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Clinical Decision Support

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https://www.readbyqxmd.com/read/28934822/stent-placement-for-benign-esophageal-leaks-perforations-and-fistulae-a-clinical-prediction-rule-for-successful-leakage-control
#1
Emo E van Halsema, Wouter F W Kappelle, Bas L A M Weusten, Robert Lindeboom, Mark I van Berge Henegouwen, Paul Fockens, Frank P Vleggaar, Manon C W Spaander, Jeanin E van Hooft
Background and study aims Sealing esophageal leaks by stent placement allows healing in 44 % - 94 % of patients. We aimed to develop a prediction rule to predict the chance of successful stent therapy. Patients and methods In this multicenter retrospective cohort study, patients with benign upper gastrointestinal leakage treated with stent placement were included. We used logistic regression analysis including four known clinical predictors of stent therapy outcome. The model performance to predict successful stent therapy was evaluated in an independent validation sample...
September 21, 2017: Endoscopy
https://www.readbyqxmd.com/read/28934785/1-year-results-of-a-randomized-controlled-trial-of-conservative-management-vs-minimally-invasive-surgical-treatment-for-sacroiliac-joint-pain
#2
Julius Dengler Dengler, Djaya Kools, Robert Pflugmacher, Alessandro Gasbarrini, Domenico Prestamburgo, Paolo Gaetani, Eddie van Eeckhoven, Daniel Cher, Bengt Sturesson
BACKGROUND: Low back pain (LBP) emanating from the sacroiliac joint (SIJ) is a common finding. Devices to fuse the SIJ are now commercially available, but high-quality evidence supporting their effectiveness is limited. OBJECTIVES: To compare the safety and effectiveness of conservative management (CM) to minimally invasive sacroiliac joint fusion (SIJF) in patients with chronic LBP originating from the SIJ. STUDY DESIGN: Prospective, multicenter randomized controlled trial...
September 2017: Pain Physician
https://www.readbyqxmd.com/read/28934370/the-risk-of-sustained-sexual-transmission-of-zika-is-underestimated
#3
Antoine Allard, Benjamin M Althouse, Laurent Hébert-Dufresne, Samuel V Scarpino
Pathogens often follow more than one transmission route during outbreaks-from needle sharing plus sexual transmission of HIV to small droplet aerosol plus fomite transmission of influenza. Thus, controlling an infectious disease outbreak often requires characterizing the risk associated with multiple mechanisms of transmission. For example, during the Ebola virus outbreak in West Africa, weighing the relative importance of funeral versus health care worker transmission was essential to stopping disease spread...
September 21, 2017: PLoS Pathogens
https://www.readbyqxmd.com/read/28934086/towards-ontology-based-decision-support-systems-for-complex-ultrasound-diagnosis-in-obstetrics-and-gynecology
#4
P Maurice, F Dhombres, E Blondiaux, S Friszer, L Guilbaud, N Lelong, B Khoshnood, J Charlet, N Perrot, E Jauniaux, D Jurkovic, J-M Jouannic
INTRODUCTION: We have developed a new knowledge base intelligent system for obstetrics and gynecology ultrasound imaging, based on an ontology and a reference image collection. This study evaluates the new system to support accurate annotations of ultrasound images. We have used the early ultrasound diagnosis of ectopic pregnancies as a model clinical issue. MATERIAL AND METHODS: The ectopic pregnancy ontology was derived from medical texts (4260 ultrasound reports of ectopic pregnancy from a specialist center in the UK and 2795 Pubmed abstracts indexed with the MeSH term "Pregnancy, Ectopic") and the reference image collection was built on a selection from 106 publications...
May 2017: Journal of gynecology obstetrics and human reproduction
https://www.readbyqxmd.com/read/28933707/high-accuracy-automatic-classification-of-parkinsonian-tremor-severity-using-machine-learning-method
#5
Hyoseon Jeon, Woongwoo Lee, Hyeyoung Park, Hong Ji Lee, Sang Kyong Kim, Han Byul Kim, Beomseok Jeon, Kwang Suk Park
Although clinical aspirations for new technology to accurately measure and diagnose Parkinsonian tremors exist, automatic scoring of tremor severity using machine learning approaches has not yet been employed. Objective: This study aims to maximize the scientific validity of automatic tremor-severity classification using machine learning algorithms to score Parkinsonian tremor severity in the same manner as the Unified Parkinson's Disease Rating Scale (UPDRS) used to rate scores in real clinical practice...
