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Clinical decision rule

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https://www.readbyqxmd.com/read/29161680/prediction-of-violent-crime-on-discharge-from-secure-psychiatric-hospitals-a-clinical-prediction-rule-fovox
#1
A Wolf, T R Fanshawe, A Sariaslan, R Cornish, H Larsson, S Fazel
BACKGROUND: Current approaches to assess violence risk in secure hospitals are resource intensive, limited by accuracy and authorship bias and may have reached a performance ceiling. This study seeks to develop scalable predictive models for violent offending following discharge from secure psychiatric hospitals. METHODS: We identified all patients discharged from secure hospitals in Sweden between January 1, 1992 and December 31, 2013. Using multiple Cox regression, pre-specified criminal, sociodemographic, and clinical risk factors were included in a model that was tested for discrimination and calibration in the prediction of violent crime at 12 and 24 months post-discharge...
August 4, 2017: European Psychiatry: the Journal of the Association of European Psychiatrists
https://www.readbyqxmd.com/read/29154810/multiple-performance-measures-are-needed-to-evaluate-triage-systems-in-the-emergency-department
#2
Joany M Zachariasse, Daan Nieboer, Rianne Oostenbrink, Henriëtte A Moll, Ewout W Steyerberg
OBJECTIVE: Emergency department triage systems can be considered prediction rules with an ordinal outcome, where different directions of misclassification have different clinical consequences. We evaluated strategies to compare the performance of triage systems and aim to propose a set of performance measures that should be used in future studies. STUDY DESIGN AND SETTING: We identified performance measures based on literature review and expert knowledge. Their properties are illustrated in a case study evaluating two triage modifications in a cohort of 14,485 pediatric emergency department visits...
November 14, 2017: Journal of Clinical Epidemiology
https://www.readbyqxmd.com/read/29154240/polish-consensus-on-treatment-of-gastric-cancer-update-2017
#3
Jan Kulig, Grzegorz Wallner, Michał Drews, Mariusz Frączek, Arkadiusz Jeziorski, Wojciech Kielan, Piotr Kołodziejczyk, Anna Nasierowska-Guttmejer, Teresa Starzyńska, Krzysztof Zinkiewicz, Marek Wojtukiewicz, W Tomasz Skoczylas, Piotr Richter, Marek Krawczyk
The "Polish Research on Gastric Cancer" project has been continued since 1986. The main aim of this project, which is a multicenter and interdisciplinary research, is enhancing the treatment results of gastric cancer patients by developing and promoting the use of optimal methods for diagnosis and treatment, both surgical as well as combined. One of the more important achievements of the project is the development and publication of a document named "Polish Consensus on Treatment of Patients with Gastric Cancer", whose first version was published in 1998...
October 31, 2017: Polski Przeglad Chirurgiczny
https://www.readbyqxmd.com/read/29149393/challenges-in-minor-tbi-and-indications-for-head-ct-in-pediatric-tbi-an-update
#4
Navneet Singh, Ash Singhal
INTRODUCTION: Pediatric head trauma is one of the commonest presentations to emergency departments. Over 90% of such head injuries are considered mild, but still present risk acute clinical deterioration and longer term morbidity. Identifying which children are at risk of clinically important brain injuries remains challenging and much of the data on minor head injuries is based on the adult population. CHALLENGES IN PEDIATRICS: Children, however, are different, both anatomically and in terms of mechanism of injury, to adults and, even within the pediatric group, there are differences with age and stage of development...
October 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/29148311/for-which-clinical-rules-do-doctors-want-decision-support-and-why-a-survey-of-dutch-general-practitioners
#5
Stephanie Medlock, Saeid Eslami, Marjan Askari, Derk L Arts, Esther M van de Glind, Henk J Brouwer, Henk C van Weert, Sophia E de Rooij, Ameen Abu-Hanna
Despite the promise of decision support for improving care, alerts are often overridden or ignored. We evaluated Dutch general practitioners' intention to accept decision support in a proposed implementation based on clinical rules regarding care for elderly patients, and their reasons for wanting or not wanting support. We developed a survey based on literature and structured interviews and distributed it to all doctors who would receive support in the proposed implementation (n = 43), of which 65 percent responded...
