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Clinical decision rule

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https://www.readbyqxmd.com/read/28208193/approach-to-suspected-acute-pulmonary-embolism-should-we-use-scoring-systems
#1
Marc Righini, Grégoire Le Gal, Henri Bounameaux
Modern diagnostic strategies for pulmonary embolism diagnosis almost all rely on an initial assessment of the pretest probability. Clinical prediction rules are decision-making tools using combinations of easily available clinical predictors to define the probability of a disease. The assessment of the clinical probability of pulmonary embolism has an important impact on the diagnostic strategy and on therapeutic management. Clinical prediction rules provide accurate and reproducible estimates of clinical probability...
February 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28203490/pulsatile-tinnitus-differential-diagnosis-and-radiological-work-up
#2
REVIEW
Sjoert A H Pegge, Stefan C A Steens, Henricus P M Kunst, Frederick J A Meijer
PURPOSE OF REVIEW: Identification of the underlying cause of pulsatile tinnitus is important for treatment decision making and for prognosis estimation. For this, an adequate diagnostic imaging strategy is crucial. RECENT FINDINGS: Both CT and MRI can be useful, and in general, these modalities provide complementary diagnostic information. The scanning protocol can be optimized based on the estimated a priori chance for finding specific pathology, or the need to rule out more rare but clinical significant disease...
2017: Current Radiology Reports
https://www.readbyqxmd.com/read/28203277/semantics-based-plausible-reasoning-to-extend-the-knowledge-coverage-of-medical-knowledge-bases-for-improved-clinical-decision-support
#3
Hossein Mohammadhassanzadeh, William Van Woensel, Samina Raza Abidi, Syed Sibte Raza Abidi
BACKGROUND: Capturing complete medical knowledge is challenging-often due to incomplete patient Electronic Health Records (EHR), but also because of valuable, tacit medical knowledge hidden away in physicians' experiences. To extend the coverage of incomplete medical knowledge-based systems beyond their deductive closure, and thus enhance their decision-support capabilities, we argue that innovative, multi-strategy reasoning approaches should be applied. In particular, plausible reasoning mechanisms apply patterns from human thought processes, such as generalization, similarity and interpolation, based on attributional, hierarchical, and relational knowledge...
2017: BioData Mining
https://www.readbyqxmd.com/read/28203120/international-lessons-in-new-methods-for-grading-and-integrating-cost-effectiveness-evidence-into-clinical-practice-guidelines
#4
REVIEW
Kathryn M Antioch, Michael F Drummond, Louis W Niessen, Hindrik Vondeling
Economic evidence is influential in health technology assessment world-wide. Clinical Practice Guidelines (CPG) can enable economists to include economic information on health care provision. Application of economic evidence in CPGs, and its integration into clinical practice and national decision making is hampered by objections from professions, paucity of economic evidence or lack of policy commitment. The use of state-of-art economic methodologies will improve this. Economic evidence can be graded by 'checklists' to establish the best evidence for decision making given methodological rigor...
2017: Cost Effectiveness and Resource Allocation: C/E
https://www.readbyqxmd.com/read/28192477/impact-of-early-in-hospital-medication-review-by-clinical-pharmacists-on-health-services-utilization
#5
Corinne M Hohl, Nilu Partovi, Isabella Ghement, Maeve E Wickham, Kimberlyn McGrail, Lisa N Reddekopp, Boris Sobolev
BACKGROUND: Adverse drug events are a leading cause of emergency department visits and unplanned admissions, and prolong hospital stays. Medication review interventions aim to identify adverse drug events and optimize medication use. Previous evaluations of in-hospital medication reviews have focused on interventions at discharge, with an unclear effect on health outcomes. We assessed the effect of early in-hospital pharmacist-led medication review on the health outcomes of high-risk patients...