September 21, 2017: Physiological Measurement
https://www.readbyqxmd.com/read/28933675/using-the-concept-of-hubots-to-understand-the-work-entailed-in-using-digital-technologies-in-healthcare
#6
Catherine Pope, Joanne Turnbull
Purpose The purpose of this paper is to explore the human work entailed in the deployment of digital health care technology. It draws on imagined configurations of computers and machines in fiction and social science to think about the relationship between technology and people, and why this makes implementation of digital technology so difficult. The term hubots is employed as a metaphorical device to examine how machines and humans come together to do the work of healthcare. Design/methodology/approach This paper uses the fictional depiction of hubots to reconceptualise the deployment of a particular technology - a computer decision support system (CDSS) used in emergency and urgent care services...
August 21, 2017: Journal of Health Organization and Management
https://www.readbyqxmd.com/read/28933516/anti-il5-therapies-for-asthma
#7
REVIEW
Hugo A Farne, Amanda Wilson, Colin Powell, Lynne Bax, Stephen J Milan
BACKGROUND: This review is the first update of a previously published review in The Cochrane Library (Issue 7, 2015). Interleukin-5 (IL-5) is the main cytokine involved in the activation of eosinophils, which cause airway inflammation and are a classic feature of asthma. Monoclonal antibodies targeting IL-5 or its receptor (IL-5R) have been developed, with recent studies suggesting that they reduce asthma exacerbations, improve health-related quality of life (HRQoL) and lung function...
September 21, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28933266/intravenous-paracetamol-dosing-guidelines-for-pain-management-in-pre-term-neonates-using-the-paediatric-study-decision-tree
#8
P Mian, C A J Knibbe, E A M Calvier, D Tibboel, K Allegaert
BACKGROUND: Intravenous paracetamol (acetaminophen) has not been licensed for analgesia in preterm neonates or infants < 2 years, respectively, in Europe and the United States. A variety of dosing regimens is therefore used off-label. Because evidence supports the use of the same target mean steady state paracetamol concentration (Cssmean, 9-11 mg/L) for pain relief in neonates compared to older children and adults, dosing regimens based on this Cssmean were evaluated in a two-step approach...
September 21, 2017: Current Pharmaceutical Design
https://www.readbyqxmd.com/read/28933247/a-bayesian-decision-support-tool-for-child-sexual-abuse-assessment-and-investigation
#9
Alessandro Tadei, Johan Pensar, Jukka Corander, Katarina Finnilä, Pekka Santtila, Jan Antfolk
In assessments of child sexual abuse (CSA) allegations, informative background information is often overlooked or not used properly. We therefore created and tested an instrument that uses accessible background information to calculate the probability of a child being a CSA victim that can be used as a starting point in the following investigation. Studying 903 demographic and socioeconomic variables from over 11,000 Finnish children, we identified 42 features related to CSA. Using Bayesian logic to calculate the probability of abuse, our instrument-the Finnish Investigative Instrument of Child Sexual Abuse (FICSA)-has two separate profiles for boys and girls...
September 1, 2017: Sexual Abuse: a Journal of Research and Treatment
https://www.readbyqxmd.com/read/28933010/economic-evaluation-of-dupilumab-for-the-treatment-of-moderate-to-severe-atopic-dermatitis-in-adults
#10
Andreas Kuznik, Gaëlle Bégo-Le-Bagousse, Laurent Eckert, Abhijit Gadkari, Eric Simpson, Christopher N Graham, LaStella Miles, Vera Mastey, Puneet Mahajan, Sean D Sullivan
INTRODUCTION: Dupilumab significantly improves signs and symptoms of atopic dermatitis (AD), including pruritus, symptoms of anxiety and depression, and health-related quality of life versus placebo in adults with moderate-to-severe AD. Since the cost-effectiveness of dupilumab has not been evaluated, the objective of this analysis was to estimate a value-based price range in which dupilumab would be considered cost-effective compared with supportive care (SC) for treatment of moderate-to-severe AD in an adult population...
