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Clinical Decision Support

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https://www.readbyqxmd.com/read/29166411/a-machine-learning-approach-to-triaging-patients-with-chronic-obstructive-pulmonary-disease
#1
Sumanth Swaminathan, Klajdi Qirko, Ted Smith, Ethan Corcoran, Nicholas G Wysham, Gaurav Bazaz, George Kappel, Anthony N Gerber
COPD patients are burdened with a daily risk of acute exacerbation and loss of control, which could be mitigated by effective, on-demand decision support tools. In this study, we present a machine learning-based strategy for early detection of exacerbations and subsequent triage. Our application uses physician opinion in a statistically and clinically comprehensive set of patient cases to train a supervised prediction algorithm. The accuracy of the model is assessed against a panel of physicians each triaging identical cases in a representative patient validation set...
2017: PloS One
https://www.readbyqxmd.com/read/29166151/biomarkers-and-imaging-of-breast-cancer
#2
Olena Weaver, Jessica W T Leung
OBJECTIVE: The goals of this review are to provide background information on the definitions and applications of the general term "biomarker" and to highlight the specific roles of breast imaging biomarkers in research and clinical breast cancer care. A search was conducted of the main electronic biomedical databases (PubMed, Cochrane, Embase, MEDLINE [Ovid], Scopus, and Web of Science). The search was focused on review literature in general radiology and biomedical sciences and on reviews and primary research articles on biomarkers in breast imaging over the 15 years ending in June 2017...
November 22, 2017: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/29165790/physician-interpretation-of-genomic-test-results-and-treatment-selection
#3
Lauren L Brusco, Chetna Wathoo, Kenna R Mills Shaw, Vijaykumar R Holla, Ann M Bailey, Amber M Johnson, Yekaterina B Khotskaya, Beate C Litzenburger, Nora S Sanchez, Jia Zeng, Elmer V Bernstam, Cathy Eng, Bryan K Kee, Rodabe N Amaria, Mark J Routbort, Gordon B Mills, John Mendelsohn, Funda Meric-Bernstam
BACKGROUND: Genomic testing is increasingly performed in oncology, but concerns remain regarding the clinician's ability to interpret results. In the current study, the authors sought to determine the agreement between physicians and genomic annotators from the Precision Oncology Decision Support (PODS) team at The University of Texas MD Anderson Cancer Center in Houston regarding actionability and the clinical use of test results. METHODS: On a prospective protocol, patients underwent clinical genomic testing for hotspot mutations in 46 or 50 genes...
November 22, 2017: Cancer
https://www.readbyqxmd.com/read/29165616/work-system-assessment-to-facilitate-the-dissemination-of-a-quality-improvement-program-for-optimizing-blood-culture-use-a-case-study-using-a-human-factors-engineering-approach
#4
Anping Xie, Charlotte Z Woods-Hill, Anne F King, Heather Enos-Graves, Judy Ascenzi, Ayse P Gurses, Sybil A Klaus, James C Fackler, Aaron M Milstone
Background: Work system assessments can facilitate successful implementation of quality improvement programs. Using a human factors engineering approach, we conducted a work system assessment to facilitate the dissemination of a quality improvement program for optimizing blood culture use in pediatric intensive care units at 2 hospitals. Methods: Semistructured face-to-face interviews were conducted with clinicians from Johns Hopkins All Children's Hospital and University of Virginia Medical Center...
November 20, 2017: Journal of the Pediatric Infectious Diseases Society
https://www.readbyqxmd.com/read/29164029/a-clinical-practice-guideline-for-the-management-of-patients-with-acute-spinal-cord-injury-recommendations-on-the-type-and-timing-of-rehabilitation
#5
Michael G Fehlings, Lindsay A Tetreault, Bizhan Aarabi, Paul Anderson, Paul M Arnold, Darrel S Brodke, Kazuhiro Chiba, Joseph R Dettori, Julio C Furlan, James S Harrop, Gregory Hawryluk, Langston T Holly, Susan Howley, Tara Jeji, Sukhvinder Kalsi-Ryan, Mark Kotter, Shekar Kurpad, Brian K Kwon, Ralph J Marino, Allan R Martin, Eric Massicotte, Geno Merli, James W Middleton, Hiroaki Nakashima, Narihito Nagoshi, Katherine Palmieri, Anoushka Singh, Andrea C Skelly, Eve C Tsai, Alexander Vaccaro, Jefferson R Wilson, Albert Yee, Anthony S Burns
Introduction: The objective of this study is to develop guidelines that outline the appropriate type and timing of rehabilitation in patients with acute spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions related to rehabilitation in patients with acute SCI. A multidisciplinary guideline development group used this information, and their clinical expertise, to develop recommendations for the type and timing of rehabilitation...
