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Clinical decision making

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https://www.readbyqxmd.com/read/28938748/random-start-ovarian-stimulation-for-fertility-preservation-appears-unlikely-to-delay-initiation-of-neoadjuvant-chemotherapy-for-breast-cancer
#1
Joseph M Letourneau, Nikita Sinha, Kaitlyn Wald, Eve Harris, Molly Quinn, Tal Imbar, Evelyn Mok-Lin, A Jo Chien, Mitchell Rosen
STUDY QUESTION: Is random start ovarian stimulation associated with delays in initiation of neoadjuvant chemotherapy for breast cancer? SUMMARY ANSWER: Among women who complete fertility preservation (FP) consultation, random start ovarian stimulation is unlikely to delay time to initiation of neoadjuvant chemotherapy start. WHAT IS KNOWN ALREADY: Neoadjuvant chemotherapy is now a widely accepted treatment modality for operable breast cancer and random start ovarian stimulation is an increasingly-utilized modality for FP...
October 1, 2017: Human Reproduction
https://www.readbyqxmd.com/read/28938738/resolution-of-infertility-and-number-of-children-1386-couples-followed-for-a-median-of-13-years
#2
A A Righarts, A Gray, N P Dickson, L Parkin, W R Gillett
STUDY QUESTION: How common were children among infertile couples? SUMMARY ANSWER: A total of 61.7% of infertile couples presenting for care subsequently had live born children 13.1 years after first being clinically assessed, with a mean of 1.7 children among those who had at least one. WHAT IS KNOWN ALREADY: While the prognoses for infertile couples undertaking specific treatments have been well described, less is known about those not undergoing these treatments or the total number of children...
October 1, 2017: Human Reproduction
https://www.readbyqxmd.com/read/28938658/comparison-of-direct-sequencing-and-amplification-refractory-mutation-system-for-detecting-epidermal-growth-factor-receptor-mutation-in-non-small-cell-lung-cancer-patients-a-systematic-review-and-meta-analysis
#3
Qi Feng, Zu-Yao Yang, Jia-Tong Zhang, Jin-Ling Tang
BACKGROUND: Direct sequencing and amplification refractory mutation system (ARMS) are commonly used to detect epidermal growth factor receptor (EGFR) mutation status in patients with non-small-cell lung cancer to inform the decision-making on tyrosine kinase inhibitors treatment. This study aimed to systematically compare the two methods in terms of the rate of detected mutations and the association of detected mutations with clinical outcomes. MATERIAL AND METHODS: PubMed, EMBASE, China National Knowledge Infrastructure (in Chinese) and Wanfang database (in Chinese) were searched to identify relevant studies...
August 29, 2017: Oncotarget
https://www.readbyqxmd.com/read/28938302/anesthesia-information-management-clinical-decision-support
#4
Robert E Freundlich, Jesse M Ehrenfeld
PURPOSE OF REVIEW: Perioperative informatics tools continue to be developed at a rapid pace and offer clinicians the potential to greatly enhance clinical decision making. The goal of this review is to bring the reader updates on perioperative information management and discuss future research directions in the field. RECENT FINDINGS: Clinical decision support tools become more timely, accurate, and, in some instances, have been shown to improve patient outcomes...
September 21, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28938268/surgical-and-survival-outcomes-following-pelvic-exenteration-for-locally-advanced-primary-rectal-cancer-results-from-an-international-collaboration
#5
(no author information available yet)
OBJECTIVE: The aim of the study was to analyze data from an international collaboration, and ascertain prognostic indicators that inform clinical decision-making and practices regarding the role of pelvic exenteration for locally advanced primary rectal cancer (LARC). BACKGROUND: With improved national screening programs fewer patients present with LARC. Despite this, select cohorts of patients require pelvic exenteration. To date, the majority of outcome data are from single-center series...
September 21, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28938252/emotional-impact-of-end-of-life-decisions-on-professional-relationships-in-the-icu-an-obstacle-to-collegiality
#6
Alexandra Laurent, Magalie Bonnet, Gilles Capellier, Pierre Aslanian, Paul Hebert
OBJECTIVES: End-of-life decisions are not only common in the ICU but also frequently elicit strong feelings among health professionals. Even though we seek to develop more collegial interprofessional approaches to care and health decision-making, there are many barriers to successfully managing complex decisions. The aim of this study is to better understand how emotions influence the end-of-life decision-making process among professionals working in ICU. DESIGN: Qualitative study with clinical interviews...
September 21, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28938179/does-simulation-enhance-nurses-ability-to-assess-deteriorating-patients
#7
Maria Bliss, Leanne M Aitken
Recognising and responding to patient deterioration has been identified as a key skill in nursing care to ensure that care is escalated for prompt, efficient management of the potentially critically ill patient. Simulation is one teaching strategy that has been established in nurse education as a method for enhancing skills. The objective was to explore the experiences of registered nurses to ascertain whether they perceived that simulation enhanced their skills in recognising the deteriorating patient. An exploratory qualitative design was used...
