scholarly journals Nail Disease: Clinical Decisions among Portuguese Dermatologists and Family Physicians

2020 ◽  
pp. 1-5
Author(s):  
Ana Filipe Monteiro ◽  
Rita Ramos Pinheiro ◽  
Célia Galhardas ◽  
André Lencastre
Keyword(s):  
Online Survey ◽  
Correct Diagnosis ◽  
Family Physicians ◽  
Treatment Decision ◽  
Disease Diagnosis ◽  
Diagnostic Methods ◽  
Treatment Decision Making ◽  
Local Institution ◽  
The Family ◽  
Nail Disease

Onychomycosis is one of the most common nail disorders and may be difficult to distinguish from other causes of nail dystrophy, based on clinical grounds alone. With this study, we aimed to describe the use of fungal testing by dermatologists and family physicians in their daily current practice, analyze their respective familiarity with nail disease diagnosis, and ultimately treatment decision-making by both groups. An online survey was distributed among Portuguese dermatologists, trainees, and family physicians by email. The survey focused on the diagnostic impression, use of diagnostic methods to confirm a fungal infection, and the subsequent assessment of treatment. One hundred fifty-one responses were obtained, 60 (39.7%) from dermatologists and 91 (60.3%) from family physicians; 98.3% of dermatologists mentioned usually requesting a fungal testing at their local institution or outside, while this percentage was 50.5% among family physicians (<i>p</i> &#x3c; 0.001). Regarding the diagnosis, the median of correct diagnosis by the dermatologist group was higher (10/15) than the family physicians (6/15). Considering the treatment strategy, we observed that in the dermatologists’ group it would result in unnecessary treatment in a median of 2 cases, while in the family physicians’ group, in a median of 4 cases.

Treatment decision-making for older adults with cancer: A qualitative study

2020 ◽  
pp. 096973302094575
Author(s):  
Ni Gong ◽  
Qianqian Du ◽  
Hongyu Lou ◽  
Yiheng Zhang ◽  
Hengying Fang ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Cancer Patients ◽  
Family Members ◽  
Treatment Decision ◽  
Chinese Society ◽  
Decision Making Process ◽  
Treatment Decision Making ◽  
The Family ◽  
Older Cancer Patients

Background: Independent decision-making is one of the basic rights of patients. However, in clinical practice, most older cancer patients’ treatment decisions are made by family members. Objective: This study attempted to analyze the treatment decision-making process and formation mechanism for older cancer patients within the special cultural context of Chinese medical practice. Method: A qualitative study was conducted. With the sample saturation principle, data collected by in-depth interviews with 17 family members and 12 patients were subjected to thematic analysis. Ethical considerations: The study was approved by the ethics committees of Sun Yat-sen University. All participants provided verbal informed consent after being told their rights of confidentiality, anonymity, and voluntary participation. They had the right to refuse to answer questions and could withdraw at any time. Results: Three themes emerged: (1) complex process; (2) transformation of family decision-making power; and (3) individual compromise. Family members inevitably had different opinions during the long process of treatment decision-making for older cancer patients. The direction of this process could be regarded as an extension of the family power relationship. The patient usually compromised the decision to survive, which was made by family members. Conclusion: This study describes the treatment decision-making process of older cancer patients in the context of Chinese culture. The reasons underlying this process are related to the views on life and death and family values. An individual is a part of the family, which is often seen as the minimal interpersonal unit in Chinese society. It is significant that while emphasizing patient autonomy in the decision-making process, health professionals should also pay attention to the important roles of culture and family.

Real-world concordance of clinical practice with ASCO and NCCN guidelines for EGFR/ALK testing in aNSCLC.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 212-212 ◽  
Author(s):  
John E. Ruggiero ◽  
Jay Rughani ◽  
Josh Neiman ◽  
Steven Swanson ◽  
Cindy Revol ◽  
...  
Keyword(s):  
Clinical Oncology ◽  
Real World ◽  
Treatment Decision ◽  
Disease Diagnosis ◽  
First Line ◽  
Nccn Guidelines ◽  
Treatment Decision Making ◽  
First Line Therapy ◽  
Line Therapy ◽  
Biomarker Testing

