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decision curve

Michala Skovlund Sørensen, Thomas Alexander Gerds, Klaus Hindsø, Michael Mørk Petersen
BACKGROUND: Survival predictions before surgery for metastatic bone disease in the extremities (based on statistical models and data of previous patients) are important for choosing an implant that will function for the remainder of the patient's life. The 2008-SPRING model, presented in 2016, enables the clinician to predict expected survival before surgery for metastatic bone disease in the extremities. However, to maximize the model's accuracy, it is necessary to maintain and update the patient database to refit the prediction models achieving more accurate calibration...
August 2018: Clinical Orthopaedics and related Research
Gokhan Kirlik, Rao Gullapalli, Warren D'Souza, Gazi Md Daud Iqbal, Michael Naslund, Jade Wong, John Papadimitrou, Steve Roys, Nilesh Mistry, Hao Zhang
Prostate cancer is the most frequently diagnosed cancer in men in the United States. The current main methods for diagnosing prostate cancer include prostate-specific antigen test and transrectal biopsy. Prostate-specific antigen screening has been criticized for overdiagnosis and unnecessary treatment, and transrectal biopsy is an invasive procedure with low sensitivity for diagnosis. We provided a quantitative tool using supervised learning with multiparametric imaging to be able to accurately detect cancer foci and its aggressiveness...
2018: Cancer Informatics
Johanna Reimer, Cornelia Montag, Alexander Schuster, Walter Moeller-Hartmann, Jan Sobesky, Wolf-Dieter Heiss, Olivier Zaro-Weber
BACKGROUND: In acute stroke, the magnetic resonance (MR) imaging-based mismatch concept is used to select patients with tissue at risk of infarction for reperfusion therapies. There is however a controversy if non-deconvolved or deconvolved perfusion weighted (PW) parameter maps perform better in tissue at risk prediction and which parameters and thresholds should be used to guide treatment decisions. METHODS: In a group of 22 acute stroke patients with consecutive MR and quantitative positron emission tomography (PET) imaging, non-deconvolved parameters were validated with the gold standard for penumbral-flow (PF) detection 15O-water PET...
July 13, 2018: Cerebrovascular Diseases
Andrew Evered
Cytologists search for rare signals (neoplastic cells) in visually noisy samples. The difficult nature of the task means that cytologists can never be completely certain about the diagnostic decisions they make. For most visual encounters a cytologist will adopt a probabilistic internal response (e.g. "I am 75% certain that this is an abnormal cell") but to be effective they must adopt a threshold, or decision criterion, that generates an explicit binary response. In other words, they must learn to decide whether each encountered cell is normal or abnormal...
July 14, 2018: Cytopathology: Official Journal of the British Society for Clinical Cytology
Bing Zhu, Jie Luo, Yiyao Jiang, Luhua Yu, Mulin Liu, Jun Fu
Interleukin (IL)-37 and neutrophils are considered to be involved in human cancer, but their prognostic significance in colorectal cancer (CRC) has not been elucidated. The aim of this study was to evaluate the prognostic value of IL-37 expression and neutrophil levels in CRC. We retrospectively analyzed IL-37 expression, CD66b+ neutrophil levels, and mismatch repair (MMR) status in 337 paraffin-embedded CRC specimens from the training cohort by immunohistochemistry. Their prognostic values were assessed using Kaplan-Meier curves and multivariate Cox regression models...
July 13, 2018: Cancer Medicine
Gary L O'Brien, Denis O'Mahony, Paddy Gillespie, Mark Mulcahy, Valerie Walshe, Marie N O'Connor, David O'Sullivan, James Gallagher, Stephen Byrne
BACKGROUND: A recent randomised controlled trial conducted in an Irish University teaching hospital that evaluated a physician-implemented medication screening tool, demonstrated positive outcomes in terms of a reduction in incident adverse drug reactions. OBJECTIVE: The present study objective was to evaluate the cost effectiveness of physicians applying this screening tool to older hospitalised patients compared with usual hospital care in the context of the earlier randomised controlled trial...
July 13, 2018: Drugs & Aging
Huw Llewelyn
In order that evidence-based medicine can prevent "too much medicine", it has to provide evidence in support of "gold standard" findings for use as diagnostic criteria, on which the assessment of other diagnostic tests and the outcomes of randomized controlled trials depend. When the results of such gold standard tests are numerical, cut-off points have to be positioned, also based on evidence, to identify those in whom offering a treatment can be justified. Such a diagnosis depends on eliminating conditions that mimic the one to be treated...