September 2017: Global Spine Journal
https://www.readbyqxmd.com/read/29163069/notes-on-the-recent-history-of-neuroscience-in-africa
#6
REVIEW
Vivienne A Russell
Neuroscience began with neuroanatomy and neurosurgery in Egypt more than 5000 years ago. Knowledge grew over time and specialized neurosurgery centers were established in north Africa in the eleventh century. However, it was not until the twentieth century that neuroscience research became established in sub-Saharan Africa. In most African countries, clinical research focused on understanding the rationale and improving treatment of epilepsy, infections, nutritional neuropathies, stroke and tumors. Significant advances were made...
2017: Frontiers in Neuroanatomy
https://www.readbyqxmd.com/read/29162557/self-management-and-clinical-decision-support-for-patients-with-complex-chronic-conditions-through-the-use-of-smartphone-based-telemonitoring-randomized-controlled-trial-protocol
#7
Emily Seto, Patrick Ware, Alexander G Logan, Joseph A Cafazzo, Kenneth R Chapman, Phillip Segal, Heather J Ross
BACKGROUND: The rising prevalence of chronic illnesses hinders the sustainability of the health care system because of the high cost of frequent hospitalizations of patients with complex chronic conditions. Clinical trials have demonstrated that telemonitoring can improve health outcomes, but they have generally been limited to single conditions such as diabetes, hypertension, or heart failure. Few studies have examined the impact of telemonitoring on complex patients with multiple chronic conditions, although these patients may benefit the most from this technology...
November 21, 2017: JMIR Research Protocols
https://www.readbyqxmd.com/read/29162279/clinical-decision-support-of-radiotherapy-treatment-planning-a-data-driven-machine-learning-strategy-for-patient-specific-dosimetric-decision-making
#8
Gilmer Valdes, Charles B Simone, Josephine Chen, Alexander Lin, Sue S Yom, Adam J Pattison, Colin M Carpenter, Timothy D Solberg
BACKGROUND AND PURPOSE: Clinical decision support systems are a growing class of tools with the potential to impact healthcare. This study investigates the construction of a decision support system through which clinicians can efficiently identify which previously approved historical treatment plans are achievable for a new patient to aid in selection of therapy. MATERIAL AND METHODS: Treatment data were collected for early-stage lung and postoperative oropharyngeal cancers treated using photon (lung and head and neck) and proton (head and neck) radiotherapy...
November 18, 2017: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
https://www.readbyqxmd.com/read/29162047/treatment-recommendations-within-the-leeway-of-clinical-guidelines-a-qualitative-interview-study-on-oncologists-clinical-deliberation
#9
I Otte, S Salloch, A Reinacher-Schick, J Vollmann
BACKGROUND: Recommending the optimal treatment for an individual patient requires a well-balanced consideration of various medical, social and ethical factors. The interplay of these factors, interpretation of the patient's situation and understanding of the existing clinical guidelines can lead to divergent therapy recommendations, depending on the attending physician. Gaining a better understanding of the individual process of medical decision-making and the differences occurring will support the delivery of optimal individualized care within the clinical setting...
