular edema (DME). The current medical approach to treating DME involves intravitreal injections with either anti-vascular endothelial growth factors or steroids. However, the burden associated with intravitreal injections and DM-derived complications is high, underlining the need to find optimal treatment regimens. In this article we describe the considerations we apply when treating DME patients with dexamethasone intravitreal implants (Ozurdex®), particularly those that influence the clinical decision-making process during the follow-up period. These considerations are based bot…
The Impact of Artificial Intelligence on Traditional Chinese Medicine
2021
Traditional Chinese Medicine (TCM) is a well-established medical system with a long history. Currently, artificial intelligence (AI) is rapidly expanding in many fields including TCM. AI will significantly improve the reliability and accuracy of diagnostics, thus increasing the use of effective therapeutic methods for patients. This systematic review provides an updated overview on the major breakthroughs in the field of AI-assisted TCM four diagnostic methods, syndrome differentiation, and treatment. AI-assisted TCM diagnosis is mainly based on digital data collected by modern electronic instruments, which makes TCM diagnosis more quantitative, objective, and standardized. As a result, th…
The timing of initial imaging in testicular cancer: impact on radiological findings and clinical decision making
2021
Background In testicular cancer determination of clinical stage and recommendation of therapeutic strategy after inguinal orchiectomy are based on primary imaging by CT-scan of the chest and CT- or MRI- abdomen. It has not been investigated so far, whether the imaging should be performed before or after primary testicular surgery. Staging before surgery means exposing all patients to CT radiation irrespective of ensured histologic malignancy while postoperative staging could pose a risk in biased clinical decision making by increased presence of unspecific lymph node enlargement caused by postsurgical effects. Therefore, we aimed to investigate the association between the timing of initial …
Pooled analysis of prospective European studies assessing the impact of using the 21-gene Recurrence Score assay on clinical decision making in women…
2016
PURPOSE: The 21-gene Recurrence Score assay (Oncotype DX) provides prognostic/predictive information in oestrogen receptor positive (ER+) early breast cancer, but access/reimbursement has been limited in most European countries in the absence of prospective outcome data. Recently, two large prospective studies and a real-life 5-year outcome study have been reported. We performed a pooled analysis of prospective European impact studies to generate robust data on impact of use in different clinical subgroups. METHODS: The analysis included four studies (French, German, Spanish, and British) in ER+ human epidermal growth factor receptor 2-negative breast cancer patients (n = 527). Node-positiv…
Advancing beyond the system: telemedicine nurses' clinical reasoning using a computerised decision support system for patients with COPD - an ethnogr…
2017
Abstract Background Telemedicine is changing traditional nursing care, and entails nurses performing advanced and complex care within a new clinical environment, and monitoring patients at a distance. Telemedicine practice requires complex disease management, advocating that the nurses’ reasoning and decision-making processes are supported. Computerised decision support systems are being used increasingly to assist reasoning and decision-making in different situations. However, little research has focused on the clinical reasoning of nurses using a computerised decision support system in a telemedicine setting. Therefore, the objective of the study is to explore the process of telemedicine …
Impact of cardiopulmonary resuscitation on a cannot intubate, cannot oxygenate condition: a randomised crossover simulation research study of the int…
2019
ObjectivesDuring a ‘cannot intubate, cannot oxygenate’ situation, asphyxia can lead to cardiac arrest. In this stressful situation, two complex algorithms facilitate decision-making to save a patient’s life: difficult airway management and cardiopulmonary resuscitation. However, the extent to which competition between the two algorithms causes conflicts in the execution of pivotal treatment remains unknown. Due to the rare incidence of this situation and the very low feasibility of such an evaluation in clinical reality, we decided to perform a randomised crossover simulation research study. We propose that even experienced healthcare providers delay cricothyrotomy, a lifesaving approach, d…
Decision making in a presumptive case of STEMI-like myocarditis
2015
In youngmales, differential diagnosis during chest pain is not always easy. When ECG findings suggest a cardiac origin of such symptoms, myo-pericarditis is usually themost likely hypothesis, beingmore common than Acute Coronary Syndromes (ACS) in the first decades of life [1]. In the presence of ST segment elevation, Troponin release and ventricular wall motion abnormalities, the diagnosis can be challenging, though. In the young a lowcoronary risk profile and atypical symptoms seldom support a working diagnosis of Coronary Heart Disease (CHD), and, therefore, urgent coronary angiography is not recommended routinely, although cases of early ACS are not so rare. In October 2014 a 26-year-ol…
Role of clinical and laboratory parameters for treatment choice in patients with inherited FVII deficiency undergoing surgical procedures: evidence f…
2018
Perioperative bleeding is a major concern in patients with factor VII (FVII) deficiency. Evaluating data of 95 FVII-deficient patients undergoing 110 surgical procedures (61 major, 49 minor), we assessed the impact of type of surgery, bleeding phenotype and FVII coagulant activity (FVII:C) levels on perioperative replacement therapy (RT). Compared to those with higher FVII:C levels, patients with <3% FVII:C received a higher number of RT doses (8 vs. 2, P = 0·003) for a longer RT duration (3 days vs. 1 day, P = 0·001), with no difference in RT dose. Similarly, patients with a history of major bleeds received a higher number of RT doses (8·5 vs. 2-3, P = 0·013) for a longer RT duration (2…
The intravascular ultrasound morphometry of iliac veins in subjects without severe chronic venous insufficiency and its implications for treatment in…
2019
Objectives The purpose of this study is to report the intravascular ultrasound morphometry of iliac veins and its relation to demographic and anthropometric factors in subjects without chronic venous insufficiency. Methods Thirty-three patients, without chronic venous insufficiency – qualified to great saphenous vein stripping due to unilateral, primary varicose veins – participated in the study. During the surgery, left and right external iliac veins, common iliac veins and inferior vena cava were interrogated with intravascular ultrasound. The morphometric analysis included measurement of a cross-sectional area at normal, non-stenosed vein segments (ref-CSA) and at the point of the most p…
Adhesive Small Bowel Obstruction: Predictive Factors of Lack of Response in Conservative Management with Gastrografin
2015
<b><i>Background:</i></b> Gastrografin represents a useful tool in the diagnosis and management of adhesive small bowel obstruction (ASBO). The aim of this study is to identify variables with negative influence in nonoperative management with gastrografin. <b><i>Methods:</i></b> From August 2008 to March 2013, 223 consecutive patients with 235 episodes of ASBO were included and received gastrografin. A protocol for prospective data collection was developed. In order to explore factors related to the failure of nonoperative treatment, univariate and multivariate analysis were performed. <b><i>Results:</i></b> One hundred…