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Clinical decision making

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https://www.readbyqxmd.com/read/28535563/the-effectiveness-and-safety-of-selective-lumbar-decompression-in-diagnostic-doubt-patients-a-retrospective-control-study
#1
Li Xiaochuan, Cheng-Fan Zhong, Jian-Hua Tang, Rong-Wei Liang, Shao-Jian Luo, Chun-Ming Huang
BACKGROUND: Our previous study demonstrated that selective nerve root block (SNRB) can influence decision-making in lumbar surgery by guiding the selection of nerve roots targeted for decompression in diagnostic doubt patients (DDPs). However, further studies were needed to determine whether this selective decompression (SD) procedure would result in similar clinical outcomes and reduce the perioperative parameters and postoperative complications as compared to the non-selective decompression (NSD) procedure...
May 2017: Pain Physician
https://www.readbyqxmd.com/read/28535552/stem-cell-therapy-for-chronic-pain-management-review-of-uses-advances-and-adverse-effects
#2
Krishnan Chakravarthy, Yian Chen, Cathy He, Paul J Christo
BACKGROUND: This review article outlines the recent advances, uses, and adverse effects of cell-based therapy for chronic pain management. Cell based therapies are gaining increasing ground as novel treatment modalities for a variety of pain pathologies that include, but are not limited to, neuropathic pain and degenerative disc disease. As these treatment modalities become more common practice, we have focused our review to provide pain practitioners and other practicing physicians an understanding of the technology and to summarize key clinical data and existing clinical trials that are being pursued by clinical investigators worldwide...
May 2017: Pain Physician
https://www.readbyqxmd.com/read/28535272/measures-of-financial-capacity-a-review
#3
Angela R Ghesquiere, Caitlin McAfee, Jason Burnett
Purpose of the Study: Capacity to manage finances and make financial decisions can affect risk for financial exploitation and is often the basis for legal determinations of conservatorship/guardianship. Several structured assessments of financial capacity have been developed, but have not been compared regarding their focus, validity, or reliability. Therefore, we conducted a review of financial capacity measures to examine these factors. Design and Methods: We searched electronic databases, reference lists in identified articles, conference proceedings and other grey literature for measures of financial capacity...
May 23, 2017: Gerontologist
https://www.readbyqxmd.com/read/28535106/value-tools-in-managed-care-decision-making-current-hurdles-and-future-opportunities
#4
Jeremy Schafer, Dominic Galante, Jason Shafrin
BACKGROUND: Organizations such as the National Comprehensive Cancer Network, American Society of Clinical Oncology, Institute for Clinical and Economic Review, and Memorial Sloan Kettering have created distinct tools to help different stakeholders assess the value of oncology treatments. However, the oncology value tools were not necessarily created for payers, and it is unclear whether payers are using these tools as part of their drug management process. OBJECTIVE: To understand what value tools payers are using in oncology management and what benefits and shortcomings the tools may have from the payer perspective...
June 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28535105/the-importance-of-economic-perspective-and-quantitative-approaches-in-oncology-value-frameworks-of-drug-selection-and-shared-decision-making
#5
A Reginald Waldeck, Marc F Botteman, Richard E White, Ben A van Hout
The debate around value in oncology drug selection has been prominent in recent years, and several professional bodies have furthered this debate by advocating for so-called value frameworks. Herein, we provide a viewpoint on these value frameworks, emphasizing the need to consider 4 key aspects: (1) the economic underpinnings of value; (2) the importance of the perspective adopted in the valuation; (3) the importance of the difference between absolute and relative measures of risk and measuring patient preferences; and (4) the recognition of multiple quality-of-life (QoL) domains, and the aggregation and valuation of those domains, through utilities within a multicriteria decision analysis, may allow prioritization of QoL above the tallying of safety events, particularly in a value framework focusing on the individual patient...