2017: PloS One
https://www.readbyqxmd.com/read/28187294/comprehensible-knowledge-model-creation-for-cancer-treatment-decision-making
#6
Muhammad Afzal, Maqbool Hussain, Wajahat Ali Khan, Taqdir Ali, Sungyoung Lee, Eui-Nam Huh, Hafiz Farooq Ahmad, Arif Jamshed, Hassan Iqbal, Muhammad Irfan, Manzar Abbas Hydari
BACKGROUND: A wealth of clinical data exists in clinical documents in the form of electronic health records (EHRs). This data can be used for developing knowledge-based recommendation systems that can assist clinicians in clinical decision making and education. One of the big hurdles in developing such systems is the lack of automated mechanisms for knowledge acquisition to enable and educate clinicians in informed decision making. MATERIALS AND METHODS: An automated knowledge acquisition methodology with a comprehensible knowledge model for cancer treatment (CKM-CT) is proposed...
January 29, 2017: Computers in Biology and Medicine
https://www.readbyqxmd.com/read/28179372/graphics-and-statistics-for-cardiology-clinical-prediction-rules
#7
REVIEW
Mark Woodward, Hugh Tunstall-Pedoe, Sanne Ae Peters
Graphs and tables are indispensable aids to quantitative research. When developing a clinical prediction rule that is based on a cardiovascular risk score, there are many visual displays that can assist in developing the underlying statistical model, testing the assumptions made in this model, evaluating and presenting the resultant score. All too often, researchers in this field follow formulaic recipes without exploring the issues of model selection and data presentation in a meaningful and thoughtful way...
February 8, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28177169/emergency-department-triage-of-traumatic-head-injury-using-brain-electrical-activity-biomarkers-a-multisite-prospective-observational-validation-trial
#8
Daniel Hanley, Leslie S Prichep, Jeffrey Bazarian, J Stephen Huff, Rosanne Naunheim, John Garrett, Elizabeth Jones, David Wright, John O'Neill, Neeraj Badjatia, Dheeraj Gandhi, Kenneth C Curley, Richard Chiacchierini, Brian O'Neil, Dallas C Hack
OBJECTIVES: A brain electrical activity biomarker for identifying traumatic brain injury (TBI) in Emergency Department (ED) patients presenting with high GCS after sustaining a head injury has shown promise for objective, rapid, triage. The main objective of this study was to prospectively evaluate the efficacy of an automated classification algorithm to determine the likelihood of being CT positive, in high functioning TBI patients in the acute state. METHODS: Adult patients admitted to the ED for evaluation within 72 hours of sustaining a closed head injury with GCS 12-15were candidates for study...
February 8, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28174819/screening-consolidated-clinical-document-architecture-ccda-documents-for-sensitive-data-using-a-rule-based-decision-support-system
#9
Beatriz H Rocha, Deepika Pabbathi, Molly Schaeffer, Howard S Goldberg
BACKGROUND: The Centers for Medicare & Medicaid Services' Stage 2 final rule requires that eligible hospitals provide a visit summary electronically at transitions of care in order to qualify for "meaningful use" incentive payments. However, Massachusetts state law and Federal law prohibit the transmission of documents containing "sensitive" data unless there is a new patient consent for each transmission. OBJECTIVES: To describe the implementation and evaluation of a rule-based decision support system used to screen transition of care documents for sensitive data...
February 8, 2017: Applied Clinical Informatics
https://www.readbyqxmd.com/read/28165632/comparison-of-3-options-for-choosing-control-limits-in-biochemistry-testing
#10
Simone Manzocchi, Erika Furman, Kathleen Freeman
BACKGROUND: The purpose of statistical quality control (QC) is to provide peace of mind with regard to the production of results that are suitable for analytically sound clinical interpretation and making reliable decisions about patient diagnosis, monitoring, and prognosis. OBJECTIVES: In this study, we compared 3 options for choosing control limits for biochemistry testing. They focus on the probability of error detection (Ped) and probability of false rejection (Pfr) achievable for a veterinary biochemical analyzer using the following 3 combinations: the quality control material (QCM) manufacturer's acceptable ranges; a standard 12s rule customized for the instrument's observed performance; and candidate rules selected for the instrument's observed performance using a computerized program (EZrules)...
