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Clinical decision rule

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https://www.readbyqxmd.com/read/28531306/association-of-long-term-opioid-therapy-with-functional-status-adverse-outcomes-and-mortality-among-patients-with-polyneuropathy
#1
E Matthew Hoffman, James C Watson, Jennifer St Sauver, Nathan P Staff, Christopher J Klein
Importance: Polyneuropathy is one of the most common painful conditions managed within general and specialty clinics. Neuropathic pain frequently leads to decisions about using long-term opioid therapy. Understanding the association of long-term opioid use with functional status, adverse outcomes, and mortality among patients with polyneuropathy could influence disease-specific decisions about opioid treatment. Objectives: To quantify the prevalence of long-term opioid use among patients with polyneuropathy and to assess the association of long-term opioid use with functional status, adverse outcomes, and mortality...
May 22, 2017: JAMA Neurology
https://www.readbyqxmd.com/read/28527501/clinical-decision-support-and-the-electronic-health-record-applications-for-physiatry
#2
REVIEW
Joel S Shoolin
Clinical decision support (CDS) is a process that provides information to assist the user in decision making for evaluation and treatment. Although many think only of rules and alerts, CDS is much more than that. Order sets, clinical documents, information fields, and medication sentences are just a few other CDS tools to be considered. CDS has been shown to improve care. Forming the third point of the triangle, CDS, along with process redesign and workflow considerations, improves care and helps create successful outcomes...
May 2017: PM & R: the Journal of Injury, Function, and Rehabilitation
https://www.readbyqxmd.com/read/28526667/patient-centered-decision-support-formative-usability-evaluation-of-integrated-clinical-decision-support-with-a-patient-decision-aid-for-minor-head-injury-in-the-emergency-department
#3
Edward R Melnick, Erik P Hess, George Guo, Maggie Breslin, Kevin Lopez, Anthony J Pavlo, Fuad Abujarad, Seth M Powsner, Lori A Post
BACKGROUND: The Canadian Computed Tomography (CT) Head Rule, a clinical decision rule designed to safely reduce imaging in minor head injury, has been rigorously validated and implemented, and yet expected decreases in CT were unsuccessful. Recent work has identified empathic care as a key component in decreasing CT overuse. Health information technology can hinder the clinician-patient relationship. Patient-centered decision tools to support the clinician-patient relationship are needed to promote evidence-based decisions...
May 19, 2017: Journal of Medical Internet Research
https://www.readbyqxmd.com/read/28512732/decision-making-in-the-surgical-management-of-invasive-breast-cancer-part-1-lumpectomy-mastectomy-and-contralateral-prophylactic-mastectomy
#4
REVIEW
Lisa A Newman
Several prospective randomized clinical trials conducted internationally have proven the safety and survival equivalence of breast-conserving surgery compared with mastectomy. Adjuvant radiation is routinely recommended following lumpectomy surgery to minimize the risk of local recurrence. Comprehensive breast imaging (including bilateral mammography with diagnostic views and ultrasound evaluation), in addition to clinical examination, is essential to rule out potential contralateral pathology and to optimally characterize the extent of disease...
May 15, 2017: Oncology (Williston Park, NY)
https://www.readbyqxmd.com/read/28512173/clinical-utility-of-risk-models-to-refer-patients-with-adnexal-masses-to-specialized-oncology-care-multicenter-external-validation-using-decision-curve-analysis
#5
Laure Wynants, Dirk Timmerman, Jan Verbakel, Antonia Testa, Luca Savelli, Daniela Fischerová, Dorella Franchi, Caroline D Van Holsbeke, Elisabeth Epstein, Wouter Froyman, Stefano Guerriero, Alberto Rossi, Robert Fruscio, Francesco Leone, Tom Bourne, Lil Valentin, Ben Van Calster
To evaluate the utility of pre-operative diagnostic models for ovarian cancer based on ultrasound and/or biomarkers for referring patients to specialized oncology care. The investigated models were RMI, ROMA, and three models from the International Ovarian Tumor Analysis (IOTA) group (LR2, ADNEX, and the Simple Rules risk score, SRRisks). <p>DESIGN: A secondary analysis of prospectively collected data from two cross-sectional cohort studies performed to externally validate diagnostic models.</p> <p>PARTICIPANTS: A total of 2763 patients (2403 in dataset 1 and 360 in dataset 2) from 18 centers (11 oncology centers and 7 non-oncology hospitals) in 6 countries...