June 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28535104/measuring-the-value-of-new-drugs-validity-and-reliability-of-4-value-assessment-frameworks-in-the-oncology-setting
#6
Tanya G K Bentley, Joshua T Cohen, Elena B Elkin, Julie Huynh, Arnab Mukherjea, Thanh H Neville, Matthew Mei, Ronda Copher, Russell Knoth, Ioana Popescu, Jackie Lee, Jenelle M Zambrano, Michael S Broder
BACKGROUND: Several organizations have developed frameworks to systematically assess the value of new drugs. OBJECTIVE: To evaluate the convergent validity and interrater reliability of 4 value frameworks to understand the extent to which these tools can facilitate value-based treatment decisions in oncology. METHODS: Eight panelists used the American Society of Clinical Oncology (ASCO), European Society for Medical Oncology (ESMO), Institute for Clinical and Economic Review (ICER), and National Comprehensive Cancer Network (NCCN) frameworks to conduct value assessments of 15 drugs for advanced lung and breast cancers and castration-refractory prostate cancer...
June 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28535103/value-frameworks-for-the-patient-provider-interaction-a-comparison-of-the-asco-value-framework-versus-nccn-evidence-blocks-in-determining-value-in-oncology
#7
Bijal Shah-Manek, Joseph S Galanto, Huong Nguyen, Robert Ignoffo
BACKGROUND: To address the rising concern about oncology drug costs, the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) recently developed unique tools to help providers and patients make informed decisions about the value of an anticancer regimen. The ASCO Value Framework (AVF) allows users to generate a net health benefit (NHB) score along with drug acquisition costs for oncology regimens that have been compared in a prospective randomized clinical trial...
June 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28535102/why-value-framework-assessments-arrive-at-different-conclusions-a-multiple-myeloma-case-study
#8
Kimberly Westrich, Lisabeth Buelt, Robert W Dubois
As the United States transitions from a volume-based health care system to one that rewards value, new frameworks are emerging to help patients, providers, and payers assess the value of medical services and biopharmaceutical products. These value assessment frameworks are intended to support various types of health care decision making. They have the potential to substantially affect patients, whether as tools for shared decision making with their doctors, as an input to care pathways used by providers, or through payer use of the frameworks to make coverage or reimbursement decisions...
June 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28534892/minimizing-next-generation-sequencing-errors-for-hiv-drug-resistance-testing
#9
José A Fernández-Caballero, Natalia Chueca, Eva Poveda, Federico García
Next-generation sequencing prototypes for the routine diagnosis of resistance to antiretrovirals approved for the treatment of HIV infection are now being used in many clinical diagnostic laboratories. As some of the next-generation sequencing platforms may be a source of errors, it is necessary to improve the currently available protocols and implement bioinformatic tools that may help to correctly identify the presence of resistance mutations with clinical impact. Several studies have addressed these issues in recent years...
May 23, 2017: AIDS Reviews
https://www.readbyqxmd.com/read/28534706/analyses-of-thrombi-in-acute-ischemic-stroke-a-consensus-statement-on-current-knowledge-and-future-directions
#10
Simon F De Meyer, Tommy Andersson, Blaise Baxter, Martin Bendszus, Patrick Brouwer, Waleed Brinjikji, Bruce Cv Campbell, Vincent Costalat, Antoni Dávalos, Andrew Demchuk, Diederik Dippel, Jens Fiehler, Urs Fischer, Michael Gilvarry, Matthew J Gounis, Jan Gralla, Olav Jansen, Tudor Jovin, David Kallmes, Pooja Khatri, Kennedy R Lees, Elena López-Cancio, Charles Majoie, Henk Marquering, Ana Paula Narata, Raul Nogueira, Peter Ringleb, Adnan Siddiqui, István Szikora, David Vale, Rüdiger von Kummer, Albert J Yoo, Werner Hacke, David S Liebeskind
Limited data exist on clot composition and detailed characteristics of arterial thrombi associated with large vessel occlusion in acute ischemic stroke. Advances in endovascular thrombectomy and related imaging modalities have created a unique opportunity to analyze thrombi removed from cerebral arteries. Insights into thrombus composition, etiology, physical properties and neurovascular interactions may lead to future advancements in acute ischemic stroke treatment and improved clinical outcomes. Advances in imaging techniques may enhance clot characterization and inform therapeutic decision-making prior to treatment and reveal stroke etiology to guide secondary prevention...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28534681/referral-of-older-thyroid-cancer-patients-to-a-high-volume-surgeon-results-of-a-multidisciplinary-physician-survey
#11
Maria Papaleontiou, Paul G Gauger, Megan R Haymart
OBJECTIVE: Surgical outcomes of thyroid cancer patients are improved with high-volume surgeons. However, age disparities in referral to specialist surgical centers still exist. The factors that influence decision-making regarding referral of older thyroid cancer patients to high-volume surgeons remain unknown. METHODS: We surveyed members of the Endocrine Society, American College of Physicians and American Academy of Family Practice. RESULTS: Overall, 270 physicians completed the survey...
