Practitioner Decisions Research Articles

Improving conservation policy with genomics: a guide to integrating adaptive potential into U.S. Endangered Species Act decisions for conservation practitioners and geneticists

Rapid environmental change makes adaptive potential—the capacity of populations to evolve genetically based changes in response to selection—more important than ever for long-term persistence of at-risk species. At the same time, advances in genomics provide unprecedented power to test for and quantify adaptive potential, enabling consideration of adaptive potential in estimates of extinction risk and laws protecting endangered species. The U.S. Endangered Species Act (ESA) is one of the most powerful environmental laws in the world, but so far, the full potential of genomics in ESA listing and recovery decisions has not been realized by the federal agencies responsible for implementing the ESA or by conservation geneticists. The goal of our paper is to chart a path forward for integrating genomics into ESA decision making to facilitate full consideration of adaptive potential in evaluating long-term risk of extinction. For policy makers, managers, and other conservation practitioners, we outline why adaptive potential is important for population persistence and what genomic tools are available for quantifying it. For conservation geneticists, we discuss how federal agencies can integrate information on the effect of adaptive potential on extinction risk—and the related uncertainty—into decisions, and suggest next steps for advancing understanding of the effect of adaptive potential on extinction risk. The mechanisms and consequences of adaptation are incredibly complex, and we may never have a complete understanding of adaptive potential for any organism. Nevertheless, we argue that the best available evidence regarding adaptive potential can now be incorporated by federal agencies into modeling and decision making processes, while at the same time conserving genome-wide variation and striving for a deeper understanding of adaptive potential and its effects on population persistence to improve decision making into the future.

Berufliche und private Standortfaktoren für die Niederlassung von Hausärzten in ländlichen Räumen

The safeguarding of primary health care in rural regions is broadly discussed in science, politics and practice. Thereby the knowledge about current location factors is insufficient, because existing studies focus on professional factors or on locational imaginations of future doctors instead of analysing effective locational decisions. Thus, this study asks which professional and private location factors influence the settling decisions of general practitioners in rural regions. Therefore two regional case studies are conducted with overall 21 interviews with regional experts and newly settled doctors, working out crucial location factors. Building on that, the influence of chosen location factors for regional unequal practitioner concentrations as well as for the development of practitioner numbers are nationwide quantified by multiple regression models. The results show, that professional aspects, like economic security, close patient contacts and organisational freedom, as well as biographical relations are especially decisive criteria for the doctors’ location decisions. Furthermore, family-friendly everyday environments are very important for many of them. Other soft location factors as high standard cultural and leisure facilities are negligible. Furthermore, there is a relationship between inpatient and outpatient care. Many general practitioners worked in a regional hospital, before they switched to the ambulant sector, due to better working conditions and an easier compatibility with family life. The results point to a change of location factors, whereby further needs for research and concrete policy recommendations arise.

Developing a Guideline for Endotracheal Suctioning of Adults With Artificial Airways in the Perianesthesia Setting in China

This study aimed to adapt a guideline for endotracheal suctioning of adults with artificial airways in the perianesthesia setting in China. This study was guided by the ADAPTE framework. The development process consisted of setup, adaptation, andfinalization phases. A heterogeneous consultant panel that includeda patient representative was established to contribute guidance andsuggestions regarding guideline development. Relevant evidence documents were searched, critically appraised, selected, and synthesized to develop the draft guideline. After revisions, the adapted guideline wasevaluated by 20 external reviewers. A 155-page adapted guideline was developed with 26 key recommendations (including 3 procedure phases and 17 points of care). The adapted guideline provided the best evidence for endotracheal suctioning of adults with artificial airways and supported practitioner decisions about appropriate endotracheal suctioning practices for this population. The study also lays the groundwork for future projects on quality improvement and knowledge translation.

Harnessing the Power of Microbiome Assessment Tools as Part of Neuroprotective Nutrition and Lifestyle Medicine Interventions.

An extensive body of evidence documents the importance of the gut microbiome both in health and in a variety of human diseases. Cell and animal studies describing this relationship abound, whilst clinical studies exploring the associations between changes in gut microbiota and the corresponding metabolites with neurodegeneration in the human brain have only begun to emerge more recently. Further, the findings of such studies are often difficult to translate into simple clinical applications that result in measurable health outcomes. The purpose of this paper is to appraise the literature on a select set of faecal biomarkers from a clinician’s perspective. This practical review aims to examine key physiological processes that influence both gastrointestinal, as well as brain health, and to discuss how tools such as the characterisation of commensal bacteria, the identification of potential opportunistic, pathogenic and parasitic organisms and the quantification of gut microbiome biomarkers and metabolites can help inform clinical decisions of nutrition and lifestyle medicine practitioners.

