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Clinical decision making

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https://www.readbyqxmd.com/read/27936437/clinical-trial-methodology-to-assess-the-efficacy-effectiveness-of-long-acting-antipsychotics-randomized-controlled-trials-vs-naturalistic-studies
#1
REVIEW
Andrea Fagiolini, Paola Rocca, Serafino De Giorgi, Edoardo Spina, Giovanni Amodeo, Mario Amore
Schizophrenia presents unique difficulties in clinical trial design associated with the condition's variable presentation and clinical course, and multiple features influencing affect, cognition, volition and perception. Randomized controlled trials (RCTs) are explanatory studies using a carefully selected patient population, predefined assessment intervals and, generally, symptom-focused endpoints. Naturalistic studies are pragmatic, with no active intervention, and outcomes that are generally those used in clinical practice (e...
November 28, 2016: Psychiatry Research
https://www.readbyqxmd.com/read/27936385/interrater-reliability-in-pediatric-urodynamic-tracings-a-pilot-study
#2
Anne G Dudley, Daniel P Casella, Chelsea J Lauderdale, Shilin Zhao, Heidi Chen, Stacy T Tanaka, John C Thomas, John C Pope, Mark C Adams, John W Brock, Chevis N Shannon, Douglass B Clayton
PURPOSE: Urodynamic studies are crucial to neuropathic bladder management and they often determine surgical intervention. However, current evidence indicates that interpretations show poor agreement across physicians. We sought to determine the interrater reliability of urodynamic interpretation in our practice. We hypothesized that there would be strong correlation among pediatric urologists of similar training in a single academic practice. MATERIALS AND METHODS: We retrospectively identified patients with neuropathic bladder who underwent urodynamics at our institution between 2014 and 2015...
December 6, 2016: Journal of Urology
https://www.readbyqxmd.com/read/27935900/-thromboangiitis-obliterans-buerger-s-disease-state-of-the-art
#3
D D Zerbino, E A Zimba, N N Bagry
Thromboangiitis obliterans (Buerger's disease) is systemic vasculitis with predominant development of thrombotic occlusions of small-to-medium diameter arteries of distal portions of both upper and lower limbs. A distinctive feature of Buerger's disease from other vasculitides is the involvement of the venous bed into the pathological process in the form of migrating thrombophlebitis. The disease is encountered more often in young adult males, predominantly tobacco smokers. The clinical pattern is presented by symptoms of increasing insufficiency of blood supply of tissues of extremities...
2016: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
https://www.readbyqxmd.com/read/27935899/-algorithm-for-selection-of-individual-therapy-with-clopidogrel-in-vascular-surgical-practice
#4
A I Shevela, A A Slepukhina, E M Zelenskaya, T A Seredina, G I Lifshits
For treatment of patients with diseases of lower limb arteries and prevention of cardiovascular complications in high-risk patients (those with diabetes mellitus, arterial hypertension, dyslipidemia, obesity) permanent antiplatelet therapy is indicated. A problem is variable individual sensitivity to therapeutic agents. For antiplatelet therapy in patients with atherosclerosis of lower limb arteries there has been obtained an evidence-supported base concerning efficacy of long-term administration of clopidogrel preparations, unlike patients with acute coronary syndrome, for whom there has been accumulated an evidence-confirmed base of administering clopidogrel preparations, as well as ticagrelor and prasugrel in various clinical situations...
2016: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
https://www.readbyqxmd.com/read/27935741/barriers-to-evidence-based-physician-decision-making-at-the-point-of-care-a-narrative-literature-review
#5
Kara Contreary, Anna Collins, Eugene C Rich
We conduct a narrative literature review using four real-world cases of clinical decisions to show how barriers to the use of evidence-based medicine affect physician decision-making at the point of care, and where adjustments could be made in the healthcare system to address these barriers. Our four cases constitute decisions typical of the types physicians make on a regular basis: diagnostic testing, initial treatment and treatment monitoring. To shed light on opportunities to improve patient care while reducing costs, we focus on barriers that could be addressed through changes to policy and/or practice at a particular level of the healthcare system...
December 9, 2016: Journal of Comparative Effectiveness Research
https://www.readbyqxmd.com/read/27935339/history-taking-and-physical-assessment-in-holistic-palliative-care
#6
Marie Donnelly, Daphne Martin
In carrying out a holistic palliative care assessment the palliative care clinical nurse specialist needs to develop the knowledge and skill of history taking and health assessment to make safe and competent decisions with patients regarding the future management of their care. This article examines this process in making a differential diagnosis with particular reference to the respiratory physical examination of a patient with a history of lung cancer using the Calgary-Cambridge Model. The model gives structure to the preparation, history taking, and physical examination (inspection, palpation, percussion and auscultation) before explaining, planning and closing the consultation, while considering the palliative patient's and family's individual wishes and goals...
December 8, 2016: British Journal of Nursing: BJN
https://www.readbyqxmd.com/read/27935179/association-between-confidence-in-smiling-and-esthetic-characteristics
#7
Francisco Wilker Mustafa Gomes Muniz, Denise Juaçaba Cavalcante, Maria Mônica Studart Mendes Moreira, Lidiany Karla Azevedo Rodrigues, Carlos Augusto de Oliveira Fernandes, Paulo César de Almeida, Rosimary de Sousa Carvalho
OBJECTIVE: This study aimed to analyze which facial, gingival and dental characteristics are associated with confidence in smiling among 75 subjects seeking treatment in a northern Brazilian public dental university. MATERIALS AND METHODS: Clinical examinations and three standardized photographs of each subject were taken by one trained examiner. In addition, a questionnaire was applied to assess confidence in smiling. The subjects were dichotomized into two groups, non-confident (n = 36) and confident (n = 39) in smiling...