212 Background: Timely and appropriate biomarker testing guides evidence-based treatment decision-making in advanced non-small cell lung cancer (aNSCLC). American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN) guidelines recommend that all treatment-eligible patients with non-squamous, or squamous histology in non-smokers undergo EGFR and ALK biomarker testing prior to initiating first line therapy. Genentech’s Learning and Clinical Integration team and Flatiron Health explored the frequency of EGFR/ALK testing and overall time between advanced disease diagnosis, results receipt and treatment initiation in clinical oncology practices. Methods: Structured and unstructured data were obtained from Flatiron’s electronic health record database. 6,991 patients from 166 clinics diagnosed after 1/1/14 with at least 2 visits before 8/31/15 were randomly selected from the Flatiron aNSCLC national cohort of > 25,000 patients. Dates of specimen collection, results receipt and treatment start were collected. Results: EGFR/ALK testing was conducted in 75% of non-squamous patients with wide variation across practices (< 20% to 100%). For squamous patients, 15% were tested overall, but with dramatic variation across practices (0% to 100%). For patients with a positive test result available prior to initiation of first line treatment, 79% of EGFR+ and 94% of ALK+ patients received the appropriate targeted therapy. However, for those patients tested after initiation of first line therapy, only 41% of EGFR+ and 65% of ALK+ patients received appropriate targeted first line therapy. EGFR/ALK tests results were received > 4 weeks from aNSCLC diagnosis in 32% and 34% of patients, respectively. Validation testing indicated that delays were attributed to non-lab factors, as test results were returned in < 2 weeks in 95% of cases. Conclusions: Wide variation in real-world practice illustrates the need to improve adherence to ASCO and NCCN biomarker testing guidelines. Educational intervention to improve quality of care in aNSCLC should focus on ensuring testing of almost all non-squamous patients, limiting testing to the non-smoking squamous cell population, and ensuring timely ordering of testing by clinicians.

scholarly journals Family Physicians' Opinion: A Survey on Possible Measures for Improving Healthcare in Romania

2019 ◽  
Vol 25 (2) ◽  
pp. 82-86
Author(s):  
Chirila Sergiu ◽  
Severin Beatrice
Keyword(s):  
Online Survey ◽  
Family Physicians ◽  
Medical Services ◽  
Primary Health ◽  
Care Processes ◽  
The Family ◽  
Primary Care Health ◽  
Care Health ◽  
And Control ◽  
First Contact

Abstract Primary health care (PHC) represents one of the most important parts of any health system, and consists of first-contact medical services (preventive, curative and rehabilitation) for the patients. Our study analyses the family physicians' opinions related to a series of measures that could improve Romania's healthcare system through an online survey. We identified three components, first one related to control over spendings, increase of medicine market efficiency and transparency in using public funds, second one related to standardization of care processes, accreditation, implementation of guidelines and control over utilization of specialty services and component number three related to type of insurance houses, with competition among them, better decentralization and integrated provision of medical services. The conclusions of the survey emphasize the fac that primary care health is affected by sub optimal financing, with a need of better support for its development through investments in health promotion, services integragion and human resources as means of increasing general health status of the population.

Patient involvement in multidisciplinary treatment planning (MTP).

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 145-145
Author(s):  
Irene Prabhu Das ◽  
Heather Rozjabek ◽  
Mary L. Fennell ◽  
Katherine Mallin ◽  
E. Greer Gay ◽  
...  
Keyword(s):  
Decision Making ◽  
Online Survey ◽  
Patient Involvement ◽  
Treatment Plan ◽  
Multidisciplinary Treatment ◽  
Treatment Decision ◽  
Case Presentation ◽  
Patient Navigators ◽  
Treatment Decision Making

145 Background: Patient involvement in treatment decision-making has been well-studied. However, little is known about how patients are involved in the MTP process prior to their consideration of treatment options. Methods: An online survey was administered to 1,261 Commission on Cancer (CoC)-accredited programs to describe current MTP practice. Survey items addressed team structure and process, case presentation, and patient involvement. A total of 797 (63%) facilities responded. Multiple aspects of patient involvement focusing on the initial case presentation and post-meeting follow-up regarding information provision and communication are examined. Initial descriptive analyses are presented. Results: 97% of facilities reported patients are not invited to attend MTP meetings. Reasons for not inviting patients included: patients may find it overwhelming (62%), physicians not able to speak freely (58%), liability (43%) and privacy (42%) concerns. Of the facilities that do invite patients, 1/3 reported that patients often or always attend. Treatment recommendations from MTP meetings are shared with patients at 75% of facilities, 42% share treatment plans, and 28% give a meeting summary to patients. Nine percent of facilities do not give patients any information from the meeting. Prior to treatment, a written treatment plan is developed at 43% of facilities, and among these, 15% give the plan to patients. Regarding communication about MTP meetings, facilities reported pre-meeting discussions with attending physicians (95%) and patient navigators (21%). Post-meeting follow-up by 93% of facilities is usually done by physicians, 26% by patient navigators and 16% by PA/NPs, and 66% follow-up within 1 week. Conclusions: Initial findings suggest that even if facilities do not invite patients to MTP meetings, they engage patients in various ways at pre- and post-MTP meetings, providing information and having discussions. Physicians are integral in communicating with patients throughout the MTP process. Further study on the multiple facets of patient involvement in MTP is needed to better understand its influence on treatment decision-making.