May 16, 2017: Clinical Cancer Research: An Official Journal of the American Association for Cancer Research
https://www.readbyqxmd.com/read/28503676/learning-optimal-individualized-treatment-rules-from-electronic-health-record-data
#6
Yuanjia Wang, Peng Wu, Ying Liu, Chunhua Weng, Donglin Zeng
Medical research is experiencing a paradigm shift from "one-size-fits-all" strategy to a precision medicine approach where the right therapy, for the right patient, and at the right time, will be prescribed. We propose a statistical method to estimate the optimal individualized treatment rules (ITRs) that are tailored according to subject-specific features using electronic health records (EHR) data. Our approach merges statistical modeling and medical domain knowledge with machine learning algorithms to assist personalized medical decision making using EHR...
October 2016: IEEE International Conference on Healthcare Informatics IEEE International Conference on Healthcare Informatics
https://www.readbyqxmd.com/read/28503347/wasting-of-extensor-digitorum-brevis-as-a-decisive-preoperative-clinical-indicator-of-lumbar-canal-stenosis-a-single-center-prospective-cohort-study
#7
S Munakomi, B M Kumar
BACKGROUND: The dilemma in managing patients with low back ache lies in differentiating radiculopathy from lumbar canal stenosis. This has a huge bearing in patients being planned for surgical intervention as underperforming leads to failed back syndrome whereas over-doing leads to instability. There still remains a loophole in clinically diagnosing lumbar canal stenosis. AIM: We opt to utilize a simple bedside clinical examination in routinely assessing patients presenting with low back ache in ruling out underlying canal stenosis...
September 2016: Annals of Medical and Health Sciences Research
https://www.readbyqxmd.com/read/28499364/clinical-classification-in-low-back-pain-best-evidence-diagnostic-rules-based-on-systematic-reviews
#8
Tom Petersen, Mark Laslett, Carsten Juhl
BACKGROUND: Clinical examination findings are used in primary care to give an initial diagnosis to patients with low back pain and related leg symptoms. The purpose of this study was to develop best evidence Clinical Diagnostic Rules (CDR] for the identification of the most common patho-anatomical disorders in the lumbar spine; i.e. intervertebral discs, sacroiliac joints, facet joints, bone, muscles, nerve roots, muscles, peripheral nerve tissue, and central nervous system sensitization...
May 12, 2017: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/28499120/characterising-bias-in-regulatory-risk-and-decision-analysis-an-analysis-of-heuristics-applied-in-health-technology-appraisal-chemicals-regulation-and-climate-change-governance
#9
Brian H MacGillivray
In many environmental and public health domains, heuristic methods of risk and decision analysis must be relied upon, either because problem structures are ambiguous, reliable data is lacking, or decisions are urgent. This introduces an additional source of uncertainty beyond model and measurement error - uncertainty stemming from relying on inexact inference rules. Here we identify and analyse heuristics used to prioritise risk objects, to discriminate between signal and noise, to weight evidence, to construct models, to extrapolate beyond datasets, and to make policy...
May 9, 2017: Environment International
https://www.readbyqxmd.com/read/28495347/a-web-based-clinical-decision-support-system-for-gestational-diabetes-automatic-diet-prescription-and-detection-of-insulin-needs
#10
Estefanía Caballero-Ruiz, Gema García-Sáez, Mercedes Rigla, María Villaplana, Belen Pons, M Elena Hernando
BACKGROUND: The growth of diabetes prevalence is causing an increasing demand in health care services which affects the clinicians' workload as medical resources do not grow at the same rate as the diabetic population. Decision support tools can help clinicians with the inspection of monitoring data, providing a preliminary analysis to ease their interpretation and reduce the evaluation time per patient. This paper presents Sinedie, a clinical decision support system designed to manage the treatment of patients with gestational diabetes...
