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Clinical Decision Support

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https://www.readbyqxmd.com/read/28096730/methodology-for-developing-evidence-based-clinical-imaging-guidelines-joint-recommendations-by-korean-society-of-radiology-and-national-evidence-based-healthcare-collaborating-agency
#1
REVIEW
Sol Ji Choi, Woo Kyoung Jeong, Ae Jeong Jo, Jin A Choi, Min-Jeong Kim, Min Lee, Seung Eun Jung, Kyung Hyun Do, Hwan Seok Yong, Seungsoo Sheen, Miyoung Choi, Jung Hwan Baek
This paper is a summary of the methodology including protocol used to develop evidence-based clinical imaging guidelines (CIGs) in Korea, led by the Korean Society of Radiology and the National Evidence-based Healthcare Collaborating Agency. This is the first protocol to reflect the process of developing diagnostic guidelines in Korea. The development protocol is largely divided into the following sections: set-up, process of adaptation, and finalization. The working group is composed of clinical imaging experts, and the developmental committee is composed of multidisciplinary experts to validate the methodology...
January 2017: Korean Journal of Radiology: Official Journal of the Korean Radiological Society
https://www.readbyqxmd.com/read/28096715/radiology-consultation-in-the-era-of-precision-oncology-a-review-of-consultation-models-and-services-in-the-tertiary-setting
#2
REVIEW
Pamela J DiPiro, Katherine M Krajewski, Angela A Giardino, Marta Braschi-Amirfarzan, Nikhil H Ramaiya
The purpose of the article is to describe the various radiology consultation models in the Era of Precision Medicine. Since the inception of our specialty, radiologists have served as consultants to physicians of various disciplines. A variety of radiology consultation services have been described in the literature, including clinical decision support, patient-centric, subspecialty interpretation, and/or some combination of these. In oncology care in particular, case complexity often merits open dialogue with clinical providers...
January 2017: Korean Journal of Radiology: Official Journal of the Korean Radiological Society
https://www.readbyqxmd.com/read/28096695/hysterosalpingo-foam-sonography-patient-selection-and-perspectives
#3
REVIEW
Hemashree Rajesh, Serene Liqing Lim, Su Ling Yu
We present an overview of the common types of tubal patency tests, with a focus on hysterosalpingo-foam sonography (HyFoSy). Current evidence suggests that HyFoSy is an accurate alternative to X-ray hysterosalpingography (HSG) for outpatient tubal evaluation in women who are at low risk for tubal disease. It may be superior to saline hysterosalpingo-contrast sonography (HyCoSy) in excluding tubal occlusion. A hyperechogenic medium may enhance contrast visualization and enable clearer delineation of tubal anatomy...
2017: International Journal of Women's Health
https://www.readbyqxmd.com/read/28096230/haemodialysis-in-acute-paracetamol-poisoning
#4
L Serjeant, J Evans, F Sampaziotis, W G Petchey
A woman aged 23 years presented late with clinical and biochemical features of a life-threatening paracetamol (acetaminophen) overdose. Despite instigating N-acetylcysteine treatment, due to evidence of mitochondrial dysfunction together with an exceedingly high paracetamol level, the decision was made to dialyse the patient acutely to remove the parent drug. This was highly effective, and with on-going supportive care, the patient made a full recovery without the need for transplantation. This case highlights the role of extracorporeal therapy as a treatment option in selected cases of paracetamol overdose, consistent with the international guidelines...
January 17, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28095934/the-effect-of-ambulance-staffing-models-in-a-metropolitan-fire-based-ems-system
#5
Eric J Cortez, Ashish R Panchal, James E Davis, David P Keseg
: Introduction The staffing of ambulances with different levels of Emergency Medical Service (EMS) providers is a difficult decision with evidence being mixed on the benefit of each model. Hypothesis/Problem The objective of this study was to describe a pilot program evaluating alternative staffing on two ambulances utilizing the paramedic-basic (PB) model (staffed with one paramedic and one emergency medical technician[EMT]). METHODS: This was a retrospective study conducted from September 17, 2013 through December 31, 2013...
