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Clinical Decision Support

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https://www.readbyqxmd.com/read/29332975/enhancing-the-clinical-value-of-medical-laboratory-testing
#1
REVIEW
Kenneth A Sikaris
The value of medical laboratory testing is often directed to the cost of testing however the clinical benefits of these tests are at least as important. Laboratory testing has an acknowledged widespread role in clinical decision making, and therefore a role in determining clinical outcome. Consequently, the value of laboratory testing should be considered in its role in affecting beneficial actions and outcomes. This includes both the requesting phase of choosing tests which will influence clinical decision making as well as the reporting phase in a way that guides clinical decisions and actions...
November 2017: Clinical Biochemist. Reviews
https://www.readbyqxmd.com/read/29332506/rape-crimes-are-victims-acute-psychological-distress-and-perceived-social-support-associated-with-police-case-decision-and-victim-willingness-to-participate-in-the-investigation
#2
Nina B Hansen, Maj Hansen, Louise H Nielsen, Rikke H Bramsen, Ask Elklit, Rebecca Campbell
This study examined level of acute psychological distress and perceived social support in 64 victims of rape and the association with police case decisions and victims' willingness to participate in the investigation. The results of independent-sample t tests revealed that victims' unwillingness to participate in the investigation was significantly associated with a higher level of psychological distress in the acute phase following the assault. The results suggest that victims of rape who disengage with the police investigation may do so because of a high level of acute psychological distress...
June 1, 2017: Violence Against Women
https://www.readbyqxmd.com/read/29332145/the-experiences-and-beliefs-of-older-people-in-scottish-very-sheltered-housing-about-using-multi-compartment-compliance-aids
#3
Derek Stewart, Kathrine Gibson Smith, Joan MacLeod, Alison Strath, Vibhu Paudyal, Katrina Forbes-McKay, Scott Cunningham, Katie MacLure
Background Multi-compartment compliance aids (MCAs) are promoted as a potential solution to medicines non-adherence despite the absence of high quality evidence of effectiveness of MCA use impacting medicines adherence or any clinical outcomes. Furthermore, there is a lack of qualitative research which focuses on the perspectives of older people receiving MCAs. Objectives To describe experiences and beliefs surrounding very sheltered housing (VSH) residents' use of MCAs with emphasis on issues of personalisation, reablement, shared decision-making, independence and support...
January 13, 2018: International Journal of Clinical Pharmacy
https://www.readbyqxmd.com/read/29331546/clinically-localized-prostate-cancer-aua-astro-suo-guideline-part-ii-recommended-approaches-and-details-of-specific-care-options
#4
Martin G Sanda, Jeffrey A Cadeddu, Erin Kirkby, Ronald C Chen, Tony Crispino, Joann Fontanarosa, Stephen J Freedland, Kirsten Greene, Laurence H Klotz, Danil V Makarov, Joel B Nelson, George Rodrigues, Howard M Sandler, Mary Ellen Taplin, Jonathan R Treadwell
PURPOSE: This guideline is structured to provide a clinical framework stratified by cancer severity to facilitate care decisions and guide the specifics of implementing the selected management options. The summary presented herein represents Part II of the two-part series dedicated to Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline discussing risk stratification and care options by cancer severity. Please refer to Part I for discussion of specific care options and outcome expectations and management...
January 10, 2018: Journal of Urology
https://www.readbyqxmd.com/read/29331259/public-and-physician-s-expectations-and-ethical-concerns-about-electronic-health-record-benefits-outweigh-risks-except-for-information-security
#5
Eleni Entzeridou, Evgenia Markopoulou, Vasiliki Mollaki
INTRODUCTION: Electronic Health Record systems (EHRs) offer numerous benefits in health care but also pose certain risks. As we progress toward the implementation of EHRs, a more in-depth understanding of attitudes that influence overall levels of EHR support is required. OBJECTIVES: To record public and physicians' awareness, expectations for, and ethical concerns about the use of EHRs. METHODS: A convenience sample was surveyed for both the public and physicians...