November 1, 2017: Health Informatics Journal
https://www.readbyqxmd.com/read/29144250/case-not-closed-prescription-errors-12-years-after-computerized-physician-order-entry-implementation
#6
Gili Kadmon, Michal Pinchover, Avichai Weissbach, Shirley Kogan Hazan, Elhanan Nahum
OBJECTIVE: To assess the prolonged impact of computerized physician order entry (CPOE) on medication prescription errors in pediatric intensive care patients. STUDY DESIGN: This observational study was conducted at a pediatric intensive care unit in which a CPOE (Metavision, iMDsoft, Israel) with a limited clinical decision support system was implemented between 2004 and 2007. Since then, no changes were made to the systems. We analyzed 2500 electronic prescriptions (1250 prescriptions from 2015 and 1250 prescriptions from 2016)...
November 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/29135901/clinical-factors-associated-with-pediatric-brain-neoplasms-versus-primary-headache-a-case-control-analysis
#7
David C Sheridan, Bethany Waites, Bradley Lezak, Robert J Coryell, Kellie J Nazemi, Amber L Lin, Rongwei Fu, Matthew L Hansen
OBJECTIVE: Pediatric headaches are a common presentation to emergency departments accounting for almost half a million annual visits. Providers are left with the difficult task of deciding who has a secondary headache etiology that warrants neuroimaging. METHODS: We conducted a retrospective case-control study. Patients from a pediatric neuro-oncology clinic database with brain cancer and a headache at presentation were identified as cases. Controls were patients from 2 local pediatric tertiary care emergency departments with a final diagnosis of headache after negative neuroimaging...
November 14, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29133377/information-provided-by-diagnostic-and-screening-tests-improving-probabilities
#8
REVIEW
Mark Weatherall
Uncertainty in clinical encounters is inevitable and despite this uncertainty clinicians must still work with patients to make diagnostic and treatment decisions. Explicit diagnostic reasoning based on probabilities will optimise information in relation to uncertainty. In clinical diagnostic encounters, there is often pre-existing information that reflects the probability any particular patient has a disease. Diagnostic testing provides extra information that refines diagnostic probabilities. However, in general diagnostic tests will be positive in most, but not all cases of disease (sensitivity) and may not be negative in all cases of disease absence (specificity)...
November 13, 2017: Postgraduate Medical Journal
https://www.readbyqxmd.com/read/29133312/exploring-perceptions-and-experiences-of-patients-who-have-chronic-pain-as-state-prescription-opioid-policies-change-a-qualitative-study-in-indiana
#9
Morhaf Al Achkar, Debra Revere, Barbara Dennis, Palmer MacKie, Sumedha Gupta, Shaun Grannis
OBJECTIVES: The misuse and abuse of prescription opioids (POs) is an epidemic in the USA today. Many states have implemented legislation to curb the use of POs resulting from inappropriate prescribing. Indiana legislated opioid prescribing rules that went into effect in December 2013. The rules changed how chronic pain is managed by healthcare providers. This qualitative study aims to evaluate the impact of Indiana's opioid prescription legislation on the patient experiences around pain management...
November 12, 2017: BMJ Open
https://www.readbyqxmd.com/read/29122932/diagnostic-performance-of-an-acoustic-based-system-for-coronary-artery-disease-risk-stratification
#10
Simon Winther, Louise Nissen, Samuel Emil Schmidt, Jelmer Sybren Westra, Laust Dupont Rasmussen, Lars Lyhne Knudsen, Lene Helleskov Madsen, Jane Kirk Johansen, Bjarke Skogstad Larsen, Johannes Jan Struijk, Lars Frost, Niels Ramsing Holm, Evald Høj Christiansen, Hans Erik Botker, Morten Bøttcher
OBJECTIVE: Diagnosing coronary artery disease (CAD) continues to require substantial healthcare resources. Acoustic analysis of transcutaneous heart sounds of cardiac movement and intracoronary turbulence due to obstructive coronary disease could potentially change this. The aim of this study was thus to test the diagnostic accuracy of a new portable acoustic device for detection of CAD. METHODS: We included 1675 patients consecutively with low to intermediate likelihood of CAD who had been referred for cardiac CT angiography...