January 18, 2017: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/28095826/non-invasive-respiratory-support-for-infants-with-bronchiolitis-a-national-survey-of-practice
#6
H Turnham, R S Agbeko, J Furness, J Pappachan, A G Sutcliffe, P Ramnarayan
BACKGROUND: Bronchiolitis is a common respiratory illness of early childhood. For most children it is a mild self-limiting disease but a small number of children develop respiratory failure. Nasal continuous positive airway pressure (nCPAP) has traditionally been used to provide non-invasive respiratory support in these children, but there is little clinical trial evidence to support its use. More recently, high-flow nasal cannula therapy (HFNC) has emerged as a novel respiratory support modality...
January 17, 2017: BMC Pediatrics
https://www.readbyqxmd.com/read/28094591/algo-used-by-homecare-nonoccupational-therapists-selecting-bathing-assistive-technology-enhancing-standardization-by-exploring-clinical-reasoning
#7
Mélanie Ruest, Annick Bourget, Nathalie Delli-Colli, Manon Guay
Algo is a clinical decision algorithm developed to support nonoccupational therapists in establishing assistive technology recommendations to enable physically disabled adults to perform their hygiene at home. This study aimed to explore the in-depth clinical reasoning of nonoccupational therapists using Algo to pinpoint the items leading to disagreements regarding recommendations. A multiple-case study was conducted with eight nonoccupational therapists trained to use Algo and filmed while using it with six standardized clients...
January 17, 2017: Occupational Therapy in Health Care
https://www.readbyqxmd.com/read/28093637/exploring-differences-in-adverse-symptom-event-grading-thresholds-between-clinicians-and-patients-in-the-clinical-trial-setting
#8
Thomas M Atkinson, Lauren J Rogak, Narre Heon, Sean J Ryan, Mary Shaw, Liora P Stark, Antonia V Bennett, Ethan Basch, Yuelin Li
PURPOSE: Symptomatic adverse event (AE) monitoring is essential in cancer clinical trials to assess patient safety, as well as inform decisions related to treatment and continued trial participation. As prior research has demonstrated that conventional concordance metrics (e.g., intraclass correlation) may not capture nuanced aspects of the association between clinician and patient-graded AEs, we aimed to characterize differences in AE grading thresholds between doctors (MDs), registered nurses (RNs), and patients using the Bayesian Graded Item Response Model (GRM)...
January 16, 2017: Journal of Cancer Research and Clinical Oncology
https://www.readbyqxmd.com/read/28093430/development-and-validation-of-a-prediction-model-for-gestational-hypertension-in-a-ghanaian-cohort
#9
Edward Antwi, Rolf H H Groenwold, Joyce L Browne, Arie Franx, Irene A Agyepong, Kwadwo A Koram, Kerstin Klipstein-Grobusch, Diederick E Grobbee
OBJECTIVE: To develop and validate a prediction model for identifying women at increased risk of developing gestational hypertension (GH) in Ghana. DESIGN: A prospective study. We used frequencies for descriptive analysis, χ(2) test for associations and logistic regression to derive the prediction model. Discrimination was estimated by the c-statistic. Calibration was assessed by calibration plot of actual versus predicted probability. SETTING: Primary care antenatal clinics in Ghana...
January 16, 2017: BMJ Open
https://www.readbyqxmd.com/read/28092685/precision-oncology-for-acute-myeloid-leukemia-using-a-knowledge-bank-approach
#10
Moritz Gerstung, Elli Papaemmanuil, Inigo Martincorena, Lars Bullinger, Verena I Gaidzik, Peter Paschka, Michael Heuser, Felicitas Thol, Niccolo Bolli, Peter Ganly, Arnold Ganser, Ultan McDermott, Konstanze Döhner, Richard F Schlenk, Hartmut Döhner, Peter J Campbell
Underpinning the vision of precision medicine is the concept that causative mutations in a patient's cancer drive its biology and, by extension, its clinical features and treatment response. However, considerable between-patient heterogeneity in driver mutations complicates evidence-based personalization of cancer care. Here, by reanalyzing data from 1,540 patients with acute myeloid leukemia (AML), we explore how large knowledge banks of matched genomic-clinical data can support clinical decision-making. Inclusive, multistage statistical models accurately predicted likelihoods of remission, relapse and mortality, which were validated using data from independent patients in The Cancer Genome Atlas...
