scholarly journals Sources of variability in computed tomography perfusion: implications for acute stroke management

2011 ◽  
Vol 30 (6) ◽  
pp. E8 ◽  
Author(s):  
Benjamin Zussman ◽  
Pascal Jabbour ◽  
Kiran Talekar ◽  
Richard Gorniak ◽  
Adam E. Flanders
Keyword(s):  
Decision Making ◽  
Data Acquisition ◽  
Acute Stroke ◽  
Clinical Decision Making ◽  
Ct Perfusion ◽  
Imaging Modality ◽  
Clinical Decision ◽  
Future Research ◽  
Original Research ◽  
Perfusion Study

Object Although dynamic, first-pass cerebral CT perfusion is used in the evaluation of acute ischemic stroke, a lack of standardization restricts the value of this imaging modality in clinical decision-making. The purpose of this study was to comprehensively review the reported sources of variability and error in cerebral CT perfusion results. Methods A systematic literature review was conducted, 120 articles were reviewed, and 23 published original research articles were included. Sources of variability and error were thematically categorized and presented within the context of the 3 stages of a typical CT perfusion study: data acquisition, postprocessing, and results interpretation. Results Seven factors that caused variability were identified and described in detail: 1) contrast media, the iodinated compound injected intravascularly to permit imaging of the cerebral vessels; 2) data acquisition rate, the number of images obtained by CT scan per unit time; 3) user inputs, the subjective selections that operators make; 4) observer variation, the failure of operators to repeatedly measure a perfusion parameter with precision; 5) software operational mode, manual, semiautomatic, or automatic; 6) software design, the mathematical algorithms used to perform postprocessing; and 7) value type, absolute versus relative values. Conclusions Standardization at all 3 stages of the CT perfusion study cycle is warranted. At present, caution should be exercised when interpreting CT perfusion results as these values may vary considerably depending on a variety of factors. Future research is needed to define the role of CT perfusion in clinical decision-making for acute stroke patients and to determine the clinically acceptable limits of variability in CT perfusion results.

Abstract W MP13: Missed Imaging Diagnosis Without CT Perfusion May Affect Clinical Decision for TPA and Thrombectomy in Acute Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Sarah W Meng ◽  
Xiang Liu ◽  
Michael Hewitt
Keyword(s):  
Decision Making ◽  
Acute Stroke ◽  
Clinical Decision Making ◽  
Ct Perfusion ◽  
Infarct Volume ◽  
Clinical Decision ◽  
Imaging Diagnosis ◽  
Imaging Protocol ◽  
Number Of Patients ◽  
Negative Imaging

Purpose: In a previous study, we found higher detection rate of 2nd and 3rd order vascular thrombosis when CT Perfusion (CTP) was performed as compared to non-contrast CT (NCCT) and CT angiography (CTA) alone. Additionally, a significant number of patients with acute infarct were reported as negative without CTP. In this study, we sought to determine whether missed imaging diagnosis without CTP might affect clinical decision making. Methods: A total of 758 cases were included in our previous study, with CTP deficits reported in all 71 cases with final infarct volume of 2.8 ml or above. Conversely, 23 of 96 (24%) cases without CTP were reported as negative. In the group without CTP, 7 of 10 patients who had 2nd or 3rd order vascular thromboses with a final infarct > 30cc were reported negative, whereas only 1 of 10 cases were missed in patients who had CTP but a negative NCCT. The treatment decisions at the time of stroke were reviewed for these patients. Results: In 10 cases with final infarct volume > 30ml reported negative without CTP, zero received TPA or thrombectomy. Conversely, in the same category, 5 of 10 cases with positive CTP received TPA (p = 0.041). There was also a higher rate of TPA or thrombectomy treatment in patients with a positive imaging diagnosis, both with CTP (13 of 71, 18.3%) and without CTP (28 of 73, 38.4%), as compared to the group reported negative without CTP (3 of 23, 13%, p = 0.059). Fewer cases in the CTP group received treatment as compared to cases reported positive without CTP. A possible reason is that the cases with CTP were from an earlier phase of our acute stroke program, when treatment tended to be more conservative. Conclusions: Our study finds discrepancies in decision making for TPA and thrombectomy in stroke cases with positive versus negative imaging diagnosis. The cases reported negative were less likely to receive treatment, including those with relatively large final infarct size (>30ml). We speculate that a negative imaging diagnosis may create doubt for clinical diagnosis in some cases. Adding CTP in the acute stroke imaging protocol will increase imaging diagnostic accuracy and exclude stroke mimics, therefore providing valuable information for treatment.