Cancer treatment and outcomes in patients of color or ethnic minority (PCEM): Oncologist perceptions of racial anxiety and/or implicit bias (RA/IB).

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 104-104
Author(s):  
Ajeet Gajra ◽  
Yolaine Jeune-Smith ◽  
Alexandrina Balanean
Keyword(s):  
Ethnic Minority ◽  
Healthcare Disparities ◽  
Online Survey ◽  
Hospice Care ◽  
Implicit Bias ◽  
Treatment Decision ◽  
Standard Of Care ◽  
Treatment Decisions ◽  
Treatment Recommendation ◽  
Treatment Decision Making

104 Background: Healthcare disparities are prevalent in cancer, with patients of color or ethnic minority (PCEM) at greatest risk for poor outcomes due to limited access to care, low health literacy and socioeconomic status, and potentially, racial anxiety and/or implicit bias (RA/IB) among oncologists. We conducted a descriptive study of medical/hematologic oncologists to assess perceptions of impact of RA/IB on treatment decisions and outcomes in PCEM. Methods: From February to April 2021, U.S.-based medical/hematologic oncologists participated in an online survey of perceptions regarding cancer care and outcomes in PCEM as part of a broader survey of various clinical and practice-related concerns. Questions used a modified 5-point Likert scale with an option of declining to answer, and respondents were aware that data would be anonymized and aggregated. Results: Among the 369 physicians surveyed, median years in practice were 17 (range 2-49). Most (72%) worked in community oncology; 64% were age 40 to 59 years; 21% identified as female, 70% as male, and 9% declined to disclose gender. Racial distribution was 32% White, 33% Asian, 7% Black, 4% Hispanic/Latinx, and 19% declined to disclose. Regarding perception of the degree of racial/ethnic healthcare disparity experienced by PCEM, 33% chose moderate, 29% very high/high, 29% low/none, and 8% declined to answer. Regarding how often RA/IB adversely affected survival among PCEM at their own practice, a majority (58%) chose rarely or never, 33% very often/almost always, often, or sometimes, and 9% declined to answer. Perceived frequency of specific scenarios involving RA/IB as adversely influencing treatment decisions at their practice (referral/recommendation for oncologic standard-of-care [SOC] modalities/services) was also assessed. The combinations of very often/almost always, often, and sometimes responses were: clinical trial referral (35%); palliative/hospice care (31%); novel therapeutic regimen vs. SOC selection (e.g., chemo/targeted/radiation therapy) (28%); surgical treatment recommendation (26%); and genetic/genomic testing referral (24%). Notably, 10% to 12% declined to answer. Conclusions: A majority of the medical/hematologic oncologists surveyed recognized the role of RA/IB in substandard treatment and outcomes among PCEM, but were less likely to perceive it within their own practice, suggesting a need for better identification. Notably, 24% to 35% recognized its adverse influence on SOC treatment decisions for PCEM. Further, 19% declined to identify their own race/ethnicity and 10% consistently declined to answer all treatment decision-making questions related to disparity, suggesting mistrust or apprehension in expressing true views. Findings suggest that oncologists may benefit from improved education regarding RA/IB and healthcare disparities in PCEM.

scholarly journals Management of Patients with COVID-19 at the Level OF PMC in Ukraine: Analysis of the Results of the Survey of Family Doctors in Comparison with Worldwide

2021 ◽  
pp. 5-11
Author(s):  
Oksana Ilkov ◽  
Pavlo Kolesnyk
Keyword(s):  
Primary Care ◽  
Comparative Analysis ◽  
Primary Care Physicians ◽  
Online Survey ◽  
Treatment Strategies ◽  
Family Physicians ◽  
Infectious Agent ◽  
Diagnostic Methods ◽  
Family Doctors ◽  
The World

The emergence of the new infectious agent SARS COVID-19 quickly led to an epidemic and later a pandemic in 2020. Currently, the world has accumulated enough descriptive data on the management of patients with COVID-19, but many countries have not yet clearly developed evidence protocols for different levels medical care. Therefore, it is actual to conduct a comparative analysis of the management of patients with coronavirus infection at the level of PMC in different countries. The objective: to conduct a comparative analysis of the management of COVID-19 patients at the level of PMC in different countries and in Ukraine. Materials and methods. Data from family physicians from 9 countries on the management of COVID-19 patients at the PMC level (which were presented in the form of reports with answers to 5 questions at the international conference «Hot topic: COVID-19 and comorbid conditions in primary care» 3–5 December 2020). The results of a survey of Ukrainian family doctors conducted by an online survey were also evaluated. The answers of Ukrainian family doctors were received in the process of anonymous questionnaires in the format of Google-forms from November to December 2020. Results. The analysis of reports of international experts and survey data of domestic doctors revealed similar features in treatment strategies, diagnosis and control strategies for recovery of patients at the level of PMC: for example, assessment of the patient’s condition by pulse oximetry, respiratory rate, telephone and video triage etc. However, certain directions in the domestic routine medical practice differed significantly from those in the management of patients by family physicians in the world (for example, the widespread use of antibiotics, anticoagulants and many other additional means, frequent unjustified use of CT by primary care physicians colleagues at the PMC level. Conclusions. A comparative analysis of diagnosis and treatment revealed both similar (diagnostic methods, assessment of patients’ condition) and distinctive features (hyperdiagnosis and оver-treatment) in the management of COVID-19 in Ukraine, compared to global strategies.