January 16, 2017: Nature Genetics
https://www.readbyqxmd.com/read/28092195/serum-bdnf-levels-in-patients-with-gambling-disorder-are-associated-with-the-severity-of-gambling-disorder-and-iowa-gambling-task-indices
#11
Sam-Wook Choi, Young-Chul Shin, Jung Yeon Mok, Dai-Jin Kim, Jung-Seok Choi, Samuel Suk-Hyun Hwang
Background and aims Gambling disorder (GD) shares many similarities with substance use disorders (SUDs) in clinical, neurobiological, and neurocognitive features, including decision-making. We evaluated the relationships among, GD, decision-making, and brain-derived neurotrophic factor (BDNF), as measured by serum BDNF levels. Methods Twenty-one male patients with GD and 21 healthy sex- and age-matched control subjects were evaluated for associations between serum BDNF levels and the Problem Gambling Severity Index (PGSI), as well as between serum BDNF levels and Iowa Gambling Task (IGT) indices...
March 2016: Journal of Behavioral Addictions
https://www.readbyqxmd.com/read/28091867/arterial-aortic-stiffness-in-patients-with-resistant-hypertension-from-assessment-to-treatment
#12
REVIEW
James E Sharman, Pierre Boutouyrie, Stéphane Laurent
PURPOSE OF REVIEW: The purpose of the review is to examine whether measurement of aortic stiffness could be especially value-adding for risk stratification and treatment among patients with resistant hypertension (RH). RECENT FINDINGS: Adverse arterial remodeling and increased aortic stiffness is associated with RH, and it may be of additional clinical benefit to measure aortic stiffness in these patients. However, there is insufficient evidence to determine whether aortic stiffness is excessively high relative to the level of blood pressure (BP) among people with RH...
January 2017: Current Hypertension Reports
https://www.readbyqxmd.com/read/28090403/a-review-of-the-relationship-of-atrial-fibrillation-and-acute-coronary-syndrome
#13
Bory Kea, Tahroma Alligood, Vincent Manning, Merritt Raitt
Atrial fibrillation (AF) is the most common arrhythmia encountered by clinicians. Clinical decision-making focuses on reducing ischemic stroke risk in AF patients; however, AF is also associated with an increased risk of acute coronary syndromes (ACS). Patients with ACS and concurrent AF are less likely to receive appropriate therapies and more likely to experience adverse outcomes than ACS patients in sinus rhythm (SR). Clinicians may be able to stratify ACS patients at increased risk of AF development based on clinical characteristics...
September 2016: Current Emergency and Hospital Medicine Reports
https://www.readbyqxmd.com/read/28090159/transition-from-paper-to-computerized-pharmacist-clinical-decision-support
#14
Albert D Stewart
No abstract text is available yet for this article.
January 2017: P & T: a Peer-reviewed Journal for Formulary Management
https://www.readbyqxmd.com/read/28089913/physicians-perception-of-alternative-displays-of-clinical-research-evidence-for-clinical-decision-support-a-study-with-case-vignettes
#15
Stacey L Slager, Charlene R Weir, Heejun Kim, Javed Mostafa, Guilherme Del Fiol
OBJECTIVE: To design alternate information displays that present summaries of clinical trial results to clinicians to support decision-making; and to compare the displays according to efficacy and acceptability. METHODS: A 6-between (information display presentation order) by 3-within (display type) factorial design. Two alternate displays were designed based on Information Foraging theory: a narrative summary that reduces the content to a few sentences; and a table format that structures the display according to the PICO (Population, Intervention, Comparison, Outcome) framework...