June 2017: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/28494618/machine-learning-methods-to-predict-diabetes-complications
#11
Arianna Dagliati, Simone Marini, Lucia Sacchi, Giulia Cogni, Marsida Teliti, Valentina Tibollo, Pasquale De Cata, Luca Chiovato, Riccardo Bellazzi
One of the areas where Artificial Intelligence is having more impact is machine learning, which develops algorithms able to learn patterns and decision rules from data. Machine learning algorithms have been embedded into data mining pipelines, which can combine them with classical statistical strategies, to extract knowledge from data. Within the EU-funded MOSAIC project, a data mining pipeline has been used to derive a set of predictive models of type 2 diabetes mellitus (T2DM) complications based on electronic health record data of nearly one thousand patients...
May 1, 2017: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/28490554/feasibility-cluster-randomised-controlled-trial-of-a-within-consultation-intervention-to-reduce-antibiotic-prescribing-for-children-presenting-to-primary-care-with-acute-respiratory-tract-infection-and-cough
#12
Peter S Blair, Sophie Turnbull, Jenny Ingram, Niamh Redmond, Patricia Jane Lucas, Christie Cabral, Sandra Hollinghurst, Padraig Dixon, Tim Peters, Jeremy Horwood, Paul Little, Nick A Francis, Anna Gilbertson, Catherine Jameson, Alastair D Hay
OBJECTIVE: To investigate recruitment and retention, data collection methods and the acceptability of a 'within-consultation' complex intervention designed to reduce antibiotic prescribing. DESIGN: Primary care feasibility cluster randomised controlled trial. SETTING: 32 general practices in South West England recruiting children from October 2014 to April 2015. PARTICIPANTS: Children (aged 3 months to <12 years) with acute cough and respiratory tract infection (RTI)...
May 9, 2017: BMJ Open
https://www.readbyqxmd.com/read/28490484/developing-a-decision-rule-to-optimise-clinical-pharmacist-resources-for-medication-reconciliation-in-the-emergency-department
#13
Sabrina De Winter, Peter Vanbrabant, Pieter Laeremans, Veerle Foulon, Ludo Willems, Sandra Verelst, Isabel Spriet
BACKGROUND: The process of obtaining a complete medication history for patients admitted to the hospital from the ED at hospital admission, without discrepancies, is error prone and time consuming. OBJECTIVES: The goal of this study was the development of a clinical decision rule (CDR) with a high positive predictive value in detecting ED patients admitted to hospital at risk of at least one discrepancy during regular medication history acquisition, along with favourable feasibility considering time and budget constraints...
May 10, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28488555/-syncope-suspect-pulmonary-embolism-especially-in-the-elderly
#14
W Opstelten, F L J Visseren
Syncope can be caused by a pulmonary embolism. This applies in particular to elderly patients admitted with syncope; in the general population, however, syncope is far more frequently caused by a vasovagal response or orthostatic hypotension. Syncope can be the symptom of a pulmonary embolism, even in the absence of any clinical manifestations of this diagnosis; it is, therefore, important to exclude pulmonary embolism in any syncope patient in the accident and emergency department by applying the Wells clinical decision rule...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28487667/when-is-a-test-score-fair-for-the-individual-who-is-being-tested-effects-of-different-scoring-procedures-across-multiple-attempts-when-testing-a-motor-skill-task
#15
Arve Vorland Pedersen, Håvard Lorås
Tests or test batteries used for assessing motor skills, either in research studies or in clinical settings, apply a variety of procedures for scoring performances, including everything from one to ten attempts, of which the best is scored or an average is computed. The rationale behind scoring procedures is rarely stated, and it seems that the number of attempts allowed is decided without much qualification from research. It is uncertain whether procedures fairly capture an individual's skill level. Thus, the validity of the tests may be compromised...