July 11, 2018: Journal of Evaluation in Clinical Practice
X Y Zhang, J Qian, P Li, L H Hu, Y Q Mi
Objective: To compare the clinical value of FibroScan, FIB-4, APRI and AAR diagnosing hepatic fibrosis in chronic hepatitis B virus (HBV) carriers. Methods: A total of 213 patients with chronic HBV carriers diagnosed by clinical and liver biopsy were selected. And according to HBeAg status, 149 patients were divided into HBeAg-positive group and 64 patients were divided into HBeAg-negative group. The liver stiffness measurements (LSM) was measured by FibroScan (FS), FIB-4, APRI and AAR values were calculated using FIB-4, APRI and AAR formula...
May 20, 2018: Zhonghua Gan Zang Bing za Zhi, Zhonghua Ganzangbing Zazhi, Chinese Journal of Hepatology
Peng Lan, Shuo-Jia Wang, Qiu-Cheng Shi, Ying Fu, Qing-Ye Xu, Tao Chen, Yun-Xian Yu, Kong-Han Pan, Ling Lin, Jian-Cang Zhou, Yun-Song Yu
Cirrhotic patients with infection are prone to develop sepsis or even septic shock rendering poorer prognosis. However, few methods are available to predict the prognosis of cirrhotic patients with infection although there are some scoring systems can be used to predict general patients with cirrhosis. Therefore, we aimed to explore the predictive value of scoring systems in determining the outcome of critically ill cirrhotic patients with suspected infection.This was a retrospective cohort study based on a single-center database...
July 2018: Medicine (Baltimore)
Xin Luo, Xiang Yang, Jiexian Li, Ge Zou, Yufeng Lin, Guoqiang Qing, Ruilin Yang, Weixiang Yao, Xuying Ye
Discrimination between urosepsis and febrile urinary tract infections is important in therapeutic decision-making to indicate suitable treatments to avoid sepsis-related organ failure. Accurate diagnosis is time-consuming and susceptible to false-positive results. Moreover, patient responses to urosepsis are complex and varied. Therefore, this study aimed to develop a new, early diagnostic predictor that could discriminate between patients with urosepsis and those with febrile urinary tract infections using a combination of initial procalcitonin and albumin levels...
July 2018: Medicine (Baltimore)
Liang Qi, Chen-Jiang Wu, Jing Zhang, Mei-Ling Bao, Xu Yan, Yu-Dong Zhang
OBJECTIVE: We developed a radiologic-risk signature (RRS) that serves as a surrogate for the pathologic status of prostate cancer (PCA) and investigated its ability to predict disease-free survival. MATERIALS AND METHODS: This study included 631 patients with localized PCA who underwent prostatic multiparametric MRI before prostatectomy. Images from 426 training datasets were structurally interpreted and correlated to a postoperative Memorial Sloan Kettering Cancer Center (MSKCC) score by a stepwise partial least-squares regression analysis...
July 11, 2018: AJR. American Journal of Roentgenology
Nikolaos Tsapanos, Anastasios Tefas, Nikolaos Nikolaidis, Ioannis Pitas
In mathematical terms, an artificial neuron computes the inner product of a d-dimensional input vector x with its weight vector w, compares it with a bias value w₀ and fires based on the result of this comparison. Therefore, its decision boundary is given by the equation wTx+w₀=0. In this paper, we propose replacing the linear hyperplane decision boundary of a neuron with a curved, paraboloid decision boundary. Thus, the decision boundary of the proposed paraboloid neuron is given by the equation (hTx+h₀)₂-||x-p||₂² = 0, where h and h₀ denote the parameters of the directrix and p denotes the coordinates of the focus...
June 14, 2018: IEEE Transactions on Neural Networks and Learning Systems
Alexis Bellot, Mihaela Van der Schaar
We study the problem of personalizing survival estimates of patients in heterogeneous populations for clinical decision support. The desiderata are to improve predictions by making them personalized to the patient-at-hand, to better understand diseases and their risk factors, and to provide interpretable model outputs to clinicians. To enable accurate survival prognosis in heterogeneous populations we propose a novel probabilistic survival model which flexibly captures individual traits through a hierarchical latent variable formulation...