November 9, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/29117964/clinical-characteristics-of-children-evaluated-for-suspected-pulmonary-embolism-with-d-dimer-testing
#11
Jessica Kanis, Jonathan Pike, Cassandra L Hall, Jeffrey A Kline
BACKGROUND: We sought to determine clinical variables in children tested for suspected pulmonary embolism (PE) that predict PE+ outcome for the development of paediatric PE prediction rule. METHODS: Data were collected by query of a laboratory database for D-dimer from January 2004 to December 2014 for a large multicentre hospital system and the radiology database for pulmonary vascular imaging in children aged 5-17. Using explicit, predefined methods, trained abstractors, determined if D-dimer was sent in the evaluation of PE and then recorded predictor data which was tested for association with PE+ outcome using univariate techniques...
November 8, 2017: Archives of Disease in Childhood
https://www.readbyqxmd.com/read/29107623/early-symptom-improvement-at-10-sessions-as-a-predictor-of-rtms-treatment-outcome-in-major-depression
#12
Kfir Feffer, Hyewon Helen Lee, Farrokh Mansouri, Peter Giacobbe, Fidel Vila-Rodriguez, Sidney H Kennedy, Zafiris J Daskalakis, Daniel M Blumberger, Jonathan Downar
BACKGROUND: Predicting rTMS nonresponse could be helpful in sparing patients from futile treatment, and in improving use of limited rTMS resources. While several predictive biomarkers have been proposed, few are accurate for individual-level prediction; none have entered routine use. An alternative approach in pharmacotherapy predicts outcome from early response; patients showing minimal (e.g., ≤20%) improvement at 2 weeks can be predicted as nonresponders with negative predictive values (NPV) > 80-90%...
October 19, 2017: Brain Stimulation
https://www.readbyqxmd.com/read/29103551/decision-support-tools-in-low-back-pain
#13
REVIEW
Veerle M H Coupé, Miranda L van Hooff, Marinus de Kleuver, Ewout W Steyerberg, Raymond W J G Ostelo
Information from individual classification systems or clinical prediction rules that aim to facilitate stratified care in low back pain is important but often not comprehensive enough to be used to support clinical decision-making. The development and implementation of a clinically useful decision support tool (DST) that considering all key features is a challenging enterprise, requiring a multidisciplinary approach. Key features are inclusion of all relevant treatment options, patient characteristics, and benefits and harms and presentation as an accessible and easy to use toolkit...
December 2016: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/29101916/pulmonary-embolism-an-update
#14
Steven Doherty
BACKGROUND: Pulmonary embolism is a common condition and can be the source of significant morbidity and mortality. OBJECTIVE: This article reviews the approach to the diagnostic assessment and management of patients with suspected pulmonary embolism. DISCUSSION: Various clinical decision rules and algorithms are available to assist in the diagnosis of pulmonary embolism, and the Wells score and Pulmonary Embolism Rule-out Criteria rule are presented in this article...
November 2017: Australian Family Physician
https://www.readbyqxmd.com/read/29098965/orthopedic-injuries-in-pediatric-trauma
#15
Eman Loubani, Rodrick Lim, Debra Bartley
Trauma remains the leading cause of death in children, of which the majority of patients have orthopedic injuries. The range of injured bones is various, each requiring knowledge and expertise to appropriately manage in a timely fashion. The importance of a systematic approach to the pediatric polytrauma patient is paramount. This chapter will highlight orthopedic issues important to the pediatric polytrauma patient including the unique anatomy and properties of pediatric bone. A systematic approach to the pediatric polytrauma patient will also be discussed...
