223 lines
8.1 KiB
TeX
223 lines
8.1 KiB
TeX
\documentclass[10pt,letterpaper,landscape]{article}
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% Landscape for wider flowcharts
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\usepackage[margin=0.4in]{geometry}
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\usepackage[utf8]{inputenc}
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\usepackage[T1]{fontenc}
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\usepackage{helvet}
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\renewcommand{\familydefault}{\sfdefault}
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\usepackage{xcolor}
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\usepackage{tcolorbox}
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\usepackage{tikz}
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\usetikzlibrary{shapes,arrows,positioning,fit,calc}
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\usepackage{fancyhdr}
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% Color definitions
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\definecolor{headerblue}{RGB}{0,102,204}
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\definecolor{actiongreen}{RGB}{0,153,76}
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\definecolor{decisionyellow}{RGB}{255,193,7}
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\definecolor{urgentred}{RGB}{220,20,60}
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\definecolor{infobox}{RGB}{33,150,243}
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\definecolor{routineblue}{RGB}{100,181,246}
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% Header/footer
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\pagestyle{fancy}
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\fancyhf{}
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\fancyhead[L]{\footnotesize \textbf{Clinical Pathway: [CONDITION/DISEASE]}}
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\fancyhead[R]{\footnotesize Version X.X | [Date]}
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\renewcommand{\headrulewidth}{0.5pt}
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\fancyfoot[C]{\footnotesize Evidence-Based Clinical Decision Pathway | For Professional Use Only | Page \thepage}
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% TikZ styles
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\tikzstyle{startstop} = [rectangle, rounded corners=8pt, minimum width=3cm, minimum height=1cm, text centered, draw=black, fill=headerblue!20, font=\small\bfseries]
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\tikzstyle{decision} = [diamond, minimum width=3cm, minimum height=1.2cm, text centered, draw=black, fill=decisionyellow!40, font=\small, aspect=2, inner sep=0pt]
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\tikzstyle{process} = [rectangle, rounded corners=4pt, minimum width=3.5cm, minimum height=0.9cm, text centered, draw=black, fill=actiongreen!20, font=\small]
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\tikzstyle{urgent} = [rectangle, rounded corners=4pt, minimum width=3.5cm, minimum height=0.9cm, text centered, draw=urgentred, line width=1.5pt, fill=urgentred!15, font=\small\bfseries]
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\tikzstyle{routine} = [rectangle, rounded corners=4pt, minimum width=3.5cm, minimum height=0.9cm, text centered, draw=black, fill=routineblue!20, font=\small]
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\tikzstyle{info} = [rectangle, rounded corners=2pt, minimum width=2.5cm, minimum height=0.7cm, text centered, draw=infobox, fill=infobox!10, font=\footnotesize]
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\tikzstyle{arrow} = [thick,->,>=stealth]
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\tikzstyle{urgentarrow} = [ultra thick,->,>=stealth,color=urgentred]
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\setlength{\parindent}{0pt}
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\begin{document}
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\begin{center}
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{\fontsize{16}{18}\selectfont\bfseries\color{headerblue} CLINICAL DECISION PATHWAY}\\[2pt]
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{\fontsize{13}{15}\selectfont\bfseries [Disease/Condition - e.g., Acute Chest Pain Management]}\\[2pt]
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{\fontsize{10}{12}\selectfont [Institution Name] | Version X.X | Effective Date: [Date]}
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\end{center}
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\vspace{6pt}
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% Legend box
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\begin{tcolorbox}[colback=white,colframe=black,width=\textwidth]
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\begin{minipage}{0.48\textwidth}
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\textbf{Pathway Symbols:}\\[2pt]
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\begin{tikzpicture}[node distance=0.5cm]
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\node[startstop, scale=0.7] (start) {Start/End};
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\node[decision, right=1cm of start, scale=0.7] (dec) {Decision\\Point};
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\node[process, right=1cm of dec, scale=0.7] (proc) {Action/Process};
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\end{tikzpicture}
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\end{minipage}
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\begin{minipage}{0.48\textwidth}
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\textbf{Urgency Color Coding:}\\[2pt]
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\begin{tikzpicture}[node distance=0.5cm]
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\node[urgent, scale=0.7] (urg) {URGENT\\<1 hour};
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\node[process, right=1cm of urg, scale=0.7] (sem) {Semi-Urgent\\<24 hours};
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\node[routine, right=1cm of sem, scale=0.7] (rout) {Routine\\>24 hours};
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\end{tikzpicture}
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\end{minipage}
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\end{tcolorbox}
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\vspace{4pt}
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% Main flowchart
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\begin{center}
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\begin{tikzpicture}[node distance=2.2cm and 3cm, auto]
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% Start
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\node [startstop] (start) {Patient Presentation:\\[2pt] [Chief Complaint]};
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% First decision
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\node [decision, below=of start] (decision1) {[Critical\\Criteria\\Present?]};
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% Urgent pathway (left branch)
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\node [urgent, left=of decision1, below=1.8cm] (urgent1) {IMMEDIATE ACTION:\\[2pt] [Specific intervention]\\[2pt] Call Code/Transfer};
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% Continue evaluation (right branch)
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\node [process, right=of decision1, below=1.8cm] (eval1) {Continue\\Evaluation:\\[2pt][Tests/Assessment]};
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% Second decision
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\node [decision, below=of eval1] (decision2) {[Risk\\Score\\$\geq$X?]};
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% High risk pathway
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\node [urgent, left=of decision2, below=1.8cm] (high) {HIGH RISK:\\[2pt] Admit ICU/Telemetry\\[2pt] [Specific management]};
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% Moderate risk
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\node [process, below=of decision2] (moderate) {MODERATE RISK:\\[2pt] Admit for observation\\[2pt] Serial testing};
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% Low risk pathway
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\node [routine, right=of decision2, below=1.8cm] (low) {LOW RISK:\\[2pt] Outpatient management\\[2pt] Follow-up in X days};
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% Final outcome node
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\node [startstop, below=of moderate, node distance=2.5cm] (outcome) {Definitive Management\\Based on Results};
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% Arrows