Osteopathic clinical reasoning: An ethnographic study of perceptual diagnostic judgments, and metacognition

BackgroundClinical reasoning has been widely researched in the health sciences; however, in osteopathy it is still in its relative infancy. ObjectiveTo explore the moment by moment clinical reasoning processes of an osteopath whilst with patients, to understand the role of perceptual diagnostic judgments, and metacognitive processes. MethodA qualitative interpretive study with a novel narrative method as an organising structure: the moment by moment thought processes of a single osteopath were recorded and transformed into descriptions of the interactions with patients. The descriptive texts were expanded into narratives using autoethnography and reflective practice. Narratives were then analysed using methods originating from grounded theory. ResultsOur interpretations indicate that osteopaths establish a multisensory construct during clinical reasoning which enables both analytic and intuitive decision-making strategies. Clinical reasoning was monitored by a variety of metacognitive processes, including intuitive discernments such as feeling that a decision is correct, and the judgment that there is sufficient information to make that decision. ConclusionsThis is the first study to explore the subjective moment by moment clinical reasoning and decision-making strategies of an osteopath whilst with patients. It suggests that perceptual diagnostic judgments are multisensory and include mental and visual imagery, and embodied senses. These enable analytic and intuitive diagnostic strategies that are accompanied by persistent metacognitive processes during the consultation, which guide the practitioner's decision strategies.

Behavioral Monitoring of Sexual Offenders Against Children in Virtual Risk Situations: A Feasibility Study.

The decision about unsupervised privileges for sexual offenders against children (SOC) is one of the most difficult decisions for practitioners in forensic high-security hospitals. Facing the possible consequences of the decision for the society, a valid and reliable risk management of SOCs is essential. Some risk management approaches provide frameworks for the construction of relevant future risk situations. Due to ethical reasons, it is not possible to evaluate the validity of constructed risk situations in reality. The aim of the study was to test if behavioral monitoring of SOCs in high-immersive virtual risk situations provides additional information for risk management. Six SOCs and seven non-offender controls (NOC) walked through three virtual risk situations, confronting the participant with a virtual child character. The participant had to choose between predefined answers representing approach or avoidance behavior. Frequency of chosen answers were analyzed in regards to knowledge of the participants about coping skills and coping skills focused during therapy. SOCs and NOCs behavior differed only in one risk scenario. Furthermore, SOCs showed in 89% of all cases a behavior not corresponding to their own belief about adequate behavior in comparable risk situations. In 62% of all cases, SOCs behaved not corresponding to coping skills they stated that therapists focused on during therapy. In 50% of all cases, SOCs behaved in correspondence to coping skills therapists stated that they focused on during therapy. Therapists predicted the behavior of SOCs in virtual risk situations incorrect in 25% of all cases. Thus, virtual risk scenarios provide the possibility for practitioners to monitor the behavior of SOCs and to test their decisions on unsupervised privileges without endangering the community. This may provide additional information for therapy progress. Further studies are necessary to evaluate the predictive and ecological validity of behavioral monitoring in virtual risk situations for real life situations.

Antibiotic usage pattern among under-five wheezers: A Bhubaneswar based study

Introduction: Acute under-five wheezers are the most suitable group for targeting focus aimed at reducing unnecessary use of antibiotics. Viral bronchiolitis is an important cause of wheezing in under-five children. Rationality behind antibiotic usage has rarely been reported from Odisha. Aim: The aim of the present study is to look into the decision of private practitioners of Bhubaneswar, Odisha, for an antibiotic prescription to under-five wheezers. Materials and Methods: Hundred prescriptions of private practitioners for under-five patients suffering from acute wheeze were analyzed between January and June 2016. The prescriptions were grouped as with antibiotics (Group A) and without antibiotics (Group B). The groups were compared for the presence of clinical, hematological, and radiological signs and results were statistically analyzed. Result: The number of prescriptions with antibiotic inclusion is higher (67%). Antibiotics are mostly prescribed to younger patients. Antibiotic administration was significantly higher with the symptoms of fever, tachypnea, crepitation’s and leukocytosis, and X-ray findings. (p<0.05) The average recovery period was almost the same in both the groups. The prescription patterns in the present study show rational usage.