February 2018: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/29331253/evaluation-of-three-machine-learning-models-for-self-referral-decision-support-on-low-back-pain-in-primary-care
#6
Wendy Oude Nijeweme-d'Hollosy, Lex van Velsen, Mannes Poel, Catharina G M Groothuis-Oudshoorn, Remko Soer, Hermie Hermens
BACKGROUND: Most people experience low back pain (LBP) at least once in their life and for some patients this evolves into a chronic condition. One way to prevent acute LBP from transiting into chronic LBP, is to ensure that patients receive the right interventions at the right moment. We started research in the design of a clinical decision support system (CDSS) to support patients with LBP in their self-referral to primary care. For this, we explored the possibilities of using supervised machine learning...
February 2018: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/29331209/ethical-and-end-of-life-considerations-for-neonates-requiring-ecmo-support
#7
REVIEW
Roxanne Kirsch, David Munson
ECMO has proven to be a life-saving intervention for a variety of disease entities with a high rate of survival in the neonatal population. However, ECMO requires clinical teams to engage in many ethical considerations. Even with ongoing improvements in technology and expertise, some patients will not survive a course of ECMO. An unsuccessful course of ECMO can be difficult to accept and cause a great deal of angst. These questions can result in real conflict both within the care team, and between the care team and the family...
January 10, 2018: Seminars in Perinatology
https://www.readbyqxmd.com/read/29331072/transcranial-ultrasonographic-image-analysis-system-for-decision-support-in-parkinson-disease
#8
Andrius Sakalauskas, Vita Špečkauskienė, Kristina Laučkaitė, Rytis Jurkonis, Daiva Rastenytė, Arūnas Lukoševičius
OBJECTIVES: Transcranial ultrasonography (US) is a relatively new neuroimaging modality proposed for early diagnostics of Parkinson disease (PD). The main limitation of transcranial US image-based diagnostics is a high degree of subjectivity caused by low quality of the transcranial images. The article presents a developed image analysis system and evaluates the potential of automated image analysis on transcranial US. METHODS: The system consists of algorithms for the segmentation and assessment of informative brain regions (midbrain and substantia nigra) and a decision support subsystem, which is equipped with 64 classification algorithms...
January 13, 2018: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
https://www.readbyqxmd.com/read/29330714/evidence-based-recommendations-to-improve-the-safe-use-of-drugs-in-patients-with-liver-cirrhosis
#9
Rianne A Weersink, Margriet Bouma, David M Burger, Joost P H Drenth, S Froukje Harkes-Idzinga, Nicole G M Hunfeld, Herold J Metselaar, Margje H Monster-Simons, Katja Taxis, Sander D Borgsteede
INTRODUCTION: The presence of liver cirrhosis can have a major impact on pharmacodynamics and pharmacokinetics, but guidance for prescribing is lacking. OBJECTIVE: The aim of this study is to provide an overview of evidence-based recommendations developed for the safe use of drugs in liver cirrhosis. METHODS: Recommendations were based on a systematic literature search combined with expert opinion from a panel of 10 experts. The safety of each drug was classified as safe, no additional risks known, additional risks known, unsafe, unknown or the safety class was dependent on the severity of liver cirrhosis (Child-Pugh classification)...
January 12, 2018: Drug Safety: An International Journal of Medical Toxicology and Drug Experience
https://www.readbyqxmd.com/read/29330217/a-systematic-review-of-network-meta-analyses-for-pharmacological-treatment-of-common-mental-disorders
#10
REVIEW
Taryn Williams, Dan J Stein, Jonathan Ipser
QUESTION: Network meta-analyses (NMAs) of treatment efficacy across different pharmacological treatments help inform clinical decision-making, but their methodological quality may vary a lot depending also on the quality of the included primary studies. We therefore conducted a systematic review of NMAs of pharmacological treatment for common mental disorders in order to assess the methodological quality of these NMAs, and to relate study characteristics to the rankings of efficacy and tolerability...
January 12, 2018: Evidence-based Mental Health
https://www.readbyqxmd.com/read/29326826/collision-tumor-consisting-of-a-colorectal-adenocarcinoma-and-dissemination-of-a-gastric-adenocarcinoma
#11
Ryoichi Miyamoto, Kazunori Kikuchi, Atsushi Uchida, Masayoshi Ozawa, Akira Kemmochi, Naoki Sano, Sosuke Tadano, Satoshi Inagawa, Shinya Adachi, Masayoshi Yamamoto
Background: Collision tumors, composed of histologically distinct tumor types, are rare entities, especially in the colorectum, and corresponding evidence-based clinical management or treatment strategies are poorly defined. This is the first report of a collision tumor composed of two histologically distinct adenocarcinomas. Case presentation: A 78-year-old male showed severe anemia and a 10% body weight loss over 1 month. Preoperative examination revealed T3N1M0 stage IIIA gastric cancer and T3N0M0 stage IIA rectal cancer...