Computer-based ICU data acquisition as an aid to clinical decision-making

1982 ◽  
Vol 10 (12) ◽  
pp. 823-830 ◽  
Author(s):  
REED M. GARDNER ◽  
BLAIR J. WEST ◽  
T. ALLAN PRYOR ◽  
KEITH G. LARSEN ◽  
HOMER R. WARNER ◽  
...  
Keyword(s):  
Decision Making ◽  
Data Acquisition ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Computer Based

scholarly journals Article Commentary: Calling for Help? Considering Function and Meaning when Patients Drunk-Dial Psychotherapists

2013 ◽  
Vol 7 ◽  
pp. SART.S12423
Author(s):  
Kelly Serafini ◽  
Donna LaPaglia ◽  
Matthew Steinfeld
Keyword(s):  
Decision Making ◽  
Substance Use ◽  
Popular Culture ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Substance Use Treatment ◽  
Future Research ◽  
Research And Practice ◽  
Use Of Technology ◽  
Literature Base

Drunk-dialing is a term documented in both popular culture and academic literatures to describe a behavior in which a person contacts another individual by phone while intoxicated. In our collective clinical experience we have found that clients drunk-dial their clinicians too, particularly while in substance use treatment, and yet there is a noticeable absence of research on the topic to guide clinical decision-making within a process-based understanding of these events. As the parameters within which psychotherapy takes place become increasingly technologized, a literature base to document clients’ idiosyncratic use of technology will become increasingly necessary and useful. We provide a brief review of the existing research on drunk-dialing and conclude with specific questions to guide future research and practice.

scholarly journals Conceptualizations of Clinical Decision-Making: A Scoping Review in Geriatric Emergency Medicine

2020 ◽  
Author(s):  
Maria Louise Gamborg ◽  
Mimi Mehlsen ◽  
Charlotte Paltved ◽  
Gitte Tramm ◽  
Peter Musaeus
Keyword(s):  
Decision Making ◽  
Emergency Medicine ◽  
Scoping Review ◽  
Clinical Decision Making ◽  
Data Extraction ◽  
Empirical Studies ◽  
Clinical Decision ◽  
Future Research ◽  
Study Results ◽  
Geriatric Emergency Medicine

Abstract Background: Clinical decision-making (CDM) is an important competency for young doctors, especially under complex and uncertain conditions, which is present in geriatric emergency medicine (GEM). Research in this field is however characterized by an unclear conceptualization of CDM. To evolve and evaluate evidence-based knowledge of CDM, it is thus important to identify different definitions and their operationalisations in studies on GEM.Objective: A scoping review of empirical articles was designed to provide an overview of the documented evidence of findings and conceptualizations of CDM in GEM.Methods: A detailed search for empirical studies focusing on CDM in a GEM setting was conducted in PubMed, ProQuest, Scopus, EMBASE and Web of Science. In total, 52 publications were included in the analysis, utilizing a data extraction sheet, following the PRISMA guidelines. Reported outcomes were summarized.Results: Four themes of operationalization of CDM emerged; CDM as dispositional decisions, CDM as cognition, CDM as a model, and CDM as clinical judgement. Study results and conclusions differed according to how CDM was conceptualized. It was evident how especially frailty- heuristics lead to biases in treatment of geriatric patients, and that the complexity of this patient group was seen as a challenge for CDM.Conclusions: This scoping review summarizes how different studies in GEM use the term CDM. It provides a snapshot of findings in GEM. Potentially, findings from CDM research can guide implementation of adequate CDM strategies in clinical practice but this requires application of more stringent definitions of CDM in future research.