September 11, 2017: Current Pediatric Reviews
https://www.readbyqxmd.com/read/29096421/glucocorticosteroids-for-people-with-alcoholic-hepatitis
#16
REVIEW
Chavdar S Pavlov, Daria L Varganova, Giovanni Casazza, Emmanuel Tsochatzis, Dimitrinka Nikolova, Christian Gluud
BACKGROUND: Alcoholic hepatitis is a form of alcoholic liver disease, characterised by steatosis, necroinflammation, fibrosis, and potential complications to the liver disease. Typically, alcoholic hepatitis presents in people between 40 and 50 years of age. Alcoholic hepatitis can be resolved if people abstain from drinking, but the risk of death will depend on the severity of the liver damage and abstinence from alcohol. Glucocorticosteroids are used as anti-inflammatory drugs for people with alcoholic hepatitis...
November 2, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29095182/reducing-unnecessary-head-computed-tomography-in-mild-traumatic-brain-injury
#17
Nathaniel John Webster, Nathan Moore, Felicia Stewart
There is growing concern about the frequency of computed tomographic (CT) scans performed for evaluation of adults with suspected mild traumatic brain injury. The Canadian CT Head Rule and the New Orleans Criteria are the most studied head CT decision tools that aid providers in determining which patients do not require a CT scan. This article examines recent research to determine which of these tools has proven to be the most effective at safely reducing the use of head CT scans. The reviewed studies concluded that both the Canadian CT Head Rule and the New Orleans Criteria had similar sensitivities, but the Canadian CT Head Rule showed superior specificity in predicting the presence of a clinically significant brain injury...
October 2017: Advanced Emergency Nursing Journal
https://www.readbyqxmd.com/read/29092054/characteristics-of-knowledge-content-in-a-curated-online-evidence-library
#18
Sowmya Varada, Ronilda Lacson, Ali S Raja, Ivan K Ip, Louise Schneider, David Osterbur, Paul Bain, Nicole Vetrano, Jacqueline Cellini, Carol Mita, Margaret Coletti, Julia Whelan, Ramin Khorasani
Objective: To describe types of recommendations represented in a curated online evidence library, report on the quality of evidence-based recommendations pertaining to diagnostic imaging exams, and assess underlying knowledge representation. Materials and Methods: The evidence library is populated with clinical decision rules, professional society guidelines, and locally developed best practice guidelines. Individual recommendations were graded based on a standard methodology and compared using chi-square test...
October 27, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/29080550/frequency-of-use-and-acceptability-of-clinical-prediction-rules-for-pulmonary-embolism-among-swiss-general-internal-medicine-residents
#19
N Faller, O Stalder, A Limacher, S Bassetti, J H Beer, D Genné, E Battegay, D Hayoz, J Leuppi, B Mueller, A Perrier, G Waeber, N Rodondi, D Aujesky
INTRODUCTION: Whether clinical prediction rules for pulmonary embolism are accepted and used among general internal medicine residents remains uncertain. We therefore evaluated the frequency of use and acceptability of the Revised Geneva Score (RGS) and the Pulmonary Embolism Severity Index (PESI), and explored which factors were associated with rule use. MATERIALS/METHODS: In an online survey among general internal medicine residents from 10 Swiss hospitals, we assessed rule acceptability using the Ottawa Acceptability of Decision Rules Instrument (OADRI) and explored the association between physician and training-related factors and rule use using mixed logistic regression models...
October 18, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/29078904/surgeon-attitudes-and-practice-patterns-in-managing-small-bowel-obstruction-a-qualitative-analysis
#20
Lucas W Thornblade, Anjali R Truitt, Giana H Davidson, David R Flum, Danielle C Lavallee
BACKGROUND: Historical training instructs surgeons to, "never let the sun set on a small bowel obstruction (SBO)" due to concern for bowel ischemia. However, the routine use of computed tomography scans for ruling out ischemia provides the opportunity for trial of nonoperative management, allowing time for resolution of adhesive SBO. In light of advances in practice, little is known about how surgeons manage these patients, in particular, whether there is consistency in the stated duration for safe nonoperative management...
November 2017: Journal of Surgical Research
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