September 12, 2017: Nurse Education in Practice
https://www.readbyqxmd.com/read/28937785/gaining-access-to-providing-medical-care-to-male-sport-teams-the-female-athletic-trainer-perspective
#8
Alicia Pike, Stephanie M Mazerolle, Jessica L Barrett
CONTEXT:   Female athletic trainers (ATs) can face barriers to employment within the profession. Although there is evidence for an increasing percentage of women in athletic training, the portion providing medical care to male sport teams within the professional sport and collegiate settings continues to be small. OBJECTIVE:   To investigate the experiences of female ATs when seeking employment with male sport teams within the Division I setting. DESIGN:   Qualitative study...
September 22, 2017: Journal of Athletic Training
https://www.readbyqxmd.com/read/28937462/instability-in-thoracolumbar-trauma-is-a-new-definition-warranted
#9
Salman Abbasi Fard, Jesse Skoch, Mauricio J Avila, Apar S Patel, Kamran V Sattarov, Christina M Walter, Ali A Baaj
STUDY DESIGN: Review of the articles. OBJECTIVE: The objective of this study was to review all articles related to spinal instability to determine a consensus statement for a contemporary, practical definition applicable to thoracolumbar injuries. SUMMARY OF BACKGROUND DATA: Traumatic fractures of the thoracolumbar spine are common. These injuries can result in neurological deficits, disability, deformity, pain, and represent a great economic burden to society...
October 2017: Clinical Spine Surgery
https://www.readbyqxmd.com/read/28937416/a-novel-entity-of-corneal-diseases-with-irregular-posterior-corneal-surface-concept-and-clinical-relevance
#10
Takefumi Yamaguchi, Eisuke Shimizu, Yukari Yagi-Yaguchi, Daisuke Tomida, Yoshiyuki Satake, Jun Shimazaki
Various corneal diseases, such as hereditary corneal dystrophies, corneal infection, and bullous keratopathy, cause corneal opacity, scarring, and edema, leading to severely decreased visual acuity and loss of vision. These diseases were regarded as corneal opacity diseases, and the decreased visual acuity was considered to be predominantly caused by corneal opacity. The influence of corneal irregular astigmatism on vision has been poorly understood to date, mainly because accurate quantification of irregular astigmatism has been technically challenging...
September 19, 2017: Cornea
https://www.readbyqxmd.com/read/28937345/practical-implications-of-the-minimally-conscious-state-diagnosis-in-adults
#11
Karola V Kreitmair, Katherine E Kruse
This article addresses questions surrounding the minimally conscious state (MCS) from the perspective of adult clinical ethics. It describes the background of the MCS diagnosis, analyzes phenomenological ambiguities inherent in the nature of MCS, and raises epistemological concerns surrounding its diagnosis. It argues that in many cases, the burdens of prolonging treatment for people who have sustained certain severe brain injuries (SBI) outweigh the benefits, even if they are in or have the prospect of entering into MCS...
October 2017: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
https://www.readbyqxmd.com/read/28936569/treatment-related-serious-adverse-events-and-fatal-adverse-events-with-regorafenib-in-cancer-patients-a-meta-analysis-of-phase-3-randomized-controlled-trials
#12
REVIEW
Meihui Cao, Feifei Li, Yue Wang, Jingdong Zhang
Regorafenib (Stivarga) is an oral small-molecule multikinase inhibitor commonly used against a variety of cancers. We performed a meta-analysis of all phase 3 randomized controlled trials (RCTs) of regorafenib to quantify the increased risk of SAEs and FAEs. We carried out a systematic search of electronic databases for studies published from inception to February 2017 without any restrictions. Eligibility criteria included phase 3 RCTs of tumors comparing regorafenib, alone or in combination with non-targeted chemotherapy (regorafenib arm) versus placebo or non-targeted chemotherapy (control arm)...
September 22, 2017: Investigational New Drugs
https://www.readbyqxmd.com/read/28936475/surgical-data-science-the-new-knowledge-domain
#13
S Swaroop Vedula, Gregory D Hager
Healthcare in general, and surgery/interventional care in particular, is evolving through rapid advances in technology and increasing complexity of care with the goal of maximizing quality and value of care. While innovations in diagnostic and therapeutic technologies have driven past improvements in quality of surgical care, future transformation in care will be enabled by data. Conventional methodologies, such as registry studies, are limited in their scope for discovery and research, extent and complexity of data, breadth of analytic techniques, and translation or integration of research findings into patient care...