November 21, 2017: BMC Cancer
https://www.readbyqxmd.com/read/29161399/global-lessons-developing-military-trauma-care-and-lessons-for-civilian-practice
#10
T Woolley, J A Round, M Ingram
The wars in Iraq and Afghanistan have helped to shape the modern Defence Medical Services. Many lessons were learnt including the need for rapid haemorrhage control, senior decision-making and the evolution of deployed transfusion support. These changes were implemented simultaneously with a coherent, end-to-end medical plan from point of wounding through to rehabilitation. Implementation of the medical plan is harmonious with the NHS trauma pathway, and is key to ensuring effective delivery. Military anaesthetists have a long pre-deployment training pathway starting with a Certificate of Completion of Training (CCT) in anaesthesia and/or critical care, and with an emphasis on military skills related to their specific role...
December 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29161173/a-relational-ethics-framework-for-advancing-practice-with-children-with-complex-health-care-needs-and-their-parents
#11
Franco A Carnevale, Gail Teachman, Aline Bogossian
Children with complex health care needs are an emerging population that commonly requires long-term supportive services. A growing body of evidence has highlighted that these children and their families experience significant challenges. Many of these challenges involve ethical concerns that have been under-recognized. In this article, we (a) outline ethical concerns that arise in clinical practice with children with complex health care needs and their families (e.g.: exclusion of children's voices in discussions and decisions that affect them; difficulties in defining their best interests; clashes across the array of social roles that parents manage; limited recognition of the ethical significance of parents' and other family members' interests) and (b) propose a relational ethics framework for addressing these concerns...
November 21, 2017: Compr Child Adolesc Nurs
https://www.readbyqxmd.com/read/29159743/morbidity-and-outcomes-following-axillary-lymphadenectomy-for-melanoma-weighing-the-risk-of-surgery-in-the-era-of-mslt-ii
#12
Lauren M Postlewait, Clara R Farley, Alexandra M Seamens, Nina Le, Monica Rizzo, Maria C Russell, Michael C Lowe, Keith A Delman
BACKGROUND: Limited data exist characterizing complications after axillary lymphadenectomy for melanoma. With high rates of complications reported after dissection for breast cancer and data suggesting that completion lymphadenectomy may have limited therapeutic benefit, this study characterized morbidity to facilitate clinical decision-making. METHODS: Using a broad definition for complications, patients who underwent axillary dissection for melanoma at a single center (from 2003 to 2015) were assessed through retrospective chart review...
November 20, 2017: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/29159541/automated-detection-of-exudative-age-related-macular-degeneration-in-spectral-domain-optical-coherence-tomography-using-deep-learning
#13
Maximilian Treder, Jost Lennart Lauermann, Nicole Eter
PURPOSE: Our purpose was to use deep learning for the automated detection of age-related macular degeneration (AMD) in spectral domain optical coherence tomography (SD-OCT). METHODS: A total of 1112 cross-section SD-OCT images of patients with exudative AMD and a healthy control group were used for this study. In the first step, an open-source multi-layer deep convolutional neural network (DCNN), which was pretrained with 1.2 million images from ImageNet, was trained and validated with 1012 cross-section SD-OCT scans (AMD: 701; healthy: 311)...
November 20, 2017: Graefe's Archive for Clinical and Experimental Ophthalmology
https://www.readbyqxmd.com/read/29159491/-algorithm-for-securing-an-unexpected-difficult-airway-user-analysis-on-a-simulator
#14
T Ott, K Truschinski, M Kriege, M Naß, S Herrmann, V Ott, S Sellin
BACKGROUND: Critical incidents in difficult airway management are still a main contributory factor for perioperative morbidity and mortality. Many national associations have developed algorithms for management of these time critical events. For implementation of these algorithms the provision of technical requirements and procedure-related training are essential. Severe airway incidents are rare events and clinical experience of the individual operators is limited; therefore, simulation is an adequate instrument for training and evaluating difficult airway algorithms...
November 20, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29159410/use-of-health-care-databases-to-support-supplemental-indications-of-approved-medications
#15
Michael Fralick, Aaron S Kesselheim, Jerry Avorn, Sebastian Schneeweiss
Importance: Manufacturers of US Food and Drug Administration-approved prescription drugs often apply for additional indications based on randomized clinical trials. Real-world database analyses on a medication's use and outcomes in routine settings of care might help to inform decision making regarding such supplemental indications. Objective: To examine whether longitudinal data from a health care database can support the results of a randomized clinical trial that led to a supplemental indication for telmisartan...
