Objective decision making between conventional and oncoplastic breast-conserving surgery or mastectomy: An aesthetic and functional prospective cohort study

2017 ◽  
Vol 43 (2) ◽  
pp. 303-310 ◽  
Author(s):  
D. Pukancsik ◽  
P. Kelemen ◽  
M. Újhelyi ◽  
E. Kovács ◽  
N. Udvarhelyi ◽  
...  
Keyword(s):  
Decision Making ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Breast Conserving Surgery

LI-RADS 4 or 5 categorization may not be clinically relevant for decision-making processes: A prospective cohort study

2020 ◽  
Vol 19 (6) ◽  
pp. 662-667
Author(s):  
Federico Piñero ◽  
Marcos A. Thompson ◽  
Federico Diaz Telli ◽  
Juan Trentacoste ◽  
Carlos Padín ◽  
...  
Keyword(s):  
Decision Making ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Decision Making Processes

scholarly journals Shunting outcomes in posthemorrhagic hydrocephalus: results of a Hydrocephalus Clinical Research Network prospective cohort study

2017 ◽  
Vol 20 (1) ◽  
pp. 19-29 ◽  
Author(s):  
John C. Wellons ◽  
Chevis N. Shannon ◽  
Richard Holubkov ◽  
Jay Riva-Cambrin ◽  
Abhaya V. Kulkarni ◽  
...  
Keyword(s):  
Decision Making ◽  
Cohort Study ◽  
Clinical Research ◽  
Prospective Cohort Study ◽  
Premature Infants ◽  
Prospective Cohort ◽  
Research Network ◽  
Complication Rates ◽  
High Grade ◽  
Clinical Research Network

OBJECTIVEPrevious Hydrocephalus Clinical Research Network (HCRN) retrospective studies have shown a 15% difference in rates of conversion to permanent shunts with the use of ventriculosubgaleal shunts (VSGSs) versus ventricular reservoirs (VRs) as temporization procedures in the treatment of hydrocephalus due to high-grade intraventricular hemorrhage (IVH) of prematurity. Further research in the same study line revealed a strong influence of center-specific decision-making on shunt outcomes. The primary goal of this prospective study was to standardize decision-making across centers to determine true procedural superiority, if any, of VSGS versus VR as a temporization procedure in high-grade IVH of prematurity.METHODSThe HCRN conducted a prospective cohort study across 6 centers with an approximate 1.5- to 3-year accrual period (depending on center) followed by 6 months of follow-up. Infants with premature birth, who weighed less than 1500 g, had Grade 3 or 4 IVH of prematurity, and had more than 72 hours of life expectancy were included in the study. Based on a priori consensus, decisions were standardized regarding the timing of initial surgical treatment, upfront shunt versus temporization procedure (VR or VSGS), and when to convert a VR or VSGS to a permanent shunt. Physical examination assessment and surgical technique were also standardized. The primary outcome was the proportion of infants who underwent conversion to a permanent shunt. The major secondary outcomes of interest included infection and other complication rates.RESULTSOne hundred forty-five premature infants were enrolled and met criteria for analysis. Using the standardized decision rubrics, 28 infants never reached the threshold for treatment, 11 initially received permanent shunts, 4 were initially treated with endoscopic third ventriculostomy (ETV), and 102 underwent a temporization procedure (36 with VSGSs and 66 with VRs). The 2 temporization cohorts were similar in terms of sex, race, IVH grade, head (orbitofrontal) circumference, and ventricular size at temporization. There were statistically significant differences noted between groups in gestational age, birth weight, and bilaterality of clot burden that were controlled for in post hoc analysis. By Kaplan-Meier analysis, the 180-day rates of conversion to permanent shunts were 63.5% for VSGS and 74.0% for VR (p = 0.36, log-rank test). The infection rate for VSGS was 14% (5/36) and for VR was 17% (11/66; p = 0.71). The overall compliance rate with the standardized decision rubrics was noted to be 90% for all surgeons.CONCLUSIONSA standardized protocol was instituted across all centers of the HCRN. Compliance was high. Choice of temporization techniques in premature infants with IVH does not appear to influence rates of conversion to permanent ventricular CSF diversion. Once management decisions and surgical techniques are standardized across HCRN sites, thus minimizing center effect, the observed difference in conversion rates between VSGSs and VRs is mitigated.

Results from a pragmatic prospective cohort study: Shared decision making improves outcomes for children with asthma

2016 ◽  
Vol 54 (4) ◽  
pp. 392-402 ◽  
Author(s):  
Hazel Tapp ◽  
Lindsay Shade ◽  
Rohan Mahabaleshwarkar ◽  
Yhenneko J. Taylor ◽  
Thomas Ludden ◽  
...  
Keyword(s):  
Decision Making ◽  
Cohort Study ◽  
Shared Decision Making ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Shared Decision ◽  
Children With Asthma ◽  
Outcomes For Children
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