A Clinical Decision Making Example: Implementing Intensive Speech Sound Intervention for School-Age Students Through Telepractice

2017 ◽  
Vol 2 (18) ◽  
pp. 15-26
Author(s):  
Vicki Pullins ◽  
Sue Grogan-Johnson
Keyword(s):  
Decision Making ◽  
Speech Intelligibility ◽  
Intervention Program ◽  
Clinical Decision Making ◽  
Speech Sound ◽  
Clinical Decision ◽  
Future Research ◽  
Decision Making Process ◽  
School Age ◽  
Efficient Manner

The purpose of this article is to describe the clinical decision making process that was utilized in implementing a speech sound intervention program delivered five times a week in individual telepractice therapy sessions lasting six minutes to school-age students in kindergarten through fifth grade (K-5). We utilized a clinical decision making process (Kamhi, 2006) to help establish this alternate way to provide speech sound intervention that resulted in improved speech intelligibility in the classroom in an efficient manner. Initial data collection on student outcomes will be provided. Limitations of this initial experiment are discussed with guidance provided for possible future research studies.

mHealth in clinical decision-making: A systematic literature review (Preprint)

2019 ◽  
Author(s):  
Amandeep Dhir
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Health Care Providers ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Future Research ◽  
Care Providers ◽  
Rigorous Approach ◽  
Almost All ◽  
Mhealth Apps

UNSTRUCTURED A large number of mHealth apps are available nowadays for patients and health care providers. Many of those apps are designed specifically for clinical decision making (CDM). Despite their proliferation, limited studies have examined the utilization and effectiveness of these apps. The current study undertakes a systematic review to organize and synthesize the extant literature on mHealth for CDM in all resource settings. A thorough search of databases resulted in a preliminary list of 1,313 titles and abstracts, of which 1,107 were excluded as they were either duplicates or irrelevant to the scope of the study. Thereafter, full-text screening of the remaining 206 articles was performed, and 175 were excluded on the basis of pre-specified inclusion/exclusion criteria. This rigorous approach resulted in the identification of 31 studies for inclusion in the review. The utilization of mHealth for CDM appears to have pervaded almost all health care settings, as demonstrated by the insights gleaned from the review of the prior studies in the domain. However, the evidence of effectiveness is still limited and unreliable, which underscores the existence of a paucity of accumulated knowledge that, in turn, invites interesting opportunities for future research.

scholarly journals Conceptualizations of clinical decision-making: a scoping review in geriatric emergency medicine

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Maria Louise Gamborg ◽  
Mimi Mehlsen ◽  
Charlotte Paltved ◽  
Gitte Tramm ◽  
Peter Musaeus
Keyword(s):  
Decision Making ◽  
Emergency Medicine ◽  
Scoping Review ◽  
Clinical Decision Making ◽  
Data Extraction ◽  
Empirical Studies ◽  
Clinical Decision ◽  
Future Research ◽  
Study Results ◽  
Geriatric Emergency Medicine

Abstract Background Clinical decision-making (CDM) is an important competency for young doctors especially under complex and uncertain conditions in geriatric emergency medicine (GEM). However, research in this field is characterized by vague conceptualizations of CDM. To evolve and evaluate evidence-based knowledge of CDM, it is important to identify different definitions and their operationalizations in studies on GEM. Objective A scoping review of empirical articles was conducted to provide an overview of the documented evidence of findings and conceptualizations of CDM in GEM. Methods A detailed search for empirical studies focusing on CDM in a GEM setting was conducted in PubMed, ProQuest, Scopus, EMBASE and Web of Science. In total, 52 publications were included in the analysis, utilizing a data extraction sheet, following the PRISMA guidelines. Reported outcomes were summarized. Results Four themes of operationalization of CDM emerged: CDM as dispositional decisions, CDM as cognition, CDM as a model, and CDM as clinical judgement. Study results and conclusions naturally differed according to how CDM was conceptualized. Thus, frailty-heuristics lead to biases in treatment of geriatric patients and the complexity of this patient group was seen as a challenge for young physicians engaging in CDM. Conclusions This scoping review summarizes how different studies in GEM use the term CDM. It provides an analysis of findings in GEM and call for more stringent definitions of CDM in future research, so that it might lead to better clinical practice.