September 20, 2017: Dermatology and Therapy
https://www.readbyqxmd.com/read/28931501/cancer-predisposition-cascade-screening-for-hereditary-breast-ovarian-cancer-and-lynch-syndromes-in-switzerland-study-protocol
#11
Maria C Katapodi, Valeria Viassolo, Maria Caiata-Zufferey, Christos Nikolaidis, Rosmarie Bührer-Landolt, Nicole Buerki, Rossella Graffeo, Henrik Csaba Horváth, Christian Kurzeder, Manuela Rabaglio, Michael Scharfe, Corinne Urech, Tobias E Erlanger, Nicole Probst-Hensch, Karl Heinimann, Viola Heinzelmann-Schwarz, Olivia Pagani, Pierre O Chappuis
BACKGROUND: Breast, colorectal, ovarian, and endometrial cancers constitute approximately 30% of newly diagnosed cancer cases in Switzerland, affecting more than 12,000 individuals annually. Hundreds of these patients are likely to carry germline pathogenic variants associated with hereditary breast ovarian cancer (HBOC) or Lynch syndrome (LS). Genetic services (counseling and testing) for hereditary susceptibility to cancer can prevent many cancer diagnoses and deaths through early identification and risk management...
September 20, 2017: JMIR Research Protocols
https://www.readbyqxmd.com/read/28931428/personalized-predictive-modeling-for-patients-with-alzheimer-s-disease-using-an-extension-of-sullivan-s-life-table-model
#12
Eric Stallard, Bruce Kinosian, Yaakov Stern
BACKGROUND: Alzheimer's disease (AD) progression varies substantially among patients, hindering calculation of residual total life expectancy (TLE) and its decomposition into disability-free life expectancy (DFLE) and disabled life expectancy (DLE) for individual patients with AD. The objective of the present study was to assess the accuracy of a new synthesis of Sullivan's life table (SLT) and longitudinal Grade of Membership (L-GoM) models that estimates individualized TLEs, DFLEs, and DLEs for patients with AD...
September 20, 2017: Alzheimer's Research & Therapy
https://www.readbyqxmd.com/read/28930815/variability-in-usual-care-mechanical-ventilation-for-pediatric-acute-respiratory-distress-syndrome-time-for-a-decision-support-protocol
#13
Christopher J L Newth, Katherine A Sward, Robinder G Khemani, Kent Page, Kathleen L Meert, Joseph A Carcillo, Thomas P Shanley, Frank W Moler, Murray M Pollack, Heidi J Dalton, David L Wessel, John T Berger, Robert A Berg, Rick E Harrison, Richard Holubkov, Allan Doctor, J Michael Dean, Tammara L Jenkins, Carol E Nicholson
OBJECTIVES: Although pediatric intensivists philosophically embrace lung protective ventilation for acute lung injury and acute respiratory distress syndrome, we hypothesized that ventilator management varies. We assessed ventilator management by evaluating changes to ventilator settings in response to blood gases, pulse oximetry, or end-tidal CO2. We also assessed the potential impact that a pediatric mechanical ventilation protocol adapted from National Heart Lung and Blood Institute acute respiratory distress syndrome network protocols could have on reducing variability by comparing actual changes in ventilator settings to those recommended by the protocol...
September 19, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28930362/rapid-development-of-specialty-population-registries-and-quality-measures-from-electronic-health-record-data-an-agile-framework
#14
Vaishnavi Kannan, Jason S Fish, Jacqueline M Mutz, Angela R Carrington, Ki Lai, Lisa S Davis, Josh E Youngblood, Mark R Rauschuber, Kathryn A Flores, Evan J Sara, Deepa G Bhat, DuWayne L Willett
BACKGROUND: Creation of a new electronic health record (EHR)-based registry often can be a "one-off" complex endeavor: first developing new EHR data collection and clinical decision support tools, followed by developing registry-specific data extractions from the EHR for analysis. Each development phase typically has its own long development and testing time, leading to a prolonged overall cycle time for delivering one functioning registry with companion reporting into production. The next registry request then starts from scratch...