Benefit relevant indicators: Ecosystem services measures that link ecological and social outcomes

There is a growing movement in government, environmental non-governmental organizations and the private sector to include ecosystem services in decision making. Adding ecosystem services into assessments implies measuring how much a change in ecological conditions affects people, social benefit, or value to society. Despite consensus around the general merit of accounting for ecosystem services, systematic guidance on what to measure and how is lacking. Current ecosystem services assessments often resort to biophysical proxies (e.g., area of wetland in a floodplain) or even disregard services that seem difficult to measure. Valuation, an important tool for assessing trade-offs and comparing outcomes, is also frequently omitted due to lack of data on social preferences, lack of expertise with valuation methods, or mistrust of valuation methods for non-market services.To address these shortcomings, we propose the use of a new type of indicator that explicitly reflects an ecosystem’s capacity to provide benefits to society, ensuring that ecosystem services assessments measure outcomes that are demonstrably and directly relevant to human welfare. We call these Benefit-relevant indicators (BRIs) and describe a process for developing them using causal chains that link management decisions through ecological responses to effects on human well-being. BRIs identify what is valued and by whom, but stop short of valuation. A BRI for the ability of wetlands to ameliorate flooding would connect measures of the quantity and quality of wetland in a floodplain, as affected by wetlands management decisions, to the number of people or properties downstream that are vulnerable to flooding. BRIs can support monetary or non-monetary valuation, but are particularly useful when valuation will not be conducted; in such cases they serve as stand-alone measures of “what is valued” by particular beneficiaries. BRIs are valid measures of ecosystem services in that they are directly linked to human well-being. Flexibility in the development of BRIs helps to ensure that they are broadly applicable across practitioner and stakeholder communities and decision contexts.

A P-spline based clustering approach for portfolio selection

In the last years, many clustering techniques dealing with time course data have been proposed due to recent interests in studying phenomena that change over time. A new clustering method suitable for time series applications has been recently proposed by exploiting the properties of the P-splines approach. This semi-parametric tool has several advantages, i.e. it facilitates the removal of noise from time series and it ensures a computational time saving. In this paper, we propose to use this clustering approach on financial data with the aim of building a financial portfolio. Our proposal works directly on time series without any pre-processing, except for the computation of the spline coefficients and, eventually, normalizing the series. We show that our strategy is useful to support the investment decisions of financial practitioners.

Need for the Development of Indonesian Clinical Practice Guideline

To date clinical practice guideline (abbreviated as CPGs) becomes a need in surgical care since they are statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options. Above definition were revised that defined a CPGs as systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances; which has contributed in changing the concept of guidelines to modern one. In accordance with report from Institute of Medicine (IOM) in 1992, the CPGs (hereafter referred to as guidelines) are one of the foundations of efforts to improve healthcare.

Qualitative interview study of parents’ perspectives, concerns and experiences of the management of lower respiratory tract infections in children in primary care

ObjectiveTo explore parents’ perspectives, concerns and experiences of the management of lower respiratory tract infections (LRTIs) in children in primary care.DesignQualitative semistructured interview study.SettingUK primary care.Participants23 parents of children aged...

Gender Parity in Critical Care Medicine.

Clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. These documents inform and shape patient care around the world. In this Perspective we discuss the importance of diversity on guideline panels, the disproportionately low representation of women on critical care guideline panels, and existing initiatives to increase the representation of women in corporations, universities, and government. We propose five strategies to ensure gender parity within critical care medicine.

Noninvasive Technologies for the Diagnosis of Cutaneous Melanoma

Multispectral analysis devices assess pigmented lesion disorganization at different levels using variable wavelengths of light. Computerized algorithms measure morphologic disorganization of the pigmented skin lesion. Aggregated data of 855 participants investigating the influence of multispectral digital skin lesion analysis (MSDSLA) on practitioner decisions to biopsy pigmented skin lesions revealed the overall sensitivity for detection of melanoma improved from 70% to 88%. Participant specificity increased from 52% to 58% after MSDSLA. Five studies using spectrophotometric intracutaneous analysis scope to evaluate suspicious pigmented skin lesions demonstrated an overall sensitivity and specificity of 85% and 81%, respectively, for the detection of melanoma.

Lymphedema: From diagnosis to treatment.