Using Intensive Longitudinal Data to Identify Early Predictors of Suicide-Related Outcomes in High-Risk Adolescents: Practical and Conceptual Considerations

Assessment ◽  
2020 ◽  
pp. 107319112093916
Author(s):  
Ewa K. Czyz ◽  
Jamie R.T. Yap ◽  
Cheryl A. King ◽  
Inbal Nahum-Shani
Keyword(s):  
Risk Factors ◽  
Decision Making ◽  
Longitudinal Data ◽  
Roc Curve ◽  
Clinical Decision Making ◽  
Predictive Accuracy ◽  
Clinical Decision ◽  
Future Research ◽  
Intensive Longitudinal Data ◽  
Suicidal Crisis

Mobile technology offers new possibilities for assessing suicidal ideation and behavior in real- or near-real-time. It remains unclear how intensive longitudinal data can be used to identify proximal risk and inform clinical decision making. In this study of adolescent psychiatric inpatients ( N = 32, aged 13-17 years, 75% female), we illustrate the application of a three-step process to identify early signs of suicide-related crises using daily diaries. Using receiver operating characteristic (ROC) curve analyses, we considered the utility of 12 features—constructed using means and variances of daily ratings for six risk factors over the first 2 weeks postdischarge (observations = 360)—in identifying a suicidal crisis 2 weeks later. Models derived from single risk factors had modest predictive accuracy (area under the ROC curve [AUC] 0.46-0.80) while nearly all models derived from combinations of risk factors produced higher accuracy (AUCs 0.80-0.91). Based on this illustration, we discuss implications for clinical decision making and future research.

How psychiatrists think

2009 ◽  
Vol 15 (1) ◽  
pp. 72-79 ◽  
Author(s):  
Niall Crumlish ◽  
Brendan D. Kelly
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Cognitive Effort ◽  
Future Research ◽  
Cognitive Error ◽  
Apply Research ◽  
Research Findings ◽  
Clinical Interest ◽  
Clinical Thinking

SummaryOver the past decade, the study of error in medicine has expanded to incorporate new insights from cognitive psychology, generating increased research and clinical interest in cognitive errors and clinical decision-making. The study of cognitive error focuses on predictable errors in thinking that result from the use of cognitive shortcuts or ‘heuristics’. Heuristics reduce the time, resources and cognitive effort required for clinical decision-making and are a feature of mature clinical thinking. Heuristics can also lead to bias and must be used with an awareness of their weaknesses. In this article, we describe heuristics commonly used in clinical decision-making and discuss how failure of heuristics results in cognitive error. We apply research findings on decision-making in medicine to decision-making in psychiatry and suggest directions for training and future research into cognitive error in psychiatry.

scholarly journals Conceptualizations of Clinical Decision-Making: A scoping review in geriatric emergency medicine

2020 ◽  
Author(s):  
Maria Louise Gamborg ◽  
Mimi Mehlsen ◽  
Charlotte Paltved ◽  
Gitte Tramm ◽  
Peter Musaeus
Keyword(s):  
Decision Making ◽  
Emergency Medicine ◽  
Scoping Review ◽  
Clinical Decision Making ◽  
Data Extraction ◽  
Empirical Studies ◽  
Clinical Decision ◽  
Future Research ◽  
Study Results ◽  
Geriatric Emergency Medicine

Abstract Background Clinical decision-making (CDM) is an important competency for young doctors especially under complex and uncertain conditions in geriatric emergency medicine (GEM). However, research in this field is characterized by a vague conceptualization of CDM. To evolve and evaluate evidence-based knowledge of CDM, it is important to identify different definitions and their operationalisations in studies on GEM. Objective A scoping review of empirical articles was conducted to provide an overview of the documented evidence of findings and conceptualizations of CDM in GEM. Methods A detailed search for empirical studies focusing on CDM in a GEM setting was conducted in PubMed, ProQuest, Scopus, EMBASE and Web of Science. In total, 52 publications were included in the analysis, utilizing a data extraction sheet, following the PRISMA guidelines. Reported outcomes were summarized. Results Four themes of operationalization of CDM emerged: CDM as dispositional decisions, CDM as cognition, CDM as a model, and CDM as clinical judgement. Study results and conclusions naturally differed according to how CDM was conceptualized. Thus, frailty-heuristics lead to biases in treatment of geriatric patients and the complexity of this patient group was seen as a challenge for young physicians engaging in CDM. Conclusions This scoping review summarizes how different studies in GEM use the term CDM. It provides an analysis of findings in GEM and call for more stringent definitions of CDM in future research, so that it might lead to better clinical practice.

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