May 2, 2018: IEEE Journal of Biomedical and Health Informatics
Hann-Hsiang Chao, Gilmer Valdes, Jose M Luna, Marina Heskel, Abigail T Berman, Timothy D Solberg, Charles B Simone
BACKGROUND AND PURPOSE: Chest wall toxicity is observed after stereotactic body radiation therapy (SBRT) for peripherally located lung tumors. We utilize machine learning algorithms to identify toxicity predictors to develop dose-volume constraints. MATERIALS AND METHODS: Twenty-five patient, tumor, and dosimetric features were recorded for 197 consecutive patients with Stage I NSCLC treated with SBRT, 11 of whom (5.6%) developed CTCAEv4 grade ≥2 chest wall pain...
July 10, 2018: Journal of Applied Clinical Medical Physics
Li-Da Chen, Jin-Yu Liang, Hui Wu, Zhu Wang, Shu-Rong Li, Wei Li, Xin-Hua Zhang, Jian-Hui Chen, Jin-Ning Ye, Xin Li, Xiao-Yan Xie, Ming-De Lu, Ming Kuang, Jian-Bo Xu, Wei Wang
AIMS: To establish multiparametric radiomics of rectal tumor for the preoperative prediction of lymph node (LN) metastasis. MATERIALS AND METHODS: This prospective study consisted of 115 consecutive patients with rectal carcinoma between April 2015 and April 2017. The multiparametric radiomics scores were extracted from the endorectal ultrasound (ERUS), computed tomography (CT) and shear-wave elastography (SWE) features of the rectal tumor, LN, and peripheral tissues...
July 7, 2018: Life Sciences
Konstantia Zarkogianni, Maria Athanasiou, Anastasia C Thanopoulou, Konstantina S Nikita
The estimation of long-term diabetes complications risk is essential in the process of medical decision making. Guidelines for the management of Type 2 Diabetes Mellitus (T2DM) advocate calculating the Cardiovascular Disease (CVD) risk to initiate appropriate treatment. The objective of this study is to investigate the use of sophisticated machine learning techniques towards the development of personalized models able to predict the risk of fatal or non-fatal CVD incidence in T2DM patients. The important challenge of handling the unbalanced nature of the available dataset is addressed, by applying novel ensemble strategies...
October 23, 2017: IEEE Journal of Biomedical and Health Informatics
Thomas J Sorenson, Roanna Vine, Giuseppe Lanzino
PURPOSE: Patients over the age of 80 years when diagnosed with an unruptured intracranial aneurysm (UIA) pose unique decision-making challenges due to shortened life-expectancy and increased risk of treatment. Thus, we investigated the risk of rupture and survival of a consecutive series of patients who were diagnosed with an UIA after the age of 80 years. METHODS: Data of consecutive patients with an UIA were reviewed, and patients were included in our study if they were first evaluated for a UIA by the senior author during their ninth decade of life...
July 7, 2018: Acta Neurochirurgica
Doreen J Bartlett, Sarah W McCoy, Lisa A Chiarello, Lisa Avery, Barbara Galuppi
In this Perspective, we suggest a process to improve physical and occupational therapists' and families' collaboration to provide appropriate, efficient, and effective evidence-based services to improve motor function, self-care performance, and participation in family and recreation activities for children with cerebral palsy (CP). This process is informed by two multisite prospective cohort studies (Move & PLAY and On Track). The heterogeneity of children with CP is described, limiting the utility of evidence from randomized controlled trials and systematic reviews to inform service planning for children with CP...
July 5, 2018: Physical Therapy
Weixing Dai, Yang Feng, Shaobo Mo, Wenqiang Xiang, Qingguo Li, Renjie Wang, Ye Xu, Guoxiang Cai
The purpose of our study was to develop a multigene signature based on transcriptome profiles of both mRNAs and lncRNAs to identify a group of patients who are at high risk of early relapse in stage II-III colon cancer. Firstly, propensity score matching was conducted between patients in early relapse group and long-term survival group from GSE39582 training series (N=359) and patients were matched 1:1. Global transcriptome analysis was then performed between the paired groups to identify tumor specific mRNAs and lncRNAs...
July 5, 2018: Carcinogenesis
Angela Bowman, Stephan Rudolfer, Peter Weller, Jeremy D P Bland
INTRODUCTION: Many prognostic factors have been studied in carpal tunnel decompression but most studies consider only a subset of variables. METHODS: 3332 operations were used to develop prognostic models and 885 operations for validation. Outcome recorded on a Likert scale was dichotomized into success or failure. Modeling was performed with both logistic regression and artificial neural networks using 87 candidate variables. RESULTS: Both approaches produced predictive multivariate models for outcome with areas under a receiver operating characteristic curve of 0·7 in the validation dataset...
July 7, 2018: Muscle & Nerve
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