2018: SAGE Open Medical Case Reports
https://www.readbyqxmd.com/read/29325622/the-emerging-genetic-landscape-of-cerebral-palsy
#12
C L van Eyk, M A Corbett, A H Maclennan
Cerebral palsy (CP) is a broad clinical descriptor that encompasses a heterogeneous group of nonprogressive neurodevelopmental disabilities affecting movement and posture. While linked by the presence of damage to the developing brain, the etiology of CP is likely varied and the clinical outcomes are diverse. There is now a large body of evidence supporting a significant role for genetics in causation of CP. An increasing number of studies have identified likely causative genetic variants in families with CP, as well as in individual sporadic cases...
2018: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/29324970/watson-for-oncology-and-breast-cancer-treatment-recommendations-agreement-with-an-expert-multidisciplinary-tumor-board
#13
S P Somashekhar, M-J Sepúlveda, S Puglielli, A D Norden, E H Shortliffe, C Rohit Kumar, A Rauthan, N Arun Kumar, P Patil, K Rhee, Y Ramya
Background: Breast cancer oncologists are challenged to personalize care with rapidly changing scientific evidence, drug approvals, and treatment guidelines. Artificial intelligence (AI) clinical decision-support systems (CDSSs) have the potential to help address this challenge. We report here the results of examining the level of agreement (concordance) between treatment recommendations made by the AI CDSS Watson for Oncology (WFO) and a multidisciplinary tumor board for breast cancer...
January 9, 2018: Annals of Oncology: Official Journal of the European Society for Medical Oncology
https://www.readbyqxmd.com/read/29324935/right-putamen-and-age-are-the-most-discriminant-features-to-diagnose-parkinson-s-disease-by-using-123i-fp-cit-brain-spet-data-by-using-an-artificial-neural-network-classifier-a-classification-tree-clt
#14
S Cascianelli, C Tranfaglia, M L Fravolini, F Bianconi, M Minestrini, S Nuvoli, N Tambasco, M E Dottorini, B Palumbo
OBJECTIVE: The differential diagnosis of Parkinson's disease (PD) and other conditions, such as essential tremor and drug-induced parkinsonian syndrome or normal aging brain, represents a diagnostic challenge. 123I-FP-CIT brain SPET is able to contribute to the differential diagnosis. Semiquantitative analysis of radiopharmaceutical uptake in basal ganglia (caudate nuclei and putamina) is very useful to support the diagnostic process. An artificial neural network classifier using 123I-FP-CIT brain SPET data, a classification tree (CIT), was applied...
September 2017: Hellenic Journal of Nuclear Medicine
https://www.readbyqxmd.com/read/29324741/facilitating-healthcare-decisions-by-assessing-the-certainty-in-the-evidence-from-preclinical-animal-studies
#15
Carlijn R Hooijmans, Rob B M de Vries, Merel Ritskes-Hoitinga, Maroeska M Rovers, Mariska M Leeflang, Joanna IntHout, Kimberley E Wever, Lotty Hooft, Hans de Beer, Ton Kuijpers, Malcolm R Macleod, Emily S Sena, Gerben Ter Riet, Rebecca L Morgan, Kristina A Thayer, Andrew A Rooney, Gordon H Guyatt, Holger J Schünemann, Miranda W Langendam
Laboratory animal studies are used in a wide range of human health related research areas, such as basic biomedical research, drug research, experimental surgery and environmental health. The results of these studies can be used to inform decisions regarding clinical research in humans, for example the decision to proceed to clinical trials. If the research question relates to potential harms with no expectation of benefit (e.g., toxicology), studies in experimental animals may provide the only relevant or controlled data and directly inform clinical management decisions...