2017: Frontiers in Psychology
https://www.readbyqxmd.com/read/28484063/clinical-diagnosis-of-bordetella-pertussis-infection-a-systematic-review
#16
Mark H Ebell, Christian Marchello, Maria Callahan
BACKGROUND: Bordetella pertussis (BP) is a common cause of prolonged cough. Our objective was to perform an updated systematic review of the clinical diagnosis of BP without restriction by patient age. METHODS: We identified prospective cohort studies of patients with cough or suspected pertussis and assessed study quality using QUADAS-2. We performed bivariate meta-analysis to calculate summary estimates of accuracy and created summary receiver operating characteristic curves to explore heterogeneity by vaccination status and age...
May 2017: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/28483211/interpretation-of-leukocyte-esterase-for-the-detection-of-periprosthetic-joint-infection-based-on-serologic-markers
#17
Majd Tarabichi, Andrew N Fleischman, Alisina Shahi, Shaoqi Tian, Javad Parvizi
BACKGROUND: Leukocyte esterase (LE) is a rapid, point-of-care test for periprosthetic joint infection. The purpose of this study was to provide a tool for interpreting LE based on an initial serologic screening. METHODS: We reviewed the records of 319 patients who had erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) screening before hip or knee aspiration; 102 had elevated ESR and CRP levels, 64 had an elevated ESR or CRP level, and 153 had normal serology...
March 27, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28471695/current-use-and-potential-role-of-procalcitonin-in-the-diagnostic-work-up-and-follow-up-of-febrile-neutropenia-in-hematological-patients
#18
Benedetto Bruno, Alessandro Busca, Stefano Vallero, Stefania Raviolo, Nicola Mordini, Luca Nassi, Alessandro Cignetti, Ernesta Audisio, Moreno Festuccia, Alessandra Corsetti, Lorenza Depaoli, Maura Faraci, Concetta Micalizzi, Silvia Corcione, Massimo Berger, Francesco Saglio, Paola Caropreso, Giulio Mengozzi, Vincenzo Squadrone, Francesco Giuseppe De Rosa, Luisa Giaccone
Febrile neutropenia (FN) represents a life-threatening complication in hematological malignancies. Its etiology is most often due to infections even though FN of other origins, such as tumor-related fever and non-infectious inflammation, should rapidly be ruled out. Initially, C-reactive protein and, more recently, procalcitonin (PCT) have been proposed as useful biomarkers for differential diagnosis. PCT was shown to be a good biomarker of bacterial infections and their clinical outcomes. Definition of standard cut-offs and design of PCT-guided treatment protocols remain however to be defined...
May 4, 2017: Expert Review of Hematology
https://www.readbyqxmd.com/read/28471321/evaluation-of-probabilistic-disease-forecasts
#19
Gareth Hughes, Fiona Burnett
The statistical evaluation of probabilistic disease forecasts often involves calculation of metrics defined conditionally on disease status, such as sensitivity and specificity. However, for the purpose of disease management decision making, metrics defined conditionally on the result of the forecast - predictive values - are also important, although less frequently reported. In this context, the application of scoring rules in the evaluation of probabilistic disease forecasts is discussed. An index of separation with application in the evaluation of probabilistic disease forecasts, described in the clinical literature, is also considered and its relation to scoring rules illustrated...
May 4, 2017: Phytopathology
https://www.readbyqxmd.com/read/28469901/use-of-electronic-clinical-decision-support-and-hard-stops-to-decrease-unnecessary-thyroid-function-testing
#20
Sonia Dalal, Siddharth Bhesania, Steven Silber, Parag Mehta
NewYork-Presbyterian Brooklyn Methodist Hospital embarked on a Zero Unnecessary Study (ZEUS) initiative, whereby all aspects of clinical care were evaluated and strategies were implemented to mitigate waste. An opportunity was found in regards to thyroid function testing. It has been shown that certain TFTs are ordered far more often than clinically indicated. Free T3 (fT3) and Free T4 (fT4) are only indicated when the TSH is abnormal in the inpatient setting, with rare exceptions. Thus, a clinical algorithm for Clinical Decision Support (CDS) and Hard Stops (HS) were incorporated into the Electronic Medical Record (EMR) to prevent fT3 or fT4 to be ordered without an abnormal TSH, with certain predefined exceptions...
2017: BMJ Quality Improvement Reports
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