November 20, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/29158574/immunogenicity-and-loss-of-response-to-tnf-inhibitors-implications-for-rheumatoid-arthritis-treatment
#16
REVIEW
Joachim R Kalden, Hendrik Schulze-Koops
The availability of monoclonal antibodies has revolutionized the treatment of an increasingly broad spectrum of diseases. Inflammatory diseases are among those most widely treated with protein-based therapeutics, termed biologics. Following the first large-scale clinical trials with monoclonal antibodies performed in the 1990s by rheumatologists and clinical immunologists, the approval of these agents for use in daily clinical practice led to substantial progress in the treatment of rheumatic diseases. Despite this progress, however, only a proportion of patients achieve a long-term clinical response...
November 21, 2017: Nature Reviews. Rheumatology
https://www.readbyqxmd.com/read/29156999/risk-factors-for-intracranial-lesions-and-mortality-in-older-patients-with-mild-traumatic-brain-injuries
#17
Ma Angustias Ibañez Pérez De La Blanca, Enrique Fernández Mondéjar, Francisco Javier Gómez Jimènez, Jóse María Alonso Morales, Ma Dolores Quijano Lombardo, Juan Luis Viso Rodriguez
PRIMARY OBJECTIVE: To identify risk factors for intracerebral lesion (ICL) in older adults with mild traumatic brain injury (MTBI) and evaluate the influence of comorbidities on outcomes. RESEARCH DESIGN: Prospective cohort study. METHODS AND PROCEDURES: Information was gathered on clinical history/examination, cranial computed tomography, admission Glasgow Coma Scale (GCS) score, analytical and coagulation findings, and mortality at 1 week post-discharge...
November 20, 2017: Brain Injury: [BI]
https://www.readbyqxmd.com/read/29156536/a-review-on-exudates-detection-methods-for-diabetic-retinopathy
#18
REVIEW
Shilpa Joshi, P T Karule
The presence of exudates on the retina is the most characteristic symptom of diabetic retinopathy. As exudates are among early clinical signs of DR, their detection would be an essential asset to the mass screening task and serve as an important step towards automatic grading and monitoring of the disease. Reliable identification and classification of exudates are of inherent interest in an automated diabetic retinopathy screening system. Here we review the numerous early studies that used for automatic exudates detection with the aim of providing decision support in addition to reducing the workload of an ophthalmologist...
November 16, 2017: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
https://www.readbyqxmd.com/read/29152294/awake-tracheotomy-in-a-patient-with-stridor-and-dyspnoea-caused-by-a-sizeable-malignant-thyroid-tumor-a-case-report-and-short-review-of-the-literature
#19
Andreas Hohn, Tālis Kauliņš, Jochen Hinkelbein, Krista Kauliņa, Andreas Kopp, Sebastian G Russo, Sigurd Kohlen, Stefan Schröder
Individual airway management is mandatory in patients with large goiters undergoing thyroid surgery. Preoperative endoscopic airway evaluation and imaging studies can support clinical decision making. Awake tracheotomy can be an effective and reasonable airway management strategy in such patients.
November 2017: Clinical Case Reports
https://www.readbyqxmd.com/read/29151026/regional-validation-and-recalibration-of-clinical-predictive-models-for-patients-with-acute-heart-failure
#20
Benjamin S Wessler, Robin Ruthazer, James E Udelson, Mihai Gheorghiade, Faiez Zannad, Aldo Maggioni, Marvin A Konstam, David M Kent
BACKGROUND: Heart failure clinical practice guidelines recommend applying validated clinical predictive models (CPMs) to support decision making. While CPMs are now widely available, the generalizability of heart failure CPMs is largely unknown. METHODS AND RESULTS: We identified CPMs derived in North America that predict mortality for patients with acute heart failure and validated these models in different world regions to assess performance in a contemporary international clinical trial (N=4133) of patients with acute heart failure treated with guideline-directed medical therapy...
November 18, 2017: Journal of the American Heart Association
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