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Clinical decision rule

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https://www.readbyqxmd.com/read/28739290/implementation-of-the-canadian-ct-head-rule-and-its-association-with-use-of-computed-tomography-among-patients-with-head-injury
#1
Adam L Sharp, Brian Z Huang, Tania Tang, Ernest Shen, Edward R Melnick, Arjun K Venkatesh, Michael H Kanter, Michael K Gould
STUDY OBJECTIVE: Approximately 1 in 3 computed tomography (CT) scans performed for head injury may be avoidable. We evaluate the association of implementation of the Canadian CT Head Rule on head CT imaging in community emergency departments (EDs). METHODS: We conducted an interrupted time-series analysis of encounters from January 2014 to December 2015 in 13 Southern California EDs. Adult health plan members with a trauma diagnosis and Glasgow Coma Scale score at ED triage were included...
July 21, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28739038/anesthetic-and-perioperative-management-of-patients-with-brugada-syndrome
#2
REVIEW
Gregory Dendramis, Claudia Paleologo, Giuseppe Sgarito, Umberto Giordano, Roberto Verlato, Adrian Baranchuk, Pedro Brugada
Brugada syndrome (BrS) is an arrhythmogenic disease reported to be one among the leading causes of cardiac death in subjects under the age of 40 years. In these patients, episodes of lethal arrhythmias may be induced by several factors or situations, and for this reason, management during anesthesia and surgery must provide some precautions and drugs restrictions. To date, it is difficult to formulate guidelines for anesthetic management of patients with BrS because of the absence of prospective studies, and there is not a definite recommendation for neither general nor regional anesthesia, and there are no large studies in merit...
June 28, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28734809/-severe-poisoning-by-traditional-medication-in-the-newborn
#3
A Oulmaati, F Hmami, S Achour, A Bouharrou
The use of traditional products for therapeutic purposes in the newborn cause many cases of severe poisoning, especially in newborns. The aim of this study was to identify the main medicinal plants causing poisoning and emphasize the seriousness of poisonous plants. We report a series of eight newborns admitted for intake of poisonous medicinal plants admitted to the neonatal unit and neonatal intensive care unit at the Fez (Morocco) Hassan II University Hospital in 2014. The reasons for use were dominated by the infant's refusing to suckle...
July 19, 2017: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
https://www.readbyqxmd.com/read/28733440/dose-transition-pathways-the-missing-link-between-complex-dose-finding-designs-and-simple-decision-making
#4
Christina Yap, Lucinda J Billingham, Ying Kuen Cheung, Charlie Craddock, John O'Quigley
The ever increasing pace of development of novel therapies mandates efficient methodologies for assessment of their tolerability and activity. Evidence increasingly support the merits of model-based dose-finding designs in identifying the recommended Phase II dose compared to conventional rule-based designs such as the 3+3 but despite this, their use remains limited. Here, we propose a useful tool, Dose Transition Pathways (DTP), which helps overcome several commonly-faced practical and methodological challenges in the implementation of model-based designs...
July 21, 2017: Clinical Cancer Research: An Official Journal of the American Association for Cancer Research
https://www.readbyqxmd.com/read/28731391/malpractice-litigation-following-spine-surgery
#5
Alan H Daniels, Roy Ruttiman, Adam E M Eltorai, J Mason DePasse, Bielinsky A Brea, Mark A Palumbo
OBJECTIVE Adverse events related to spine surgery sometimes lead to litigation. Few studies have evaluated the association between spine surgical complications and medical malpractice proceedings, outcomes, and awards. The aim of this study was to identify the most frequent causes of alleged malpractice in spine surgery and to gain insight into patient demographic and clinical characteristics associated with medical negligence litigation. METHODS A search for "spine surgery" spanning February 1988 to May 2015 was conducted utilizing the medicolegal research service VerdictSearch (ALM Media Properties, LLC)...