February 6, 2017: Veterinary Clinical Pathology
https://www.readbyqxmd.com/read/28145070/a-systematic-review-of-instruments-to-identify-mental-health-and-substance-use-problems-among-children-in-the-emergency-department
#11
Amanda S Newton, Amir Soleimani, Scott W Kirkland, Rebecca J Gokiert
OBJECTIVE: Specialized instruments to screen and diagnose mental health problems in children and adolescents are not yet standard components of clinical assessments in emergency departments (EDs). We conducted a systematic review to investigate the psychometric properties, accuracy, and performance metrics of instruments used in the ED to identify pediatric mental health and substance use problems. METHODS: We searched seven electronic databases and the grey literature for psychometric validation studies, diagnostic studies, and cohort studies that assessed any instrument to screen for or diagnose mental illness, emotional or behavioral problems, or substance use disorders...
February 1, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28137453/ovarian-preservation-from-tumors-and-torsions-in-girls-prospective-diagnostic-study
#12
Z B Stanković, K Sedlecky, D Savić, B J Lukač, I Mažibrada, S Perovic
STUDY OBJECTIVE: To develop a new decision tree system (DTS) for the management of adnexal masses in prepubertal and adolescent girls, aimed to improve the distinction between benign and malignant masses, help preserve affected ovaries during surgery and reduce the rate of surgical management of uncomplicated functional ovarian cysts. DESIGN: A prospective diagnostic study using clinical and ultrasound data collected for all patients under 19 years of age with adnexal masses managed between 2006 and 2015...
January 27, 2017: Journal of Pediatric and Adolescent Gynecology
https://www.readbyqxmd.com/read/28135827/a-conceptual-model-for-the-development-process-of-confirmatory-adaptive-clinical-trials-within-an-emergency-research-network
#13
Samkeliso C Mawocha, Michael D Fetters, Laurie J Legocki, Timothy C Guetterman, Shirley Frederiksen, William G Barsan, Roger J Lewis, Donald A Berry, William J Meurer
BACKGROUND: Adaptive clinical trials use accumulating data from enrolled subjects to alter trial conduct in pre-specified ways based on quantitative decision rules. In this research, we sought to characterize the perspectives of key stakeholders during the development process of confirmatory-phase adaptive clinical trials within an emergency clinical trials network and to build a model to guide future development of adaptive clinical trials. METHODS: We used an ethnographic, qualitative approach to evaluate key stakeholders' views about the adaptive clinical trial development process...
January 1, 2017: Clinical Trials: Journal of the Society for Clinical Trials
https://www.readbyqxmd.com/read/28125977/supporting-clinical-rules-engine-in-the-adjustment-of-medication-scream-protocol-of-a-multicentre-prospective-randomised-study
#14
Carlota Mestres Gonzalvo, Hugo A J M de Wit, Brigit P C van Oijen, Kim P G M Hurkens, Rob Janknegt, Jos M G A Schols, Wubbo J Mulder, Frans R Verhey, Bjorn Winkens, Paul-Hugo M van der Kuy
BACKGROUND: In the nursing home population, it is estimated that 1 in every 3 patients is polymedicated and given their considerable frailty, these patients are especially prone to adverse drug reactions. Clinical pharmacist-led medication reviews are considered successful interventions to improve medication safety in the inpatient setting. Due to the limited available evidence concerning the benefits of medication reviews performed in the nursing home setting, we propose a study aiming to demonstrate a positive effect that a clinical decision support system, as a health care intervention, may have on the target population...
January 26, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/28124724/number-of-positive-radiographic-findings-in-pediatric-trauma-patients
#15
Thomas Ruffing, Tim Danko, Thomas Henzler, Christel Weiss, Alexander Hofmann, Markus Muhm
PURPOSE: Conventional radiography is frequently performed in pediatric patients in whom fractures and dislocations are suspected. However, until now, the rate of positive findings of the most commonly performed radiographic examinations in pediatric patients is unknown. The aim of this study was to evaluate the number of positive findings in the 20 most frequently requested standard radiographic examinations in pediatric patients in a level 1 trauma center systematically. METHODS: A transversal cohort study was conducted at a level 1 trauma center in Germany (2008-2014)...
