PURPOSE: We evaluated the clinical role of rapid next-generation sequencing (NGS) for identifying BRCA1/2 mutations compared to traditional Sanger sequencing. METHODS: Twenty-four paired samples from 12 patients were analyzed in this prospective study to compare the performance of NGS to the Sanger method. Both NGS and Sanger sequencing were performed in 2 different laboratories using blood samples from patients with breast cancer. We then analyzed the accuracy of NGS in terms of variant calling and determining concordance rates of BRCA1/2 mutation detection. RESULTS: The overall concordance rate of BRCA1/2 mutation identification was 100%. Variants of unknown significance (VUS) were reported in two cases of BRCA1 and 3 cases of BRCA2 after Sanger sequencing, whereas NGS reported only 1 case of BRCA1 VUS, likely due to differences in reference databases used for mutation identification. The median turnaround time of Sanger sequencing was 22 days (range, 14–26 days), while the median time of NGS was only 6 days (range, 3–21 days). CONCLUSION: NGS yielded comparably accurate results to Sanger sequencing and in a much shorter time with respect to BRCA1/2 mutation identification. The shorter turnaround time and higher accuracy of NGS may help clinicians make more timely and informed decisions regarding surgery or neoadjuvant chemotherapy in patients with breast cancer.
Breast Neoplasms* ; Breast* ; Clinical Decision-Making* ; Drug Therapy ; High-Throughput Nucleotide Sequencing ; Humans ; Methods ; Prospective Studies

Taking children respiratory infectious diseases as the research object, CDSS transform from isolated clinical data to an integration Model. With integrating pharmacy and laboratory knowledge, the system establishes children typical characterization data of common infectious diseases and medical efficacy data repository to providing treatment recommendations for doctor. Based on the clinical characteristics of children infectious diseases, this paper proposes knowledge inference engine and an information integration model. decision-making inference engine, medical information integration model.
Child ; Clinical Decision-Making ; Communicable Diseases ; Databases, Factual ; Humans ; Medical Informatics ; Pediatrics ; methods ; Respiratory Tract Infections

No abstract available.
Clinical Decision-Making/*methods ; *Evidence-Based Medicine ; *Practice Patterns, Physicians' ; *Uncertainty

Clinical trials are often designed as either pragmatic or explanatory. The pragmatic clinical trials are generally used for measuring the effectiveness of a treatment in common clinical practice, while the explanatory trial for measuring the efficacy of a treatment under ideal conditions. Since the methods concerning pragmatic clinical trials are less introduced in China, its archetypal features, advantages and limitations were introduced in this paper. And a current study of pragmatic clinical trials on using acpuncture for treatment of low back pain carried out in German was taken as an example to illustrate the practical methods concretely. The key steps of the design were presented in detail, and reasonable suggestions about the problems often encountered in the trial, as well as how to balance the internal and external validity, outcome measurement, etc., were offered.
Clinical Trials as Topic ; methods ; standards ; Data Interpretation, Statistical ; Decision Making, Organizational ; Humans

PURPOSE: This study aims to investigate how competitive orientation influences unethical decision-making (UDM) through relationship conflict and the moderating effect of hostile attribution bias. METHODS: This study was conducted using a self-report questionnaire. Data were collected from 727 employees in Chinese hospitals. For each variable, measures were adopted or adapted from existing literature. Data were analyzed using descriptive statistics, correlation analysis, confirmatory factor analysis, and hierarchical regression analysis. Common method variance was established using Harman's single-factor test. RESULTS: Competitive orientation is significantly and positively associated with relationship conflict (β = .36, p < .001) and UDM (β = .35, p < .001). Relationship conflict is significantly and positively associated with UDM (β = .51, p < .001). Relationship conflict partially mediates the relationship between competitive orientation and UDM. In addition, hostile attribution bias strengthens the positive relationship between competitive orientation and UDM through relationship conflict. CONCLUSION: This study provides some implications for hospital employees to deal with ethical dilemmas in decision-making. Hospital employees including nurses, physicians, and other health-care professionals should raise awareness of competitive orientation and adopt a cooperative approach to human relations. Effective training programs should be utilized to direct all hospital employees to depress hostile attribution bias whenever possible to everything in clinical practice.
Asian Continental Ancestry Group ; Bias (Epidemiology) ; Conflict (Psychology) ; Decision Making ; Education ; Ethics, Clinical ; Hostility ; Humans ; Methods

When selecting implant guidance methods or judging whether the patient can be implanted, many doctors ignore or only use visual inspection to estimate a patient's mouth opening. This phenomenon often leads to failure to complete the implantation due to insufficient mouth opening or the deflection of the implant due to limited angle, resulting in the high incidence of corresponding complications. The main reason is that doctors lack accurate analysis and control of the overall geometric conditions of the intraoral surgical area, and three-dimensional position blocking of surgical instruments occurs during the operation. In the past, mouth opening was defined as the distance between the incisor edges of the upper and lower central incisors when the patient opens his mouth widely, and the implant area could be in any missing tooth position. When it is in the posterior tooth area, the specific measurement scheme of the mouth opening could not be simply equivalent to the previous measurement method in the anterior tooth area. However, how to measure quickly and conveniently the mouth opening of any surgical area to determine whether it could be implanted and meet the needs of the selected guidance method remains unclear. This paper introduces new concepts, establishes new classification and corresponding accurate measurement scheme of implant area, and establishes a decision tree of implant methods guided by the actually measured value. Results provide a quantitative basis for rational formulation and implementation of implant treatment.
Humans ; Mouth ; Dental Implantation, Endosseous/methods* ; Incisor ; Clinical Decision-Making ; Dental Implants