April 2017: Innov Surg Sci
https://www.readbyqxmd.com/read/28936373/shared-decision-making-in-immigrant-patients
#14
EDITORIAL
Claudia C Dobler, Gabriela Spencer-Bonilla, Michael R Gionfriddo, Juan Pablo Brito
Communication is at the core of shared decision making, and communication difficulties are therefore barriers to using shared decision making in clinical practice. In clinical encounters with immigrant patients from culturally and linguistically diverse backgrounds, a number of communication challenges arise, which can be obstacles to the implementation of shared decision making. Here, we discuss some of these challenges, possible solutions and research required to address identified knowledge gaps.
July 12, 2017: Curēus
https://www.readbyqxmd.com/read/28936235/health-literacy-and-atrial-fibrillation-relevance-and-future-directions-for-patient-centred-care
#15
Konstantinos N Aronis, Brittany Edgar, Wendy Lin, Maria Auxiliadora Parreiras Martins, Michael K Paasche-Orlow, Jared W Magnani
Atrial fibrillation (AF) is a common cardiac arrhythmia with significant clinical outcomes, and is associated with high medical and social costs. AF is complicated for patients because of its specialised terminology, long-term adherence, symptom monitoring, referral to specialty care, array of potential interventions and potential for adversity. Health literacy is a frequently under-recognised, yet fundamental, component towards successful care in AF. Health literacy is defined as the capacity to obtain, process and understand health information, and has had markedly limited study in AF...
2017: European Cardiology
https://www.readbyqxmd.com/read/28935887/bitter-or-not-bitterpredict-a-tool-for-predicting-taste-from-chemical-structure
#16
Ayana Dagan-Wiener, Ido Nissim, Natalie Ben Abu, Gigliola Borgonovo, Angela Bassoli, Masha Y Niv
Bitter taste is an innately aversive taste modality that is considered to protect animals from consuming toxic compounds. Yet, bitterness is not always noxious and some bitter compounds have beneficial effects on health. Hundreds of bitter compounds were reported (and are accessible via the BitterDB http://bitterdb.agri.huji.ac.il/dbbitter.php ), but numerous additional bitter molecules are still unknown. The dramatic chemical diversity of bitterants makes bitterness prediction a difficult task. Here we present a machine learning classifier, BitterPredict, which predicts whether a compound is bitter or not, based on its chemical structure...
September 21, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28935665/evaluating-the-impact-of-implementing-a-clinical-practice-guideline-for-febrile-infants-with-positive-respiratory-syncytial-virus-or-enterovirus-testing
#17
Adrienne DePorre, David D Williams, Jennifer Schuster, Jason Newland, Jacqueline Bartlett, Rangaraj Selvarangan, Keith Mann, Russell McCulloh
OBJECTIVES: To evaluate clinical practice patterns and patient outcomes among febrile low-risk infants with respiratory syncytial virus (RSV) infection or enterovirus (EV) meningitis after implementing a clinical practice guideline (CPG) that provides recommendations for managing febrile infants with RSV infection and EV meningitis. METHODS: Our institution implemented a CPG for febrile infants, which gives explicit recommendations for managing both RSV-positive and EV-positive infants in 2011...
September 21, 2017: Hospital Pediatrics
https://www.readbyqxmd.com/read/28935477/the-clinical-usefulness-of-prognostic-prediction-models-in-critical-illness
#18
Tim Baker, Martin Gerdin
Critical illness is any immediately life-threatening disease or trauma and results in several million deaths globally every year. Responsive hospital systems for managing critical illness include quick and accurate identification of the critically ill patients. Prognostic prediction models are widely used for this aim. To be clinically useful, a model should have good predictive performance, often measured using discrimination and calibration. This is not sufficient though: a model also needs to be tested in the setting where it will be used, it should be user-friendly and should guide decision making and actions...
September 18, 2017: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/28935200/benefit-risk-of-intraoperative-liver-biopsy-during-bariatric-surgery-review-and-perspectives
#19
REVIEW
Sandrine Barbois, Catherine Arvieux, Vincent Leroy, Fabian Reche, Nathalie Stürm, Anne-Laure Borel
Nonalcoholic fatty liver disease (NAFLD) is a metabolic complication of obesity that encompasses a spectrum of conditions, including hepatic steatosis, nonalcoholic steatohepatitis (NASH), cirrhosis, and end-stage liver disease. Screening for NAFLD is important to limit progression, allow early detection of carcinoma, and follow the need for liver transplantation. Although noninvasive markers exist, hepatic histologic evaluation remains the gold standard for diagnosis. To reduce the risk of complications after liver biopsy but increase the accuracy of NAFLD diagnosis, hepatic tissue can be sampled during bariatric surgery...
August 14, 2017: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
https://www.readbyqxmd.com/read/28934822/stent-placement-for-benign-esophageal-leaks-perforations-and-fistulae-a-clinical-prediction-rule-for-successful-leakage-control
#20
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
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