A Case for Elsevier’s Clinical Decision Support tools

•  CaseStudy–ExpertPath

•  February2016

A Case for Elsevier’s Clinical Decision Support tools ExpertPath™ and ImmunoQuery®

Dr.XimenaAlvira,MD,PhD25/05/2018


Background •  30 year old female presents to her primary care

physician complaining of mild pain in her right flank of one-week duration.

•  No associated history of hematuria or any other systemic symptoms.

•  The physical examination reveals a large mass comprising the right lumbar and right hypochondriac region.

•  The patient is referred to the nephrologist, who orders an abdominopelvic computed tomography, which reveals a large 14 × 9.5 × 8 cm mass with areas of necrosis over the mid-region and lower pole of the right kidney.

•  The patient is admitted for surgery, during which the tumor is seen to invade the whole kidney.

•  A left radical nephrectomy is performed, and the specimen is sent for histopathological analysis.


Macroscopic features The kidney weighed 458 grams after removal of perinephric adipose tissue. The upper portion of the kidney contained a 10 x 9 x 9 cm rubbery mass with smooth-walled cysts and mucoid degeneration. Areas of necrosis and hemorrhage were noted. The adrenal gland was grossly normal.


•  I log into ExpertPath, type some of the terms from the gross features to obtain diagnostic suggestions, and click on text to obtain a description of the cases and compare between possible diagnoses.


•  In the results panel, I select the eligible items to compare.


•  I click Compare to review the images and characteristics of the diagnoses.


•  I compare the Images of the selected diagnoses.


•  And also review the comparative accompanying texts.


•  I start typing “Synovial sarcoma” to obtain diagnostic suggestions.

Now that I’m confident about the diagnosis, I log into ImmunoQuery to chose the antibody panel that will best support my clinical decision.


•  I select the diagnosis I am looking for. •  Click on Build Panel.


•  Immediately, I have access to information on the antibodies’ percentage of positiveness, and the number of cases where they have been described/tested.


•  However, to discard the other diagnosis suggested, I decide to compare antibody panels between both diagnoses.

•  Click on Build Panel.


•  I click on Suggested Panel to obtain the antibodies that yield the best information to differentiate between the two diagnoses.


•  And I also click on Suggested Panel to review the complete panel of all the antibodies, their percentage of positivity, the number of cases where they have been described/tested, and how well they differentiate one or the other diagnosis.


With the support of and

I was able to confidently reach a diagnosis and provide enough information for the management of the patient’s disease.

Thank you

Documents

A Case for Elsevier’s Clinical Decision Support tools