June 14, 2017: Methods of Information in Medicine
https://www.readbyqxmd.com/read/28929097/integrated-clinical-decision-support-systems-promote-absolute-cardiovascular-risk-assessment-an-important-primary-prevention-measure-in-aboriginal-and-torres-strait-islander-primary-health-care
#15
Veronica Matthews, Christopher P Burgess, Christine Connors, Elizabeth Moore, David Peiris, David Scrimgeour, Sandra C Thompson, Sarah Larkins, Ross Bailie
BACKGROUND: Aboriginal and Torres Strait Islander Australians experience a greater burden of disease compared to non-Indigenous Australians. Around one-fifth of the health disparity is caused by cardiovascular disease (CVD). Despite the importance of absolute cardiovascular risk assessment (CVRA) as a screening and early intervention tool, few studies have reported its use within the Australian Indigenous primary health care (PHC) sector. This study utilizes data from a large-scale quality improvement program to examine variation in documented CVRA as a primary prevention strategy for individuals without prior CVD across four Australian jurisdictions...
2017: Frontiers in Public Health
https://www.readbyqxmd.com/read/28928111/personalized-hypertension-management-using-patient-generated-health-data-integrated-with-electronic-health-records-empower-h-six-month-pre-post-study
#16
Nan Lv, Lan Xiao, Martha L Simmons, Lisa G Rosas, Albert Chan, Martin Entwistle
BACKGROUND: EMPOWER-H (Engaging and Motivating Patients Online With Enhanced Resources-Hypertension) is a personalized-care model facilitating engagement in hypertension self-management utilizing an interactive Web-based disease management system integrated with the electronic health record. The model is designed to support timely patient-provider interaction by incorporating decision support technology to individualize care and provide personalized feedback for patients with chronic disease...
September 19, 2017: Journal of Medical Internet Research
https://www.readbyqxmd.com/read/28927507/providing-physical-care-to-persons-with-serious-mental-illness-attitudes-confidence-barriers-and-psychological-empowerment
#17
Margaret Knight, Paula Bolton, Lynne Kopeski
The prevalence of metabolic syndrome (MetS) in people with serious mental illness (SMI) has been well documented in the mental health literature. Despite the adoption of various guidelines for monitoring risk factors for diabetes and cardiovascular risk in this population, limited translation has occurred in actual practice (Hermes, Sernyak, & Rosenheck, 2013). The Institute of Medicine (IoM) (2009) has noted a lag time in the application of knowledge within clinical settings. Evidence-based practice was deemed as a means of improving healthcare outcomes through the use of science supported standards of care...
October 2017: Archives of Psychiatric Nursing
https://www.readbyqxmd.com/read/28927443/towards-achieving-semantic-interoperability-of-clinical-study-data-with-fhir
#18
Hugo Leroux, Alejandro Metke-Jimenez, Michael J Lawley
BACKGROUND: Observational clinical studies play a pivotal role in advancing medical knowledge and patient healthcare. To lessen the prohibitive costs of conducting these studies and support evidence-based medicine, results emanating from these studies need to be shared and compared to one another. Current approaches for clinical study management have limitations that prohibit the effective sharing of clinical research data. METHODS: The objective of this paper is to present a proposal for a clinical study architecture to not only facilitate the communication of clinical study data but also its context so that the data that is being communicated can be unambiguously understood at the receiving end...
September 19, 2017: Journal of Biomedical Semantics
https://www.readbyqxmd.com/read/28927305/discovery-and-application-of-immune-biomarkers-for-hematological-malignancies
#19
Dimitrios Zafeiris, Jayakumar Vadakekolathu, Sarah Wagner, Alan Graham Pockley, Graham Roy Ball, Sergio Rutella
Hematological malignancies originate and progress in primary and secondary lymphoid organs, where they establish a uniquely immune-suppressive tumour microenvironment. Although high-throughput transcriptomic and proteomic approaches are being employed to interrogate immune surveillance and escape mechanisms in patients with solid tumours, and to identify actionable targets for immunotherapy, our knowledge of the immunological landscape of hematological malignancies, as well as our understanding of the molecular circuits that underpin the establishment of immune tolerance, is not comprehensive...
September 19, 2017: Expert Review of Molecular Diagnostics
https://www.readbyqxmd.com/read/28926426/epigenetics-and-precision-oncology
#20
Rachael J Werner, Andrew D Kelly, Jean-Pierre J Issa
Epigenetic alterations such as DNA methylation defects and aberrant covalent histone modifications occur within all cancers and are selected for throughout the natural history of tumor formation, with changes being detectable in early onset, progression, and ultimately recurrence and metastasis. The ascertainment and use of these marks to identify at-risk patient populations, refine diagnostic criteria, and provide prognostic and predictive factors to guide treatment decisions are of growing clinical relevance...
September 2017: Cancer Journal
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