May 23, 2017: Endocrine Practice
https://www.readbyqxmd.com/read/28534277/how-do-small-groups-make-decisions-a-theoretical-framework-to-inform-the-implementation-and-study-of-clinical-competency-committees
#12
Saad Chahine, Sayra Cristancho, Jessica Padgett, Lorelei Lingard
In the competency-based medical education (CBME) approach, clinical competency committees are responsible for making decisions about trainees' competence. However, we currently lack a theoretical model for group decision-making to inform this emerging assessment phenomenon. This paper proposes an organizing framework to study and guide the decision-making processes of clinical competency committees.This is an explanatory, non-exhaustive review, tailored to identify relevant theoretical and evidence-based papers related to small group decision-making...
May 22, 2017: Perspectives on Medical Education
https://www.readbyqxmd.com/read/28533922/correlation-of-rapid-point-of-care-vs-send-out-fecal-calprotectin-monitoring-in-pediatric-inflammatory-bowel-disease
#13
Alexis Rodriguez, Lauren Yokomizo, Megan Christofferson, Danielle Barnes, Nasim Khavari, K T Park
AIM: To assess the correlation between the send-out enzyme-linked immuno sorbent assay (ELISA) and the point-of-care (POC) calprotectin test in pediatric inflammatory bowel disease (IBD) patients. METHODS: We prospectively collected stool samples in pediatric IBD patients for concomitant send-out ELISA analysis and POC calprotectin testing using the Quantum Blue(®) (QB) Extended immunoassay. Continuous results between 17 to 1000 μg/g were considered for comparison...
May 6, 2017: World Journal of Gastrointestinal Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/28533475/first-line-palliative-her2-targeted-therapy-in-her2-positive-metastatic-breast-cancer-is-less-effective-after-previous-adjuvant-trastuzumab-based-therapy
#14
Hánah N Rier, Mark-David Levin, Joost van Rosmalen, Monique M E M Bos, Jan C Drooger, Paul de Jong, Johanneke E A Portielje, Elisabeth M P Elsten, Albert-Jan Ten Tije, Stefan Sleijfer, Agnes Jager
BACKGROUND: Survival of patients with human epidermal growth receptor 2 (HER2)-positive metastatic breast cancer (MBC) has improved dramatically since trastuzumab has become available, although the disease eventually progresses in most patients. This study investigates the outcome (overall survival [OS] and time to next treatment [TNT]) in MBC patients pretreated with trastuzumab in the adjuvant setting (TP-group) compared with trastuzumab-naïve patients (TN-group) in order to investigate the possibility of trastuzumab resistance...
May 22, 2017: Oncologist
https://www.readbyqxmd.com/read/28532709/image-texture-features-predict-renal-function-decline-in-patients-with-autosomal-dominant-polycystic-kidney-disease
#15
Timothy L Kline, Panagiotis Korfiatis, Marie E Edwards, Kyongtae T Bae, Alan Yu, Arlene B Chapman, Michal Mrug, Jared J Grantham, Douglas Landsittel, William M Bennett, Bernard F King, Peter C Harris, Vicente E Torres, Bradley J Erickson
Magnetic resonance imaging (MRI) examinations provide high-resolution information about the anatomic structure of the kidneys and are used to measure total kidney volume (TKV) in patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD). Height-adjusted TKV (HtTKV) has become the gold-standard imaging biomarker for ADPKD progression at early stages of the disease when estimated glomerular filtration rate (eGFR) is still normal. However, HtTKV does not take advantage of the wealth of information provided by MRI...