July 21, 2017: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/28728206/-subaxial-cervical-spine-injuries-treatment-recommendations-of-the-german-orthopedic-and-trauma-society
#6
Philipp Schleicher, Matti Scholz, Frank Kandziora, Andreas Badke, Florian Hans Brakopp, Helmut Klaus Friedrich Ekkerlein, Erol Gercek, Rene Hartensuer, Philipp Hartung, Jan-Sven Gilbert Jarvers, Philipp Kobbe, Stefan Matschke, Robert Morrison, Christian W Müller, Miguel Pishnamaz, Maximilian Reinhold, Klaus John Schnake, Gregor Schmeiser, Gregor Stein, Bernhard Ullrich, Thomas Weiß, Volker Zimmermann
In a consensus process during four sessions in 2016, the working group "lower cervical spine" of the German Society for Orthopedic and Trauma Surgery (DGOU), formulated "Therapeutic Recommendations for the Lower Cervical Spine", taking into consideration the current literature. Therapeutic goals are a permanently stable, painless cervical spine and the protection against secondary neurologic damage while retaining the greatest possible amount of motion and spinal profile. Due to its ease of use and its proven good reliability, the AOSpine classification for subaxial cervical injuries should be used...
July 20, 2017: Zeitschrift Für Orthopädie und Unfallchirurgie
https://www.readbyqxmd.com/read/28725589/multi-parametric-magnetic-resonance-imaging-as-a-management-decision-tool
#7
REVIEW
David C Johnson, Robert E Reiter
The ability to image the prostate accurately and better characterize cancerous lesions makes multiparametric magnetic resonance imaging (mpMRI) an invaluable tool to improve management of localized prostate cancer (PCa). Improved risk stratification is warranted given the evidence of significant overtreatment of indolent PCa. mpMRI can more accurately rule out clinically significant PCa in men deciding between surveillance and definitive treatment to reduce overtreatment. mpMRI improves detection of clinically significant PCa, which helps minimize sampling error, a major limitation of the traditional diagnostic paradigm...
June 2017: Translational Andrology and Urology
https://www.readbyqxmd.com/read/28722083/-a-perception-of-the-development-trend-of-radiological-t-staging-in-gastric-cancer-through-uicc-ajcc-8-th-edition
#8
Lei Tang
More and more emphases were put on pre-therapy staging following the promotion of multidisciplinary team(MDT) collaboration and individualized medicine in gastric cancer. However, the accuracy of traditional radiology staging system which applies mechanically pathological staging is not satisfactory during clinical practice, therefore, the objectivity of treatment decisions is affected. Under such conditions, the newly introduced staging system from Union for International Cancer Control/American Joint Committee on Cancer(UICC/AJCC)(8(th) edition) divided out an independent cTNM system for the first time, and summarized the application range, operation specification and staging criteria...
July 25, 2017: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
https://www.readbyqxmd.com/read/28715289/survey-of-methods-used-to-determine-if-a-patient-has-a-deep-vein-thrombosis-an-exploratory-research-report
#9
John D Heick, James W Farris
BACKGROUND: The use of evidence-based practice (EBP) is encouraged in the physical therapy profession, but integrating evidence into practice can be difficult for clinicians because of lack of time and other constraints. OBJECTIVE: To survey physical therapy clinical instructors and determine the methods they use for screening for deep vein thrombosis (DVT), a type of venous thromboembolism (VTE) in the lower extremities. DESIGN: Exploratory survey...
July 17, 2017: Physiotherapy Theory and Practice
https://www.readbyqxmd.com/read/28711299/fracture-risk-assessment-in-clinical-practice-why-do-it-what-to-do-it-with
#10
Manju Chandran
Fracture is the outcome of concern in osteoporosis, and fracture reduction is the primary goal of osteoporosis treatment. Fracture risk assessment is a critical component in osteoporosis management. The earlier approach of deciding on whether to treat solely based on bone mineral density (BMD) T-scores has been supplanted by employing the concept of absolute risk over medium time periods and more encompassing integration of clinical risk factors with or without BMD into robust fracture risk assessment tools...
