scholarly journals Resurgence of Polymyxin B for MDR/XDR Gram-Negative Infections: An Overview of Current Evidence

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Suneel Kumar Garg ◽  
Omender Singh ◽  
Deven Juneja ◽  
Niraj Tyagi ◽  
Amandeep Singh Khurana ◽  
...  
Keyword(s):  
Decision Making ◽  
Literature Review ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Polymyxin B ◽  
Multidrug Resistant ◽  
Current Evidence ◽  
Drug Resistant ◽  
Gram Negative

Polymyxin B has resurged in recent years as a last resort therapy for Gram-negative multidrug-resistant (MDR) and extremely drug resistant (XDR) infections. Understanding newer evidence on polymyxin B is necessary to guide clinical decision making. Here, we present a literature review of polymyxin B in Gram-negative infections with update on its pharmacology.

scholarly journals Novel Neurotechnological Interventions for Pediatric Drug-Resistant Epilepsy: Physician Perspectives

2020 ◽  
pp. 088307382096693
Author(s):  
Patrick J. McDonald ◽  
Viorica Hrincu ◽  
Mary B. Connolly ◽  
Mark J. Harrison ◽  
George M. Ibrahim ◽  
...  
Keyword(s):  
Decision Making ◽  
Best Practice ◽  
Clinical Decision Making ◽  
Qualitative Content Analysis ◽  
Scientific Evidence ◽  
Clinical Decision ◽  
Drug Resistant ◽  
Ethical Considerations ◽  
Pediatric Drug ◽  
Drug Resistant Epilepsy

This qualitative study investigated factors that guide physicians’ choices for minimally invasive and neuromodulatory interventions as alternatives to conventional surgery or medical management for pediatric drug-resistant epilepsy. North American physicians were recruited to one of 4 focus groups at national conferences. Discussions were analyzed using qualitative content analysis. A pragmatic neuroethics framework was applied to interpret results. Discussions revealed 2 major thematic branches: (1) clinical decision making and (2) ethical considerations. Under clinical decision making, physicians emphasized scientific evidence and patient candidacy when assessing neurotechnologies for patients. Ongoing seizures without intervention was important for safety and neurodevelopment. Under ethical considerations, resource allocation, among other financial considerations for technology adoption, were considerable sources of pressure on decision making. Access to neurotechnology was a salient theme differentiating Canadian and American contexts. When assessing novel neurotechnological interventions for pediatric drug-resistant epilepsy, physicians balance clinical and ethical factors to guide decision making and best practice.

scholarly journals Patient attrition in Molecular Tumour Boards: A Review

2021 ◽  
Author(s):  
Hannah Frost ◽  
Donna M. Graham ◽  
Louise Carter ◽  
Paul O’Regan ◽  
Donal Landers ◽  
...  
Keyword(s):  
Decision Making ◽  
Literature Review ◽  
Precision Medicine ◽  
Clinical Decision Making ◽  
New Technologies ◽  
Clinical Decision ◽  
Clinical Deterioration ◽  
Treatment Data ◽  
Patient Attrition ◽  
Receive Treatment

AbstractMolecular Tumour Boards (MTBs) were created with the purpose of supporting clinical decision making within precision medicine. Though these meetings are in use globally reporting often focuses on the small percentages of patients that receive treatment via this process and are less likely to report on, and assess, patients who do not receive treatment. A literature review was performed to understand patient attrition within MTBs and barriers to patients receiving treatment. A total of 56 papers were reviewed spanning a 6 year period from 11 different countries. 20% of patients received treatment through the MTB process. Of those that did not receive treatment the main reasons were no mutations identified (26%), no actionable mutations (22%) and clinical deterioration (15%). However, the data was often incomplete due to inconsistent reporting of MTBs with only 54% reporting on patients having no mutations, 48% reporting on presence of actionable mutations and 57% reporting on clinical deterioration. Patient attrition in MTBs is an issue which is very rarely alluded to in reporting, more transparent reporting is needed to understand barriers to treatment and integration of new technologies is required to process increasing omic and treatment data.

First-time Glenohumeral Dislocations: Current Evidence and Considerations in Clinical Decision Making

2020 ◽  
Vol 28 (4) ◽  
pp. 122-131
Author(s):  
Kyle N. Kunze ◽  
Matthew R. Cohn ◽  
Brady T. Williams ◽  
Grant Garrigues ◽  
Jorge Chahla
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Current Evidence ◽  
First Time

Clinical decision making involved in secluding and restraining an adult psychiatric patient: an integrative literature review

2012 ◽  
Vol 20 (9) ◽  
pp. 830-839 ◽  
Author(s):  
T. Laiho ◽  
E. Kattainen ◽  
P. Åstedt-Kurki ◽  
H. Putkonen ◽  
N. Lindberg ◽  
...  
Keyword(s):  
Decision Making ◽  
Literature Review ◽  
Psychiatric Patient ◽  
Clinical Decision Making ◽  
Clinical Decision

Clinical use of intravenous polymyxin B for the treatment of patients with multidrug-resistant Gram-negative bacterial infections: An evaluation of the current evidence