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\draw [urgentarrow] (start) -- (decision1);
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\draw [urgentarrow] (decision1) -| node[near start,left] {YES} (urgent1);
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\draw [arrow] (decision1) -| node[near start,right] {NO} (eval1);
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\draw [arrow] (eval1) -- (decision2);
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\draw [arrow] (decision2) -| node[near start,left] {HIGH} (high);
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\draw [arrow] (decision2) -- node[right] {MODERATE} (moderate);
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\draw [arrow] (decision2) -| node[near start,right] {LOW} (low);
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\draw [arrow] (urgent1) |- (outcome);
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\draw [arrow] (high) |- (outcome);
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\draw [arrow] (moderate) -- (outcome);
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\draw [arrow] (low) |- (outcome);
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% Information boxes
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\node [info, right=1.5cm of eval1] (info1) {[Criteria]:\\[1pt] \footnotesize • Item 1\\• Item 2\\• Item 3};
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\node [info, right=1.5cm of decision2] (info2) {[Score]:\\[1pt] \footnotesize Calculate:\\risk score};
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\end{tikzpicture}
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\end{center}
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\vspace{8pt}
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% Detailed pathway steps
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\begin{tcolorbox}[colback=highlightgray!30,colframe=headerblue,title=\textbf{Detailed Pathway Steps},fonttitle=\bfseries]
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\textbf{STEP 1: Initial Assessment}
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\begin{itemize}
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\item Vital signs: BP, HR, RR, temp, O₂ saturation
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\item Focused history: [Key elements]
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\item Physical examination: [Key findings]
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\item Initial labs: [Specify tests]
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\item ECG (if applicable)
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\end{itemize}
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\textbf{STEP 2: Risk Stratification}
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\begin{itemize}
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\item Calculate [Risk Score Name] (see scoring table below)
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\item Identify high-risk features requiring immediate intervention
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\item Document risk category in medical record
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\end{itemize}
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\textbf{STEP 3: Treatment Initiation}
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\begin{itemize}
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\item Urgent: [Specific interventions within 1 hour]
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\item Semi-urgent: [Interventions within 24 hours]
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\item Routine: [Standard management approach]
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\end{itemize}
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\textbf{STEP 4: Monitoring and Reassessment}
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\begin{itemize}
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\item Frequency: [Based on risk category]
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\item Parameters: [What to monitor]
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\item Escalation criteria: [When to intensify treatment]
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\item De-escalation criteria: [When to transition to lower intensity]
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\end{itemize}
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\end{tcolorbox}
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\vspace{4pt}
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% Risk scoring table
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\begin{tcolorbox}[colback=white,colframe=headerblue,title=\textbf{[Risk Score Name] Calculation},fonttitle=\bfseries]
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{\small
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\begin{tabular}{lc}
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\toprule
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\textbf{Clinical Feature} & \textbf{Points} \\
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\midrule
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[Feature 1 - e.g., Age $\geq$65 years] & +1 \\
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[Feature 2 - e.g., Prior history] & +1 \\
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[Feature 3 - e.g., Abnormal lab value] & +2 \\
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[Feature 4 - e.g., Specific symptom] & +1 \\
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[Feature 5 - e.g., Imaging finding] & +2 \\
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\midrule
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\textbf{Total Score} & \textbf{0-X points} \\
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\bottomrule
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\end{tabular}
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\vspace{4pt}
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\textbf{Risk Categories}:
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\begin{itemize}
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\item \textbf{Low Risk}: 0-1 points → [Management approach, predicted outcome]
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\item \textbf{Moderate Risk}: 2-3 points → [Management approach, predicted outcome]
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\item \textbf{High Risk}: $\geq$4 points → [Management approach, predicted outcome]
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\end{itemize}
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}
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\end{tcolorbox}
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\vspace{4pt}
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% Evidence basis
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\begin{tcolorbox}[colback=actiongreen!5,colframe=actiongreen,title=\textbf{Evidence Basis for Pathway},fonttitle=\bfseries]
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{\small
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\textbf{Key Supporting Evidence}:
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\begin{enumerate}
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\item \textbf{[Clinical Trial/Study]}: [Key finding supporting pathway decision]
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\item \textbf{Guidelines}: NCCN/ASCO/AHA/ACC/[Relevant society] [Year] - [Recommendation level]
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\item \textbf{Meta-Analysis}: [If applicable - pooled results supporting approach]
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\end{enumerate}
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\textbf{Validation}: Pathway validated at [institution] with [X\%] adherence rate and [outcome metrics].
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\textbf{Last Updated}: [Date] based on [new trial, guideline update, or scheduled review]
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}
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\end{tcolorbox}
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\vspace{8pt}
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\hrule
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\vspace{4pt}
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{\footnotesize
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\textbf{Pathway Committee}: [Names, titles] | \textbf{Approved}: [Date] | \textbf{Next Review}: [Date]\\
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\textbf{Contact for Questions}: [Name, email, phone]
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}
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\end{document}
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