July 12, 2017: Journal of Clinical Densitometry
https://www.readbyqxmd.com/read/28705240/a-rule-based-electronic-phenotyping-algorithm-for-detecting-clinically-relevant-cardiovascular-disease-cases
#11
Santiago Esteban, Manuel Rodríguez Tablado, Ricardo Ignacio Ricci, Sergio Terrasa, Karin Kopitowski
BACKGROUND: The implementation of electronic medical records (EMR) is becoming increasingly common. Error and data loss reduction, patient-care efficiency increase, decision-making assistance and facilitation of event surveillance, are some of the many processes that EMRs help improve. In addition, they show a lot of promise in terms of data collection to facilitate observational epidemiological studies and their use for this purpose has increased significantly over the recent years...
July 14, 2017: BMC Research Notes
https://www.readbyqxmd.com/read/28701055/perspectives-of-dutch-health-professionals-regarding-auditory-processing-disorders-a-focus-group-study
#12
Karin Neijenhuis, Ellen de Wit, Margreet Luinge
OBJECTIVE: This study investigated the perspectives of professionals from the Dutch audiological centres on the definition and care pathways of children with suspected auditory processing disorders (susAPD). DESIGN: focus group interviews. STUDY SAMPLE: In total, 45 professionals from 6 disciplines, representing 22 different audiological centres and one ambulatory service, participated in five parallel focus group interviews. Participants had a variety of experience in diagnosing and advising children with suspected APD...
July 13, 2017: International Journal of Audiology
https://www.readbyqxmd.com/read/28700585/validation-of-the-sensitivity-of-the-national-emergency-x-radiography-utilization-study-nexus-head-computed-tomographic-ct-decision-instrument-for-selective-imaging-of-blunt-head-injury-patients-an-observational-study
#13
William R Mower, Malkeet Gupta, Robert Rodriguez, Gregory W Hendey
BACKGROUND: Clinicians, afraid of missing intracranial injuries, liberally obtain computed tomographic (CT) head imaging in blunt trauma patients. Prior work suggests that clinical criteria (National Emergency X-Radiography Utilization Study [NEXUS] Head CT decision instrument [DI]) can reliably identify patients with important injuries, while excluding injury, and the need for imaging in many patients. Validating this DI requires confirmation of the hypothesis that the lower 95% confidence limit for its sensitivity in detecting serious injury exceeds 99...
July 2017: PLoS Medicine
https://www.readbyqxmd.com/read/28694271/proposed-clinical-decision-rules-to-diagnose-acute-rhinosinusitis-among-adults-in-primary-care
#14
Mark H Ebell, Jens Georg Hansen
PURPOSE: To reduce inappropriate antibiotic prescribing, we sought to develop a clinical decision rule for the diagnosis of acute rhinosinusitis and acute bacterial rhinosinusitis. METHODS: Multivariate analysis and classification and regression tree (CART) analysis were used to develop clinical decision rules for the diagnosis of acute rhinosinusitis, defined using 3 different reference standards (purulent antral puncture fluid or abnormal finding on a computed tomographic (CT) scan; for acute bacterial rhinosinusitis, we used a positive bacterial culture of antral fluid)...
July 2017: Annals of Family Medicine
https://www.readbyqxmd.com/read/28678042/consensus-derived-clinical-decision-rules-to-guide-advanced-imaging-decisions-for-pulmonary-embolism-in-pregnancy-and-the-postpartum-period
#15
Gordon W Fuller, Catherine Nelson-Piercy, Beverley J Hunt, Fiona E Lecky, Steve Thomas, Kimberley Horspool, Steve Goodacre
No abstract text is available yet for this article.
