Prostate-specific membrane antigen-based imaging in prostate cancer: Impact on clinical decision making process

The Prostate ◽  
2015 ◽  
Vol 75 (7) ◽  
pp. 748-757 ◽  
Author(s):  
Mehmet Onur Demirkol ◽  
Ömer Acar ◽  
Burcu Uçar ◽  
Sultan Rana Ramazanoğlu ◽  
Yeşim Sağlıcan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Decision Making Process ◽  
Prostate Specific Membrane Antigen ◽  
Specific Membrane

scholarly journals Accompanying the Prostate Cancer Patient Pathway: Evaluation of Novel Clinical Decision Support Software

2021 ◽  
Author(s):  
Maurice Henkel ◽  
Tobias Horn ◽  
Francois Leboutte ◽  
Pawel Trotsenko ◽  
Sarah G. Dugas ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Decision Support ◽  
Information Systems ◽  
Data Quality ◽  
Clinical Decision Support ◽  
User Satisfaction ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Decision Making Process

Abstract Introduction Physicians spend more than half of their workday interacting with health information systems to care for their patients. Effective data management that provides physicians with comprehensive patient information from various information systems is required to ensure high quality clinical decision making.Objectives We evaluated the impact of a novel, CE-certified clinical decision support tool on physician’s effectiveness and satisfaction in the clinical decision-making process.Methods Using pre-therapeutic prostate cancer management cases, we compared physician’s expenditure of time, data quality, and user satisfaction in the decision-making process comparing the current standard with the software. Ten urologists from our department conducted the diagnostic work-up to the treatment decision for a total of 10 patients using both approaches.Results A significant reduction in the physician’s expenditure of time for the decision-making process by -59.9 % (p < 0,001) was found using the software. System usage showed a high positive effect on evaluated data quality parameters completeness (Cohen's d of 2.36), format (6.15), understandability (2.64), as well as user satisfaction (4.94).Conclusion The software demonstrated that effective data management can improve physician’s effectiveness and satisfaction in the clinical decision-making process. Further development is needed to map more complex patient pathways, such as the follow-up treatment of prostate cancer.

68-Ga prostate-specific membrane antigen-PET as a diagnostic and clinical decision making tool in biochemical recurrences post-radical prostatectomy.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 377-377
Author(s):  
Janice Ser Huey Tan ◽  
Charles Xian-Yang Goh ◽  
Youquan Li ◽  
Jeffrey Tuan ◽  
Eu Tiong Chua ◽  
...  
Keyword(s):  
Decision Making ◽  
Radical Prostatectomy ◽  
Clinical Decision Making ◽  
Systemic Disease ◽  
False Negative ◽  
Clinical Decision ◽  
Prostate Specific Membrane Antigen ◽  
Detection Rates ◽  
Psma Pet ◽  
Specific Membrane

377 Background: In patients with biochemical relapse (BCR) following radical prostatectomy (RadP), risk stratification by clinical indices alone is suboptimal for identifying subgroups likely to benefit from salvage radiotherapy (RT). It is also recommended that combination hormonal therapy (HT)-RT improves rates of salvage and survival, hence the need for a clinical tool to better stratify patients for RT and HT-RT; the latter approach for patients at risk of occult metastases. Herein, we investigated the role of 68Ga-Prostate-specific Membrane Antigen (PSMA)-PET in the detection of regional and distal recurrences, and for clinical decision making in a prospective cohort of patients with BCR post-RadP. Methods: 68Ga-PSMA-PET and CT were performed in a cohort of 50 RadP patients with BCR. Radiological interpretation was independently performed by two assessors, who were blinded to the patient identifiers. PSMA+ lesions were considered as true positives; negative-PSMA in the presence of continued PSA rise defined false negative. Impact on clinical decision making was reviewed by comparison of PSMA-PET and CT findings in the post-RadP PSA 0.5-2.0 ng/ml subgroup. Results: Overall detection rate for 68Ga-PSMA/PET was 74% (37 of 50) in our cohort with a median post-RadP PSA level of 2.19 (IQR = 0.45-4.26). Detection rates were significantly increased at a PSA cut-off > 1.0; 96% (25 of 26) at > 2.0 and 100% (5 of 5) at 1.0-2.0 compared to 67% (4 of 6) at 0.5-1.0, and 23% (3 of 13) at < 0.5 (P < 0.001). In 0.5-2.0 PSA subgroup, 3 regional nodes and 11 distal (6 nodes, 4 bones, 1 lung) lesions were detected. This altered treatment in 5 of the 11 (46%) cases; 3 N+ cases would have been recommended for HT-RT and pelvic nodal RT, while RT would be omitted in 2 patients due to low volume systemic disease. Conclusions: Our findings support the existing data for PSMA-PET as a sensitive diagnostic tool for clinical recurrences post-RadP. Additionally, the detection of small volume nodal and distal lesions at post-RadP PSA levels of < 2.0 ng/ml highlights the potential utility of PSMA-PET for selecting patients to treatment intensification with HT-RT or omission of RT in cases of distal relapse.

