Basis for clinical decision making

Our plain-English summary of Basis for clinical decision making, by H. Weill (Chest, 1980).

The study

• Author: H. Weill
• Journal: Chest
• Published: 1980;78(2 Suppl):382-3
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000876).

In plain English

This short symposium paper by Hans Weill was a commentary, not a full research report. The author set out to link epidemiologic evidence from the author's group and others to two clinical questions: what to advise asbestos-exposed workers who already show lung or pleural changes, and when lung cancer can be attributed to asbestos. The author drew on the group's longitudinal study of 244 asbestos cement manufacturing workers. In that cohort, progression of small irregular opacities (asbestosis) on X-ray was related to average and cumulative asbestos dust exposure. Progression of pleural thickening and plaques was related to length of exposure and time since first exposure, not to dust dose. On this basis the author advised that workers with asbestosis avoid further exposure. Workers with only pleural changes needed monitoring but not a job transfer. The author considered expertly diagnosed pleural or peritoneal mesothelioma in an occupationally exposed person to be work-related. For lung cancer, the author's approach required X-ray or tissue evidence of asbestosis. The author stated that new data may substantially modify this approach.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Commentary or opinion paper from a symposium, drawing mainly on the author's group's longitudinal cohort study, which is only summarized here
• Who was studied: A cohort of 244 asbestos cement manufacturing workers followed by the author's group. The location and study dates are not stated in this article.
• Exposure: Asbestos dust in asbestos cement manufacturing, measured as average and cumulative dust exposure and length of exposure. Fiber types are not named for this cohort.
• Main results:
  • In the cohort, the greater the past cumulative dust exposure, the higher the probability that small irregular opacities (asbestosis) progressed on X-ray. Table 1 lists the p-values for average and cumulative exposure; in the scan they are printed without decimal points as 0001 and 0002.
  • Progression of these radiographic signs also correlated with excessive decline in lung function
  • Progression of pleural thickening and pleural plaques was related to length of exposure and time since first exposure, but not to average or cumulative dust dose. Table 1 lists p-values for length of exposure for pleural thickening and pleural calcification; in the scan they are printed as 02 and 03.
  • In Table 1, age and smoking were not significantly related to progression of any of the three radiographic abnormalities
• The authors' conclusion: The author's group judged that workers with radiographic asbestosis, even if minimal, should avoid further exposure by changing jobs. Workers with only pleural changes needed continued monitoring, but job transfer was not necessary. In the author's view, pleural or peritoneal mesothelioma diagnosed by expert pathologists in an occupationally exposed person or family member should be considered work-related. For lung cancer, the author's approach required radiographic and/or histologic evidence of asbestosis.
• Limitations the authors state:
  • The author stated that substantial changes to this approach may be needed as new data become available
  • The author noted that past individual exposures can rarely be estimated
  • The author acknowledged mesothelioma cases where asbestos exposure cannot be established

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis, Lung cancer.

Related studies

• Ki67 (MIB-1) as a Prognostic Marker for Clinical Decision Making Before Extended Pleurectomy Decortication in Malignant Pleural Mesothelioma — R.A. Belderbos, A.P.W.M. Maat, et al. (2021)
• Gender Differences in the Use of ChatGPT as Generative Artificial Intelligence for Clinical Research and Decision-Making in Occupational Medicine — P. Mashburn, F.A. Weuthen, et al. (2025)
• Understanding clinical decision-making in mesothelioma care: a mixed methods study — C. Henshall, P. Dawson, et al. (2022)
• Communicating imaging findings in peritoneal mesothelioma: the impact of 'PAUSE' on surgical decision-making — A. Chandramohan, N. Shah, et al. (2021)
• Research cost analyses to aid in decision making in the conduct of a large prevention trial, CARET. Carotene and Retinol Efficacy Trial — M.D. Thornquist, N. Urban, et al. (1993)
• Epidemiology: a foundation of environmental decision making — K.C.K. Deener, J.D. Sacks, et al. (2018)

Browse more research in Chest, or return to medical research.