July 3, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/28666562/emergency-medicine-myths-computed-tomography-of-the-head-prior%C3%A2-to-lumbar-puncture-in-adults-with-suspected-bacterial-meningitis-due-diligence-or-antiquated-practice
#16
Michael D April, Brit Long, Alex Koyfman
BACKGROUND: Various sources purport an association between lumbar puncture and brainstem herniation in patients with intracranial mass effect lesions. Several organizations and texts recommend head computed tomography (CT) prior to lumbar puncture in selected patients. OBJECTIVE: To review the evidence regarding the utility of obtaining head CT prior to lumbar puncture in adults with suspected bacterial meningitis. DISCUSSION: Observational studies report a risk of post-lumbar puncture brainstem herniation in the presence of intracranial mass effect (1...
June 27, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28657261/rare-case-of-non-tuberculous-mycobacterium-a-diagnostic-dilemma
#17
N Marathe, B Canavan
Non-Tuberculous Mycobacterial (NTM) infections occur in HIV-negative patients with or without underlying lung disease. It is generally felt that these organisms are acquired from the environment. Unlike tuberculosis, there are no convincing data demonstrating human-to-human OR animal-to-human transmission of NTM. We report a case of NTM infection in a 38 year old patient with underlying emphysematous lung disease. The case highlights the diagnostic dilemma which occurs when persistent sputum Acid- Fast Bacilli (AFB) smears are positive, but Nucleic acid amplification test is negative...
February 10, 2017: Irish Medical Journal
https://www.readbyqxmd.com/read/28647160/a-clinical-decision-rule-to-predict-zygomatico-maxillary-fractures
#18
Simon Haworth, Anthony Bates, Andrea Beech, Greg Knepil
Patients presenting with periorbital trauma require clinical assessment to exclude zygomatico-maxillary fractures. A single-centre pilot investigation was undertaken at a general hospital in the United Kingdom. The sample was composed of 229 adult patients attending our emergency department with periorbital injuries. Findings from 17 signs or symptoms of facial injury were recorded on a validated tool. The relationship between clinical presentation and displaced zygomatico-maxillary fracture was assessed using diagnostic test parameters and tests for correlation...
May 25, 2017: Journal of Cranio-maxillo-facial Surgery
https://www.readbyqxmd.com/read/28643629/faecal-immunochemical-tests-to-triage-patients-with-lower-abdominal-symptoms-for-suspected-colorectal-cancer-referrals-in-primary-care-a-systematic-review-and-cost-effectiveness-analysis
#19
Marie Westwood, Isaac Corro Ramos, Shona Lang, Marianne Luyendijk, Remziye Zaim, Lisa Stirk, Maiwenn Al, Nigel Armstrong, Jos Kleijnen
BACKGROUND: Colorectal cancer (CRC) is the third most common cancer in the UK. Presenting symptoms that can be associated with CRC usually have another explanation. Faecal immunochemical tests (FITs) detect blood that is not visible to the naked eye and may help to select patients who are likely to benefit from further investigation. OBJECTIVES: To assess the effectiveness of FITs [OC-Sensor (Eiken Chemical Co./MAST Diagnostics, Tokyo, Japan), HM-JACKarc (Kyowa Medex/Alpha Laboratories Ltd, Tokyo, Japan), FOB Gold (Sentinel/Sysmex, Sentinel Diagnostics, Milan, Italy), RIDASCREEN Hb or RIDASCREEN Hb/Hp complex (R-Biopharm, Darmstadt, Germany)] for primary care triage of people with low-risk symptoms...
May 2017: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/28639051/adjuvant-treatment-for-pancreatic-ductal-carcinoma
#20
REVIEW
T Macarulla, T Fernández, M E Gallardo, O Hernando, A M López, M Hidalgo
Pancreatic ductal adenocarcinoma (PDAC) is a tumor with a very poor prognosis. Most of the patients are diagnosed in advanced stages of the disease, and 5-year survival rates in these patients remains <10%. Surgery still remains the only radical treatment option, although only 15-20% of patients are candidates for surgical resection at the time of the diagnosis. Patients who undergo radical surgery still have a limited survival rate, being the average of 23 months. Three clinical trials have shown that adjuvant chemotherapy therapy after surgery may improve survival: CONKO-1, ESPAC-3, and ESPAC-4...
June 21, 2017: Clinical & Translational Oncology
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