scholarly journals Quantitative and Qualitative Analysis of Blood-based Liquid Biopsies to Inform Clinical Decision-making in Prostate Cancer

2021 ◽  
Author(s):  
Irene Casanova-Salas ◽  
Alejandro Athie ◽  
Paul C. Boutros ◽  
Marzia Del Re ◽  
David T. Miyamoto ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Qualitative Analysis ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Liquid Biopsies

Benner’s Framework and Clinical Decision-Making in the Critical Care Environment

2016 ◽  
Vol 30 (1) ◽  
pp. 52-57 ◽  
Author(s):  
Kristi J. Stinson
Keyword(s):  
Decision Making ◽  
Critical Care ◽  
Clinical Experience ◽  
Strong Correlation ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Decision Making Process ◽  
Clinical Experiences ◽  
Care Environment ◽  
Decision Making Processes

Completed as part of a larger dissertational study, the purpose of this portion of this descriptive correlational study was to examine the relationships among registered nurses’ clinical experiences and clinical decision-making processes in the critical care environment. The results indicated that there is no strong correlation between clinical experience in general and clinical experience in critical care and clinical decision-making. There were no differences found in any of the Benner stages of clinical experience in relation to the overall clinical decision-making process.

scholarly journals Pet owners’ and veterinarians’ perceptions of information exchange and clinical decision-making in companion animal practice

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0245632
Author(s):  
Natasha Janke ◽  
Jason B. Coe ◽  
Theresa M. Bernardo ◽  
Cate E. Dewey ◽  
Elizabeth A. Stone
Keyword(s):  
Decision Making ◽  
Focus Groups ◽  
Information Exchange ◽  
Clinical Decision Making ◽  
Current Knowledge ◽  
Exchange Process ◽  
Clinical Decision ◽  
Decision Making Process ◽  
Pet Owners ◽  
Pet Owner

One of the most complex aspects of the veterinarian-client-patient interaction is the clinical decision-making process. Research suggests that the approach to communication used by veterinarians can impact veterinary clients’ involvement in the decision-making process and their ultimate satisfaction. Using different approaches to the decision-making process may affect how information is exchanged and consequently how decisions are made. The objective of this study was to determine pet owners’ expectations with respect to information exchange and decision-making during veterinarian-client-patient interactions and to compare veterinarians’ perceptions of those expectations and the challenges they face in meeting them. Five pet owner focus groups (27 owners) and three veterinarian focus groups (24 veterinarians) were conducted with standardized open-ended questions and follow-up probes. Thematic analysis of the transcribed data was conducted to identify trends and patterns that emerged during the focus groups. Three pet owner-based themes were identified: 1) understanding the client; 2) providing information suitable for the client; and 3) decision-making. In addition, three barriers for veterinarians affecting information exchange and decision-making were identified: 1) time constraints; 2) involvement of multiple clients; and 3) language barriers. Results suggest that pet owners expect to be supported by their veterinarian to make informed decisions by understanding the client’s current knowledge, tailoring information and educating clients about their options. Breakdowns in the information exchange process can impact pet owners’ perceptions of veterinarians’ motivations. Pet owners’ emphasis on partnership suggests that a collaborative approach between veterinarians and clients may improve client satisfaction.

scholarly journals Prognostic Genomic Tissue-Based Biomarkers in the Treatment of Localized Prostate Cancer

2022 ◽  
Vol 12 (1) ◽  
pp. 65
Author(s):  
Gianluca Ingrosso ◽  
Emanuele Alì ◽  
Simona Marani ◽  
Simonetta Saldi ◽  
Rita Bellavita ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Positive Impact ◽  
Wide Spectrum ◽  
Locally Advanced ◽  
Treatment Strategies ◽  
Quality Criteria ◽  
Localized Prostate Cancer ◽  
Decision Making Process

In localized prostate cancer clinicopathologic variables have been used to develop prognostic nomograms quantifying the probability of locally advanced disease, of pelvic lymph node and distant metastasis at diagnosis or the probability of recurrence after radical treatment of the primary tumor. These tools although essential in daily clinical practice for the management of such a heterogeneous disease, which can be cured with a wide spectrum of treatment strategies (i.e., active surveillance, RP and radiation therapy), do not allow the precise distinction of an indolent instead of an aggressive disease. In recent years, several prognostic biomarkers have been tested, combined with the currently available clinicopathologic prognostic tools, in order to improve the decision-making process. In the following article, we reviewed the literature of the last 10 years and gave an overview report on commercially available tissue-based biomarkers and more specifically on mRNA-based gene expression classifiers. To date, these genomic tests have been widely investigated, demonstrating rigorous quality criteria including reproducibility, linearity, analytical accuracy, precision, and a positive impact in the clinical decision-making process. Albeit data published in literature, the systematic use of these tests in prostate cancer is currently not recommended due to insufficient evidence.

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