scholarly journals Pengambilan Keputusan mengenai Pengobatan pada Pasien Kanker Payudara yang Menjalani Pengobatan Tradisional

2019 ◽  
Vol 46 (1) ◽  
pp. 72 ◽  
Author(s):  
Arina Shabrina ◽  
Aulia Iskandarsyah
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Online Survey ◽  
Treatment Decision ◽  
Breast Cancer Patients ◽  
Contributing Factors ◽  
Traditional Treatment ◽  
Treatment Decision Making ◽  
Perceived Benefit ◽  
Treatment Clinic

There were breast cancer patients who undergo a traditional treatment. The aim of this study was to describe the contributing factors in traditional treatment decision making. Five breast cancer patients were recruited from online survey, cancer community and traditional treatment clinic. Respondents filled demographic and clinical characteristic form and also interviewed. Thematic analysis was used to analyze the data. The result of this study was most of the respondents put more trust on traditional treatment therapist rather than doctor. Most of them undergo a traditional treatment because they perceived the benefits from the treatment. Family member suggested they to undergo a traditional treatment. There were several factors that contributed to participant’s decision to undergo a traditional treatment; ie (1) the view about health care provider, (2) the perceived benefit from the treatment and (3) the source of recommen­dation about the use of traditional treatment.

Parent Perceptions in Choosing Treatment for Infants With Spinal Muscular Atrophy Diagnosed Through Newborn Screening

2021 ◽  
pp. 088307382110402
Author(s):  
Stella Deng ◽  
Bo Hoon Lee ◽  
Emma Ciafaloni
Keyword(s):  
Spinal Muscular Atrophy ◽  
Newborn Screening ◽  
Online Survey ◽  
Muscular Atrophy ◽  
Treatment Decision ◽  
Treatment Frequency ◽  
Treatment Decision Making ◽  
Administration Method ◽  
Receive Treatment ◽  
Theme Identification

Objective: To identify factors parents considered in treatment decision making for children diagnosed with spinal muscular atrophy on newborn screening. Methods: Participants were recruited through the University of Rochester or through flyers and Cure SMA social media outreach and asked to complete a telephone or online survey. Data were analyzed through mixed methods using descriptive statistics and theme identification in narrative responses. Results: Eighteen parents with children diagnosed with spinal muscular atrophy on newborn screening participated. Thirteen of 18 chose onasemnogene abeparvovec, 2 of 18 chose risdiplam, 1 of 18 chose nusinersen, and 2 of 18 did not receive treatment. The most commonly reported factors impacting treatment choice included treatment frequency and administration method. Seventeen (94.4%) parents felt that inclusion of spinal muscular atrophy on newborn screening was positive because it could allow for better outcomes with earlier treatment. Conclusion: Treatment frequency and administration method were the most important factors for parents in determining spinal muscular atrophy treatment. Parents felt positively about newborn screening due to opportunity for earlier treatment.

scholarly journals A Promising and Challenging Approach: Radiologists’ Perspective on Deep Learning and Artificial Intelligence for Fighting COVID-19

Diagnostics ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1924
Author(s):  
Tianming Wang ◽  
Zhu Chen ◽  
Quanliang Shang ◽  
Cong Ma ◽  
Xiangyu Chen ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Medical Imaging ◽  
Treatment Decision ◽  
Disease Diagnosis ◽  
Future Research ◽  
X Rays ◽  
Imaging Data ◽  
Efficacy Evaluation ◽  
Treatment Decision Making ◽  
Diagnosis And Classification

Chest X-rays (CXR) and computed tomography (CT) are the main medical imaging modalities used against the increased worldwide spread of the 2019 coronavirus disease (COVID-19) epidemic. Machine learning (ML) and artificial intelligence (AI) technology, based on medical imaging fully extracting and utilizing the hidden information in massive medical imaging data, have been used in COVID-19 research of disease diagnosis and classification, treatment decision-making, efficacy evaluation, and prognosis prediction. This review article describes the extensive research of medical image-based ML and AI methods in preventing and controlling COVID-19, and summarizes their characteristics, differences, and significance in terms of application direction, image collection, and algorithm improvement, from the perspective of radiologists. The limitations and challenges faced by these systems and technologies, such as generalization and robustness, are discussed to indicate future research directions.

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