January 13, 2017: Journal of Biomedical Informatics
https://www.readbyqxmd.com/read/28089673/the-value-of-participatory-development-to-support-antimicrobial-stewardship-with-a-clinical-decision-support-system
#16
Nienke Beerlage-de Jong, Jobke Wentzel, Ron Hendrix, Lisette van Gemert-Pijnen
BACKGROUND: Current clinical decision support systems (CDSSs) for antimicrobial stewardship programs (ASPs) are guideline- or expert-driven. They are focused on (clinical) content, not on supporting real-time workflow. Thus, CDSSs fail to optimally support prudent antimicrobial prescribing in daily practice. Our aim was to demonstrate why and how participatory development (involving end-users and other stakeholders) can contribute to the success of CDSSs in ASPs. METHODS: A mixed-methods approach was applied, combining scenario-based prototype evaluations (to support verbalization of work processes and out-of-the-box thinking) among 6 medical resident physicians with an online questionnaire (to cross-reference findings of the prototype evaluations) among 54 Dutch physicians...
January 12, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28089501/effectiveness-of-conventional-disease-modifying-antirheumatic-drugs-in-psoriatic-arthritis-a-systematic-review
#17
Jesús Maese, Petra Díaz Del Campo, Daniel Seoane-Mato, Mercedes Guerra, Juan D Cañete
BACKGROUND: Due to the clinical heterogeneity of psoriatic arthritis (PsA), recommendations have been developed by international groups to guide therapeutic decisions of the rheumatologist. The objective of the current systematic review (RS) was to evaluate the evidence of efficacy of disease-modifying antirheumatic drugs (DMARDs) in PsA. METHODS: Literature search in Medline, EMBASE, Cochrane Library, from 2008 to 2014. We included RS, randomized clinical trials and observational studies, in patients with PsA and an evaluation of efficiency of conventional DMARDs (methotrexate, sulfasalazine, leflunomide), according to the following outcomes: peripheral and axial symptoms; peripheral radiological damage; enthesitis according to power Doppler ultrasound or magnetic resonance imaging (enthesitis count before and after therapy); dactylitis; uveitis...
January 12, 2017: Reumatología Clinica
https://www.readbyqxmd.com/read/28088774/association-between-e-alert-implementation-for-detection-of-acute-kidney-injury-and-outcomes-a-systematic-review
#18
Philippe Lachance, Pierre-Marc Villeneuve, Oleksa G Rewa, Francis P Wilson, Nicholas M Selby, Robin M Featherstone, Sean M Bagshaw
BACKGROUND: Electronic alerts (e-alerts) for acute kidney injury (AKI) in hospitalized patients are increasingly being implemented; however, their impact on outcomes remains uncertain. METHODS: We performed a systematic review. Electronic databases and grey literature were searched for original studies published between 1990 and 2016. Randomized, quasi-randomized, observational and before-and-after studies that included hospitalized patients, implemented e-alerts for AKI and described their impact on one of care processes, patient-centred outcomes or resource utilization measures were included...
January 14, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28088171/assessing-the-sustainability-of-daily-chlorhexidine-bathing-in-the-intensive-care-unit-of-a-veteran-s-hospital-by-examining-nurses-perspectives-and-experiences
#19
Jackson S Musuuza, Tonya J Roberts, Pascale Carayon, Nasia Safdar
BACKGROUND: Daily bathing with chlorhexidine gluconate (CHG) of intensive care unit (ICU) patients has been shown to reduce healthcare-associated infections and colonization by multidrug resistant organisms. The objective of this project was to describe the process of daily CHG bathing and identify the barriers and facilitators that can influence its successful adoption and sustainability in an ICU of a Veterans Administration Hospital. METHODS: We conducted 26 semi-structured interviews with a convenience sample of 4 nurse managers (NMs), 13 registered nurses (RNs) and 9 health care technicians (HCTs) working in the ICU...
January 14, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/28088009/cardiac-output-and-systemic-vascular-resistance-clinical-assessment-compared-with-a-noninvasive-objective-measurement-in-children-with-shock
#20
Asma Razavi, Christopher J L Newth, Robinder G Khemani, Fernando Beltramo, Patrick A Ross
PURPOSE: To evaluate physician assessment of cardiac output and systemic vascular resistance in patients with shock compared with an ultrasonic cardiac output monitor (USCOM). To explore potential changes in therapy decisions if USCOM data were available using physician intervention answers. STUDY DESIGN: Double-blinded, prospective, observational study in a tertiary hospital pediatric intensive care unit. Forty children (<18years) admitted with shock, requiring ongoing volume resuscitation or inotropic support...
December 28, 2016: Journal of Critical Care
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