January 26, 2017: Emergency Radiology
https://www.readbyqxmd.com/read/28121973/emergency-department-care-of-young-children-at-risk-for-traumatic-brain-injury-what-are-we-doing-and-do-parents-understand
#16
Caroline Reilly, Nanhua Zhang, Lynn Babcock, Shari L Wade, Tara Rhine
OBJECTIVES: The aims of the study were to describe emergency department (ED) management of young children with head injury and to assess parental comfort level and perceptions of ED care. METHODS: This was a prospective observational study of children younger than 5 years who presented to a pediatric ED after head injury. Children were eligible if clinical observation was an appropriate ED management option per the Pediatric Emergency Care Academic Research Network's neuroimaging clinical decision rule...
January 24, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28118686/two-sample-binary-phase-2-trials-with-low-type-i-error-and-low-sample-size
#17
Samuel Litwin, Stanley Basickes, Eric A Ross
We address design of two-stage clinical trials comparing experimental and control patients. Our end point is success or failure, however measured, with null hypothesis that the chance of success in both arms is p0 and alternative that it is p0 among controls and p1  > p0 among experimental patients. Standard rules will have the null hypothesis rejected when the number of successes in the (E)xperimental arm, E, sufficiently exceeds C, that among (C)ontrols. Here, we combine one-sample rejection decision rules, E⩾m, with two-sample rules of the form E - C > r to achieve two-sample tests with low sample number and low type I error...
January 24, 2017: Statistics in Medicine
https://www.readbyqxmd.com/read/28114435/undertriage-of-firearm-related-injuries-in-a-major-metropolitan-area
#18
Allison Lale, Allison Krajewski, Lee S Friedman
Importance: National anatomic triage criteria prescribe specific transport rules for injured patients. However, there is limited information about patients with firearm-related injuries undertriaged to nondesignated facilities (ie, hospitals without specialized trauma teams or units), including what clinical outcomes are achieved and how many are transferred to a higher level of care. Without these data, it is difficult to make informed regional or national policy decisions about triage practices...
January 18, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28110290/guided-and-unguided-internet-based-vestibular-rehabilitation-versus-usual-care-for-dizzy-adults-of-50%C3%A2-years-and-older-a-protocol-for-a-three-armed-randomised-trial
#19
Vincent A van Vugt, Johannes C van der Wouden, Judith E Bosmans, Martin Smalbrugge, Willianne van Diest, Rosie Essery, Lucy Yardley, Henriëtte E van der Horst, Otto R Maarsingh
INTRODUCTION: Dizziness is a common symptom in general practice with a high prevalence among older adults. The most common cause of dizziness in general practice is peripheral vestibular disease. Vestibular rehabilitation (VR) is a safe and effective treatment for peripheral vestibular disease that entails specific exercises to maximise the central nervous system compensation for the effects of vestibular pathology. An internet-based VR intervention has recently been shown to be safe and effective...
January 20, 2017: BMJ Open
https://www.readbyqxmd.com/read/28108796/a-clinical-decision-rule-for-the-use-of-ultrasound-in-children-presenting-with-acute-inflammatory-neck-masses
#20
Farahnaz Golriz, George S Bisset, Beth D'Amico, Andrea T Cruz, Kiyetta H Alade, Wei Zhang, Lane F Donnelly
OBJECTIVE: To identify the association between clinical and ultrasound findings and surgical drainage in children with inflammatory neck masses and to create a clinical decision rule that allows for reduction of unnecessary use of ultrasound in inflammatory neck masses. MATERIALS AND METHODS: We reviewed data on patients ≤18 years who visited our emergency department between 2012 and 2014 with inflammatory neck swelling and who underwent ultrasound examinations of the neck...
January 21, 2017: Pediatric Radiology
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