scholarly journals Can Gait Signatures Provide Quantitative Measures for Aiding Clinical Decision-Making? A Systematic Meta-Analysis of Gait Variability Behavior in Patients with Parkinson's Disease

2016 ◽  
Vol 10 ◽  
Author(s):  
Niklas König ◽  
Navrag B. Singh ◽  
Christian R. Baumann ◽  
William R. Taylor
Keyword(s):  
Parkinson’S Disease ◽  
Decision Making ◽  
Parkinson's Disease ◽  
Clinical Decision Making ◽  
Meta Analysis ◽  
Clinical Decision ◽  
Gait Variability

scholarly journals Lessons Learned: Conducting Cases of Manualized, Telephone-Based, Cognitive Behavioral Treatment for Depression in Parkinson’s Disease (dPD)

2020 ◽  
Vol 16 (1) ◽  
pp. 124-131
Author(s):  
Logan Durland
Keyword(s):  
Parkinson’S Disease ◽  
Decision Making ◽  
Parkinson's Disease ◽  
Case Studies ◽  
Behavioral Treatment ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Lessons Learned ◽  
Clinical Population ◽  
Recent Experience

My current clinical practice has been shifted to a telehealth format for the last three months due to the COVID-19 pandemic, and it seems an apt moment to reexamine my participation in Dr. Roseanne Dobkin’s research on manualized telehealth therapy for depression in Parkinson’s disease patients (dPD), using a protocol titled "Teleheath Guided Self-Help for dPD," or "TH-GSH-dPD," for short (Dobkin et al., 2020). My participation involved, in part, being the therapist in  four case studies I have written about with "Alice," "Carl," "Ethan," and "Gary" (Durland, 2020). In these case studies, a subset of those in Dr. Dobkin’s group studies, I explored my clinical decision-making, seeking insight into how best to flexibly apply the dPD protocol to meet the needs of a heterogeneous clinical population. Here, my aim is to recontextualize and expand on the conclusions of my four case studies, based on my dissertation and conducted over three years ago (Durland, 2017), in light of both my recent experience providing mental health services and the Commentaries on the four case studies so perceptively contributed by Dr. Dobkin and her colleagues (Mann, Miller, St. Hill, Dobkin, 2020) and by Liza Pincus (2020). In particular, I will focus first on (a) continuing the analysis of clinical decision-making involved in the case studies described in my earlier article (Duland, 2020); and then on (b) general issues related to the delivery of telehealth treatment.

A meta-analysis of confidence and judgment accuracy in clinical decision making.

2015 ◽  
Vol 62 (4) ◽  
pp. 553-567 ◽  
Author(s):  
Deborah J. Miller ◽  
Elliot S. Spengler ◽  
Paul M. Spengler
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Meta Analysis ◽  
Clinical Decision ◽  
Judgment Accuracy

Does the Evidence Support Use of the Baha Implant System (Baha) in Patients with Congenital Unilateral Aural Atresia?

2010 ◽  
Vol 21 (04) ◽  
pp. 274-286 ◽  
Author(s):  
Jeffrey L. Danhauer ◽  
Carole E. Johnson ◽  
Melissa Mixon
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Meta Analysis ◽  
Scientific Evidence ◽  
Clinical Decision ◽  
Clinical Expertise ◽  
Patient Benefit ◽  
Level Of Evidence ◽  
Aural Atresia ◽  
Laboratory Measures

Purpose: To determine if the evidence supports the recommendation of Baha implant systems (Bahas) over unaided conditions in persons with conductive hearing loss due to congenital unilateral aural atresia (CUAA), and if laboratory measures predict patient benefit and satisfaction. Research Design: A systematic review. Methods: The authors constructed and submitted search strings to PubMed and other electronic databases to identify studies in peer-reviewed journals that were at an appropriate level of evidence (systematic reviews, randomized controlled trials, or nonrandomized intervention studies); used outcome measures assessing audibility, localization, or speech-recognition in noise; included patients with CUAA using Bahas; and had intrepretable data. References of all retrieved articles were also hand searched for relevant studies. Evaluation forms were completed by the authors for each of the included studies at all phases of the review including quality assessment and data extraction. Results: The authors reviewed 88 retrieved titles and excluded four that had no relevance to the topic and 67 that were duplicates. Abstracts were reviewed for the remaining 17, and six nonrelevant studies were excluded. The remaining 11 articles were retrieved for full-text review; only three studies met inclusion criteria and were analyzed further. The three studies were not appropriate for a meta-analysis due to limited data, too few participants, and insufficient presentations of results. Qualitative analysis revealed inconsistent findings across audiometric measures, and few significant differences were noted with and without Bahas, yet most participants believed that Bahas improved their quality of life. Laboratory measures did not always predict patient benefit and satisfaction with Bahas. Conclusions: Results were limited for this narrow population having CUAA and the specific criteria used for this review. Audiologic measures generally failed to predict patients' success and/or satisfaction with their Bahas, but most of the included studies showed that patients perceived some benefits. Ideally, clinical decision making should include the highest levels of scientific evidence. However, when evidence is unavailable or does not support a clear-cut recommendation for a particular treatment across patients, as seems to be the case for the use of Bahas with CUAA, then clinicians must rely more heavily on clinical expertise and individual patient preferences in guiding clinical decision making.

The Statistical Fragility of Platelet-Rich Plasma in Rotator Cuff Surgery: A Systematic Review and Meta-analysis

2021 ◽  
pp. 036354652198997
Author(s):  
Robert L. Parisien ◽  
Cooper Ehlers ◽  
Antonio Cusano ◽  
Paul Tornetta ◽  
Xinning Li ◽  
...  
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Rotator Cuff ◽  
Clinical Decision Making ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Clinical Decision ◽  
Statistical Stability ◽  
Lost To Follow Up

Background: The practice of evidence-based medicine relies on objective data to guide clinical decision-making with specific statistical thresholds conveying study significance. Purpose: To determine the utility of applying the fragility index (FI) and the fragility quotient (FQ) analysis to randomized controlled trials (RCTs) evaluating the utilization of platelet-rich plasma (PRP) in rotator cuff repairs (RCRs). Study Design: Systematic review and meta-analysis. Methods: RCTs pertaining to the utilization of PRP in surgical RCRs published in 13 peer-reviewed journals from 2000 to 2020 were evaluated. The FI was determined by manipulating each reported outcome event until a reversal of significance was appreciated. The associated FQ was determined by dividing the FI by the sample size. Results: Of the 9746 studies screened, 19 RCTs were ultimately included for analysis. The overall FI incorporating all 19 RCTs was only 4, suggesting that the reversal of only 4 events is required to change study significance. The associated FQ was determined as 0.092. Of the 43 outcome events reporting lost to follow-up data, 13 (30.2%) represented lost to follow-up >4. Conclusion: Our analysis suggests that RCTs evaluating PRP for surgical RCRs may lack statistical stability with only a few outcome events required to alter trial significance. Therefore, we recommend the reporting of an FI and an FQ in conjunction with P value analysis to carefully interpret the integrity of statistical stability in future comparative trials. Clinical Relevance: Clinical decisions are often informed by statistically significant results. Thus, a true understanding of the robustness of the statistical findings informing clinical decision-making is of critical importance.

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