2021 ◽  
Vol 24 ◽  
pp. 342-359
Author(s):  
Matthew E. Falagas ◽  
Margarita Kyriakidou ◽  
Georgios L. Voulgaris ◽  
Filippos Vokos ◽  
Sevasti Politi ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Polymyxin B ◽  
Multidrug Resistant ◽  
Current Evidence ◽  
Clinical Use ◽  
Gram Negative

Evaluating the Effects of an Evidence-Based Hemostasis and Thrombosis Treatment Algorithm Tool on Medical Practitioner and Trainee Clinical Decision Making

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4736-4736
Author(s):  
Joseph Shatzel ◽  
Derrick Tao ◽  
Sven R Olson ◽  
Edward Kim ◽  
Molly Daughety ◽  
...  
Keyword(s):  
Decision Making ◽  
Medical Students ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Mean Difference ◽  
Current Evidence ◽  
Evidence Based ◽  
Clinical Vignettes ◽  
Evidence Based Guidelines ◽  
Attending Physicians

Abstract INTRODUCTION There are many interventions in the disciplines of hemostasis and thrombosis that have been shown to be effective by high quality evidence, leading to the development of evidence-based guidelines by several professional groups. The extent to which providers and medical trainees make use of these guidelines in real-time clinical decision making is not known. Current hemostasis and thrombosis guidelines also lack an easy to navigate algorithmic design such as what is used by the National Comprehensive Cancer Network (NCCN) which may limit their utilization. Using several evidence based guidelines and consensus expert opinion we created an algorithmic tool designed to easily answer clinical questions in thrombosis and hemostasis, and conducted a prospective study assessing provider understanding of current evidence based recommendations and the effects of the algorithmic tool on clinical decision making. METHODS We implemented a prospective survey study of health care providers and medical students from the Oregon Health & Science University during July of 2016. Practitioners who care for patients with thrombotic or hemostatic issues were eligible; including internists, hematologist and oncologists, family medicine practitioners, nurse practitioners & physician assistants, hematology and oncology fellows, internal medicine and family medicine residents, and medical students. The survey included demographic questions, 11 clinical vignettes with multiple-choice questions asking participants for the most evidence-based treatment decision and to rate their confidence in the answer, and post-assessment feedback. Participants were encouraged to use the resources they would typically use in a clinical setting to make these decisions. Included subjects were randomly assigned access to our evidence-based algorithmic tool, (available online at http://tinyurl.com/Hemostasis-ThrombosisGuideline) available as downloadable PDF. The 11 clinical questions were scored, and an unpaired t-test was performed to determine if any significant difference existed in scores between participants with and without the evidence-based algorithmic tool. RESULTS During the study period, 101 individuals participated: 48 medical students, 23 medicine residents, 17 attending physicians, 9 fellows, and 4 NP/PAs. Across all participants, those with access to the algorithms on average answered 3.84 (34%) more questions correctly (95% CI 3.08 - 4.60, P < 0.0001) (Table 1). Participants randomized to receive the algorithm were significantly more confident in their treatment decisions than participants without the algorithm (P < 0.0001). Significantly higher scores were found among individual groups including medical students, (mean difference 4.73, 95% CI 3.64 - 5.82, P < 0.0001), attending physicians (mean difference 2.58, 95% CI 0.63 - 4.53, P = 0.0131), and residents & fellows (mean difference 3.81, 95% CI 2.66 - 4.96, P < 0.0001). There was insufficient data to find a difference in score among NP/PAs who did and did not receive the algorithm. Participant reported confidence in their answers was significantly higher in those who were randomized to receive the algorithm (mean difference of0.95 on a 5-point confidence scale, 95% CI0.50 to 1.39, P < 0.0001). CONCLUSION Our study found that at baseline, there were limitations in provider and trainee understanding of the current evidence based management of clinical issues relevant to hemostasis and thrombosis, and that the use of an easy to navigate algorithmic tool significantly altered treatment decisions in commonly encountered clinical vignettes. Our findings suggest that utilization and decision-making may benefit from a more streamlined, algorithmic display of guidelines. Future prospective studies are needed to determine if such a tool improves management and outcomes in practice. Disclosures No relevant conflicts of interest to declare.

scholarly journals Understanding Neonatal Ventilation: Strategies for Decision Making in the NICU

2013 ◽  
Vol 32 (4) ◽  
pp. 246-261 ◽  
Author(s):  
Julia Petty
Keyword(s):  
Decision Making ◽  
Best Practice ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Current Evidence ◽  
Individual Level ◽  
Neonatal Ventilation ◽  
Ventilation Modes ◽  
Ventilation Strategies

AbstractNeonatal ventilation is an integral component of care delivered in the neonatal unit. The aim of any ventilation strategy is to support the neonate’s respiratory system during compromise while limiting any long-term damage to the lungs. Understanding the principles behind neonatal ventilation is essential so that health professionals caring for sick neonates and families have the necessary knowledge to understand best practice. Given the range of existing ventilation modes and parameters available, these require explanation and clarification in the context of current evidence. Many factors can influence clinical decision making on both an individual level and within the wider perspective of neonatal care.

Sign in / Sign up

Export Citation Format

Share Document