May 20, 2017: Kidney International
https://www.readbyqxmd.com/read/28532698/validation-of-the-mayo-clinic-staging-system-in-determining-prognoses-of-patients-with-perihilar-cholangiocarcinoma
#16
Robert J S Coelen, Marcia P Gaspersz, Tim A Labeur, Jeroen L A van Vugt, Susan van Dieren, François E J A Willemssen, Chung Y Nio, Jan N M IJzermans, Heinz-Josef Klümpen, Bas Groot Koerkamp, Thomas M van Gulik
BACKGROUND AND AIMS: Most systems for staging perihilar cholangiocarcinoma (PHC) have been developed for the minority of patients with resectable disease. The recently developed Mayo Clinic system for staging PHC requires only clinical and radiological variables, but has not yet been validated. We performed a retrospective study to validate the Mayo Clinic staging system. METHODS: We identified consecutive patients with suspected PHC evaluated and treated at 2 tertiary centers in The Netherlands, from January 2002 through December 2014...
May 19, 2017: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28532673/-neuraxial-anesthesia-in-patients-with-multiple-sclerosis-a-systematic-review
#17
Helmar Bornemann-Cimenti, Nikki Sivro, Frederike Toft, Larissa Halb, Andreas Sandner-Kiesling
BACKGROUND AND OBJECTIVES: Current guidelines for neuraxial analgesia in patients with multiple sclerosis are ambiguous and offer the clinician only a limited basis for decision making. This systematic review examines the number of cases in which multiple sclerosis has been exacerbated after central neuraxial analgesia in order to rationally evaluate the safety of these procedures. METHODS: A systematic literature search with the keywords "anesthesia or analgesia" and "epidural, peridural, caudal, spinal, subarachnoid or intrathecal" in combination with "multiple sclerosis" was performed in the databases PubMed and Embase, looking for clinical data on the effect of central neuraxial analgesia on the course of multiple sclerosis...
May 19, 2017: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/28532642/optical-mammography-in-patients-with-breast-cancer-undergoing-neoadjuvant-chemotherapy-individual-clinical-response-index
#18
Pamela G Anderson, Sirishma Kalli, Angelo Sassaroli, Nishanth Krishnamurthy, Shital S Makim, Roger A Graham, Sergio Fantini
RATIONALE AND OBJECTIVES: We present an optical mammography study that aims to develop quantitative measures of pathologic response to neoadjuvant chemotherapy (NAC) in patients with breast cancer. Such quantitative measures are based on the concentrations of oxyhemoglobin ([HbO2]), deoxyhemoglobin ([Hb]), total hemoglobin ([HbT]), and hemoglobin saturation (SO2) in breast tissue at the tumor location and at sequential time points during chemotherapy. MATERIALS AND METHODS: Continuous-wave, spectrally resolved optical mammography was performed in transmission and parallel-plate geometry on 10 patients before treatment initiation and at each NAC administration (mean number of optical mammography sessions: 12, range: 7-18)...
May 19, 2017: Academic Radiology
https://www.readbyqxmd.com/read/28532630/shared-decision-making-as-part-of-value-based-care-new-u-s-policies-challenge-our-readiness
#19
Erica S Spatz, Glyn Elwyn, Benjamin W Moulton, Robert J Volk, Dominick L Frosch
Shared decision making in the United States is increasingly being recognized as part of value-based care. During the last decade, several state and federal initiatives have linked shared decision making with reimbursement and increased protection from litigation. Additionally, private and public foundations are increasingly funding studies to identify best practices for moving shared decision making from the research world into clinical practice. These shifts offer opportunities and challenges for ensuring effective implementation...
May 20, 2017: Zeitschrift Für Evidenz, Fortbildung und Qualität Im Gesundheitswesen
https://www.readbyqxmd.com/read/28532613/the-practice-of-evidence-based-medicine-involves-the-care-of-whole-persons
#20
W Scott Richardson
In this issue of the Journal, Dr. Fava posits that evidence-based medicine (EBM) was bound to fail. I share some of the concerns he expresses, yet I see more reasons for optimism. Having been on rounds with both Drs. Engel and Sackett, I reckon they would have agreed more than they disagreed. Their central teaching was the compassionate and well-informed care of sick persons. The model that emerged from these rounds was that patient care could be both person-centered and evidence-based, that clinical judgment was essential to both, and the decisions could and should be shared...
April 2017: Journal of Clinical Epidemiology
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