Lymphedema is a chronic and progressive disorder resulting from impaired lymphatic system function. In developed countries, upper extremity lymphedema is mainly the consequence of breast cancer surgery in which axillary lymph node dissection and radiation alter upper extremity lymphatic flow. Diagnosis of lymphedema is made clinically. Nevertheless, there are numerous diagnostic tools available for disease staging. Recently, a new technology namely magnetic resonance lymphangiography has emerged in the medical field to assist in both diagnosis and management. There are non-surgical and surgical treatment options available. Non-surgical methods are always the first-line treatment; however, surgical options can be explored in appropriate patients. Recent studies focus on the prevention of lymphedema using surgical techniques utilizing axillary reverse mapping to delineate arm lymphatics from axillary lymphatics. Finding the most suitable technique for each type of lymphedema with variable stages is one of the most complicated decisions for practitioners. More studies are needed to reveal the exact biology of lymphedema to ensure complete understanding of the disease and improve outcomes.

Factors leading to overutilisation of hospital pathology testing: the junior doctor's perspective.

Objective Pathology overutilisation is a significant issue affecting the quality and cost of health care. Because junior medical officers (JMOs) order most pathology tests in the hospital setting, the aim of the present study was to identify the main reasons for hospital pathology overutilisation from the perspective of the JMO. Methods A qualitative method, using focus group methodology, was undertaken. Sixteen JMOs from two hospitals participated in three focus groups. Data were analysed using thematic analysis. Results Three major themes contributed to overutilisation: the real and perceived expectations of senior colleagues, the level of JMO clinical experience and strategies to manage JMO workload around clinical systems. Within these themes, 12 subthemes were identified. Conclusions Overutilisation of hospital pathology testing occurs when there are high social costs to JMOs for underordering, with little cost for overordering. Interventions should restore this balance through reframing overutilisation as both a costly and potentially harmful activity, promoting a supportive culture with regular senior guidance, and addressing clinical systems in which missed tests create an excessive workload. What is known about the topic? Mean overutilisation rates of pathology testing are reported to be as high as 44%. Although numerous studies have reported successful efforts to decrease hospital pathology overutilisation, no primary research was identified that examined the JMO perspective on this subject. What does this paper add? Clinical need is not the primary factor guiding the pathology-ordering decisions of junior practitioners; rather, medical team culture, limited JMO experience and systems factors have a significant role. What are the implications for practitioners? The social and behavioural determinants of pathology ordering must be considered to achieve appropriate pathology test utilisation. These include senior medical officer engagement, the guidance of JMOs and clinical workflows.

Türkiye’deki Sivil Toplum Kuruluşlarının Klinik Uygulama Rehberleri Alanındaki Faaliyetleri

Objectives: Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. Development of the CPGs by Non-Governmental Organizations (NGOs), specified to certain parts of health sector, increases the quality and timeliness of the guidelines. This study aims to detect existing guidelines developed by the NGOs in the field of health in our country and map them according to their features. Materials and Methods: NGOs that work for the health sector were determined by using the data obtained from the Ministry of Internal Affairs. As a result of scanning the list of NGOs, the webpages of the organizations has been revealed on the internet site. “Map of the Clinical Practice Guidelines Developed by NGOs ” were determined according to accessability of the online guidelines, presentation in Turkish or English and development methods (original guidelines, the adaptation or resulting translation). Results: 47 non-governmental organizations were defined which provided access to CPGs in their websites, 3 of them were only open to the members so these could not be reached. 88.8% (n=356) of 401 CPGs from 44 NGOs were in Turkish and 11.2% (n=) of them were in English. Of Turkish CPG(s), 72.9% (n=290) were developed by de novo method and 16.4% (n=66) were adoption guidelines. Conclusion: To the best of our knowledge this is the first study in Turkey mapping out clinical practice guidelines developed by NGOs. This study contributes to current limited amount of information in the literature. Further studies are needed to provide the efficiency and continuity and help to develop and generalize the application of guidelines.

Evaluation of hypersensitivity after the placement of metal-ceramic crowns cemented with two luting agents: Long-term results of a prospective clinical study