2018: PloS One
https://www.readbyqxmd.com/read/29324635/diagnostic-value-of-serum-urokinase-type-plasminogen-activator-receptor-in-children-with-acute-appendicitis
#16
Mustafa Onur Oztan, Aysegul Aksoy Gokmen, Fatma Demet Arslan, Ebru Cakir, Ali Sayan, Elif Abay, Selçuk Kaya, Gokhan Koyluoglu
OBJECTIVES: Acute appendicitis (AA) is the most common surgical emergency in children. The accurate and timely diagnosis of AA in children can be challenging, and delayed diagnosis rates have been reported to range from 5.9% to 27.6%. Although combining clinical history and repeated physical examination with laboratory tests and radiographic imaging modalities help reach the diagnosis, novel biomarkers can support the surgeons' decision as well. The aims of this study were to evaluate a new plasma marker, urokinase-type plasminogen activator receptor (uPAR), to improve diagnostic accuracy in AA patients, and to determine a cutoff value of uPAR, which can safely include/exclude the diagnosis of AA...
January 11, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29323618/measuring-attitudes-towards-the-dying-process-a-systematic-review-of-tools
#17
Bernadette Groebe, Julia Strupp, Yvonne Eisenmann, Holger Schmidt, Anna Schlomann, Christian Rietz, Raymond Voltz
BACKGROUND: At the end of life, anxious attitudes concerning the dying process are common in patients in Palliative Care. Measurement tools can identify vulnerabilities, resources and the need for subsequent treatment to relieve suffering and support well-being. AIM: To systematically review available tools measuring attitudes towards dying, their operationalization, the method of measurement and the methodological quality including generalizability to different contexts...
January 1, 2018: Palliative Medicine
https://www.readbyqxmd.com/read/29322372/examination-of-patient-reported-outcomes-in-association-with-tnf-inhibitor-treatment-response-results-from-a-us-observational-cohort-study
#18
Cynthia J Larmore, Natalie N Boytsov, Carol L Gaich, Xiang Zhang, Andre B Araujo, Sabrina Rebello, Bob A Salim, George W Reed, Leslie R Harrold
INTRODUCTION: Implementation of a treat-to-target strategy is challenging when the patient and physician prioritize different goals. This study aimed to "translate" improvements in Clinical Disease Activity Index (CDAI) to concepts that resonate with patients (such as pain, fatigue, morning stiffness) by examining the association between changes in disease activity and patient-reported outcomes (PROs) in a national cohort of patients with rheumatoid arthritis (RA) initiating their first biologic treatment...
January 10, 2018: Rheumatology and Therapy
https://www.readbyqxmd.com/read/29321654/motivating-cord-blood-donation-with-information-and-behavioral-nudges
#19
Daniela Grieco, Nicola Lacetera, Mario Macis, Daniela Di Martino
Umbilical cord blood is a source of hematopoietic stem cells essential to treat life-threatening diseases, such as leukemia and lymphoma. However, only a very small percentage of parents donate upon delivery. The decision to donate the cord blood occurs at a very specific time and when parents likely experience emotional, informational, and decisional overloads; these features of cord blood donation make it different from other pro-social activities. In collaboration with an OB-GYN clinic in Milan, Italy, we conducted the first randomized controlled trial that applies tools from behavioral science to foster cord blood donation, and quantified the gains that informational and behavioral "nudges" can achieve...
January 10, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29321134/efficacy-of-a-chronic-care-based-intervention-on-secondary-stroke-prevention-among-vulnerable-stroke-survivors-a-randomized-controlled-trial
#20
Eric M Cheng, William E Cunningham, Amytis Towfighi, Nerses Sanossian, Robert J Bryg, Thomas L Anderson, Frances Barry, Susan M Douglas, Lillie Hudson, Monica Ayala-Rivera, Jeffrey J Guterman, Sandra Gross-Schulman, Sylvia Beanes, Andrea S Jones, Honghu Liu, Barbara G Vickrey
BACKGROUND: Disparities of care among stroke survivors are well documented. Effective interventions to improve recurrent stroke preventative care in vulnerable populations are lacking. METHODS AND RESULTS: In a randomized controlled trial, we tested the efficacy of components of a chronic care model-based intervention versus usual care among 404 subjects having an ischemic stroke or transient ischemic attack within 90 days of enrollment and receiving care within the Los Angeles public healthcare system...
January 2018: Circulation. Cardiovascular Quality and Outcomes
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