According to the different surgical approaches and its corresponding lymph node dissection modes, surgical treatment for esophageal cancer can be divided into different surgical treatment modes. Currently in China, the surgical treatment modes for esophageal cancer including left and right thoracic approaches and its corresponding lymph node dissection modes (two-field or three-field) are widely practiced. Different surgical approaches may influence lymph node dissection results, and it may eventually affect the survival of the esophageal cancer patients, therefore, individual selection of appropriate surgical approaches and lymph node dissection extent for esophageal cancer patients based on precise preoperative examinations and clinical stages is very important. By summarizing the recent domestic and foreign research results, it demonstrates that 2-field lymph node dissection by right approach is more radical than left approach, 3-field lymph node dissection by right approach is more radical than 2-field right approach, and may eventually improve the prognosis of patients. However, most of them are retrospective studies which need large sample randomized controlled trials support. This article reviews and summarizes recently published literatures, and discuss the selection of surgical approach and the extent of lymph node dissection for esophageal cancer from three aspects that the effect of left and right thoracic approach on lymph node dissection and prognosis, how to choose individual surgical approach by different position and stage, and what kind of patients need right thoracic approaches with 3-field lymph node dissection.
China ; Clinical Decision-Making ; methods ; Clinical Protocols ; Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Female ; Humans ; Lymph Node Excision ; methods ; Male ; Prognosis ; Thoracic Surgical Procedures ; methods

clinical decision-making in the management of patients with orbital blowout fractures is challenging, and various aspects of orbital fracture management are uncertain. Numerous approaches have been used for reduction of blowout fracture. Controversies exist regarding indications for surgery, timing of surgery, and optimal reconstruction material. Recently, with expanding use of and indications for endoscopy in orbital blowout fracture surgery, otolaryngologists participate more often in facial trauma surgery, including blowout fracture. In this review, several controversial issues of surgical indication, surgical timing, method of approach, and choice of reconstruction material are discussed from the perspective of otolaryngology surgeons.]]>
Clinical Decision-Making ; Diagnosis ; Diplopia ; Endoscopy ; Enophthalmos ; Humans ; Incidence ; Methods ; Orbit ; Orbital Fractures ; Otolaryngology ; Paranasal Sinuses ; Prolapse ; Surgeons

Clinical epidemiology is defined as a method for investigating the distribution and determinants of diseases and for applying this knowledge in their prevention, and simply means application of epidemiological methods for medical research. In evidence-based medicine, randomized controlled trials (RCT) are the gold standard for assessing efficacy and safety of the intervention, while it is commonly impractical because of many limitations, such as ethical/legal problems and weak external-validity. High internal-validity of RCT permits to assess the direct efficacy of intervention without interference with bias and confounder; however, it has less generalizability or applicability to the real-life practice. Evidence-based practical guidelines are developed for patient management and decision making in real-life practice; paradoxically, the evidence of the guidelines does not come from real life, but from strict trial life. To overcome these limitations, pragmatic clinical trials for assessing the effectiveness of intervention in real-life practice or high-quality observational studies would be the best alternatives or could add more strong evidence. This article provides an overview of clinicoepidemiological research designs in the field of childhood allergic diseases and their strength/weakness.
Bias (Epidemiology) ; Child ; Decision Making ; Epidemiologic Methods ; Epidemiology ; Evidence-Based Medicine ; Humans ; Hypersensitivity ; Pragmatic Clinical Trial ; Pragmatic Clinical Trials as Topic ; Research Design*

PURPOSE: This study aimed to develop a triage competency scale (TCS) for emergency nurses, and to evaluate its validity and reliability. METHODS: Preliminary items were derived based on the attributes and indicators elicited from a concept analysis study on triage competency. Ten experts assessed whether the preliminary items belonged to the construct factor and determined the appropriateness of each item. A revised questionnaire was administered to 250 nurses in 18 emergency departments to evaluate the reliability and validity of the scale. Data analysis comprised item analysis, confirmatory factor analysis, contrasted group validity, and criterion-related validity, including criterion-related validity of the problem solving method using video scenarios. RESULTS: The item analysis and confirmatory factor analysis yielded 5 factors with 30 items; the fit index of the derived model was good (χ2/df =2.46, Root Mean squared Residual=.04, Root Mean Squared Error of Approximation=.08). Additionally, contrasted group validity was assessed. Participants were classified as novice, advanced beginner, competent, and proficient, and significant differences were observed in the mean score for each group (F=6.02, p=.001). With reference to criterion-related validity, there was a positive correlation between scores on the TCS and the Clinical Decision Making in Nursing Scale (r=.48, p < .001). Further, the total score on the problem solving method using video scenarios was positively correlated with the TCS score (r=.13, p=.04). The Cronbach's α of the final model was .91. CONCLUSION: Our TCS is useful for the objective assessment of triage competency among emergency nurses and the evaluation of triage education programs.
Clinical Competence ; Clinical Decision-Making ; Education ; Emergencies* ; Emergency Nursing ; Emergency Service, Hospital ; Factor Analysis, Statistical ; Methods ; Nursing ; Problem Solving ; Reproducibility of Results ; Statistics as Topic ; Triage*