Statement of problemDifferent luting materials are available for the cementation of fixed dental prostheses. Postcementation hypersensitivity is an occasional complication in the definitive delivery. How the choice of luting agent affects long-term postcementation sensitivity is unknown. PurposeThe purpose of this prospective, randomized, controlled, split-mouth clinical trial was to compare the hypersensitivity of 2 cementation methods for metal-ceramic crowns. The primary endpoint was the evaluation of differences in hypersensitivity between the study groups over a study period of 5 years. Material and methodsThe study investigated 20 participants with 40 metal-ceramic crowns cemented with either zinc phosphate cement or a self-adhesive resin cement, each in nonantagonistic contralateral quadrants (observation period of 5 years). The data regarding postcementation hypersensitivity included continuous patient-related outcome variables assessed using a visual analog scale (sign test; primary endpoint, level of significance α/3=.0167; secondary endpoint, level of significance, α=.05) and categorical variables represented by yes/no replies (absolute and relative frequencies). The sensitivity of teeth was controlled in relation to mastication, air streams, and hot and cold temperatures. ResultsThe observation period was 5 years, with a dropout rate of 12.5% in the last 2 years. The results indicated no significant differences between the cement groups for patient- and clinical-related outcomes at any of the observed time points. ConclusionsAs no differences were found between the 2 different cementation modes with respect to developing hypersensitivity after 5 years, the choice of a luting agent remains an individual practitioner decision.

Factors influencing decision of general practitioners and managers to train and employ a nurse practitioner or physician assistant in primary care: a qualitative study

BackgroundDue to the increasing demand on primary care, it is not only debated whether there are enough general practitioners (GPs) to comply with these demands but also whether specific tasks can be performed by other care providers. Although changing the workforce skill mix care by employing Physician Assistants (PAs) and Nurse Practitioners (NPs) has proven to be both effective and safe, the implementation of those professionals differs widely between and within countries. To support policy making regarding PAs/NPs in primary care, the aim of this study is to provide insight into factors influencing the decision of GPs and managers to train and employ a PA/NP within their organisation.MethodsA qualitative study was conducted in 2014 in which 7 managers of out-of-hours primary care services and 32 GPs who owned a general practice were interviewed. Three main topic areas were covered in the interviews: the decision-making process in the organisation, considerations and arguments to train and employ a PA/NP, and the tasks and responsibilities of a PA/NP.ResultsEmployment of PAs/NPs in out-of-hours services was intended to substitute care for minor ailments in order to decrease GPs’ caseload or to increase service capacity. Mangers formulated long-term planning and role definitions when changing workforce skill mix. Lastly, out-of-hours services experienced difficulties with creating team support among their members regarding the employment of PAs/NPs.In general practices during office hours, GPs indented both substitution and supplementation for minor ailments and/or target populations through changing the skill mix. Supplementation was aimed at improving quality of care and extending the range of services to patients. The decision-making in general practices was accompanied with little planning and role definition. The willingness to employ PAs/NPs was highly influenced by an employees’ motivation to start the master’s programme and GPs’ prior experience with PAs/NPs. Knowledge about the PA/NP profession and legislations was often lacking.ConclusionsRole standardisations, long-term political planning and support from professional associations are needed to support policy makers in implementing skill mix in primary care.

Use of Global initiative for asthma (GINA) guidelines in asthma management among paediatric residents in a Sub Saharan African country: a cross-sectional descriptive study.

IntroductionClinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. Despite abundance of asthma guidelines, prevalence has continued to increase globally. There is need to assess how the contents of asthma guidelines are put to clinical use by doctors in the management of children with asthma. This study aims at evaluating the clinical practice of paediatric residents in applying GINA guidelines.MethodsCross-sectional descriptive study of paediatric residents from 23 university teaching hospitals in Nigeria using structured questionnaire. Data analyses were with Statistical Package for Social Sciences (SPSS) version 19 (Chicago IL). Chi square was used to assess for any significant associations between categorical variables. A p < 0.05 was regarded to be statistically significant.ResultsSixty-six paediatric residents aged 27- 40 years were enrolled into the study (37 females and 29 males). One-third had spent more than three years in residency training. Fifty-eight residents (87.9%) were aware of the GINA guidelines while 46 (69.7%) were familiar with its contents. Only 39 (59.1%) residents adhered to the GINA guidelines. Twenty of the 35 junior residents (57.1%) compared to 26 of 31 (83.9%) senior residents were familiar with the GINA guidelines (p=0.031) while 15 of 35 junior residents (42.9%) compared to 24 of 31 senior residents (77.4%) consistently follow the GINA guidelines (p=0.006). Adherence to GINA guidelines was not influenced significantly by years of graduation or training (p>0.05).ConclusionThe use of the GINA guidelines was poor among paediatric residents. Application of contents rather than just availability of asthma guidelines may partly account for increasing asthma prevalence globally.

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

INTRODUCTIONThere 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.METHODSWe 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.RESULTSDuring 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).CONCLUSIONOur 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. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.