December 9, 2016: Journal of Esthetic and Restorative Dentistry
https://www.readbyqxmd.com/read/27933732/hypothesis-driven-physical-examination-curriculum
#8
Sharon Allen, Andrew Olson, Jeremiah Menk, James Nixon
BACKGROUND: Medical students traditionally learn physical examination skills as a rote list of manoeuvres. Alternatives like hypothesis-driven physical examination (HDPE) may promote students' understanding of the contribution of physical examination to diagnostic reasoning. We sought to determine whether first-year medical students can effectively learn to perform a physical examination using an HDPE approach, and then tailor the examination to specific clinical scenarios. Medical students traditionally learn physical examination skills as a rote list of manoeuvres CONTEXT: First-year medical students at the University of Minnesota were taught both traditional and HDPE approaches during a required 17-week clinical skills course in their first semester...
December 9, 2016: Clinical Teacher
https://www.readbyqxmd.com/read/27933569/decision-making-in-clinical-practice-oral-anticoagulant-therapy-in-patients-with-non-valvular-atrial-fibrillation-and-a-single-additional-stroke-risk-factor
#9
REVIEW
Tatjana S Potpara, Nikolaos Dagres, Nebojša Mujović, Dragan Vasić, Milika Ašanin, Milan Nedeljkovic, Francisco Marin, Laurent Fauchier, Carina Blomstrom-Lundqvist, Gregory Y H Lip
Approximately 1 in 3-4 patients presenting with an ischemic stroke will also have atrial fibrillation (AF), and AF-related strokes can be effectively prevented using oral anticoagulant therapy (OAC), either with well-controlled vitamin K antagonists (VKAs) or non-vitamin K antagonist oral anticoagulants (NOACs). In addition, OAC use (both VKAs and NOACs) is associated with a 26% reduction in all-cause mortality (VKAs) or an additional 10% mortality reduction with NOACs relative to VKAs. The decision to use OAC in individual AF patient is based on the estimated balance of the benefit from ischemic stroke reduction against the risk of major OAC-related bleeding [essentially intracranial hemorrhage (ICH)]...
December 8, 2016: Advances in Therapy
https://www.readbyqxmd.com/read/27933279/is-there-a-role-for-genetic-information-in-risk-assessment-and-decision-making-in-prostate-cancer
#10
Mohamadreza Nowroozi, Mohsen Ayati, Erfan Amini, Reza Mahdian, Behzad Yousefi, Amir Arbab, Mansour Jamali Zawarei, Hasan Niroomand, Hamidreza Ghorbani, Alireza Ghadian
OBJECTIVES: Prostate cancer is a neoplasm with a variable natural history and clinical behavior. There is much debate on the use of inherited genetic information in clinical application including risk assessment and treatment decisions. This study was performed to evaluate the relationship between clinical parameters of prostate cancer (PSA, Gleason score, and metastasis) and expression of NKX3.1, AMACR, TMPRSS2-ERG, ERG, and SPINK1 genes. METHODS: Newly diagnosed cases of prostate cancer were selected for this study...
November 2016: Nephro-urology Monthly
https://www.readbyqxmd.com/read/27933214/integrating-next-generation-sequencing-into-clinical-oncology-strategies-promises-and-pitfalls
#11
REVIEW
Peter Horak, Stefan Fröhling, Hanno Glimm
We live in an era of genomic medicine. The past five years brought about many significant achievements in the field of cancer genetics, driven by rapidly evolving technologies and plummeting costs of next-generation sequencing (NGS). The official completion of the Cancer Genome Project in 2014 led many to envision the clinical implementation of cancer genomic data as the next logical step in cancer therapy. Stemming from this vision, the term 'precision oncology' was coined to illustrate the novelty of this individualised approach...
2016: ESMO Open
https://www.readbyqxmd.com/read/27933181/what-are-the-pros-and-cons-of-electronically-monitoring-inhaler-use-in-asthma-a-multistakeholder-perspective
#12
Sam Howard, Alexandra Lang, Sarah Sharples, Dominick Shaw
INTRODUCTION: Electronic monitoring devices (EMDs) are the optimal method for collecting objective data on inhaler use in asthma. Recent research has investigated the attitudes of patients with asthma towards these devices. However, no research to date has formally considered the opinions of stakeholders and decision-makers in asthma care. These individuals have important clinical requirements that need to be taken into account if EMDs are to be successfully provisioned, making collecting their opinions on the key barriers facing these devices a valuable process...
2016: BMJ Open Respiratory Research
https://www.readbyqxmd.com/read/27932721/can-you-reduce-the-dose-of-meloxicam-in-dogs-with-osteoarthritis
#13
Hannah Doit, Kathryn Wareham
BestBETs for Vets are generated by the Centre for Evidence-based Veterinary Medicine at the University of Nottingham to help answer specific questions and assist in clinical decision making. Although evidence is often limited, they aim to find, present and draw conclusions from the best available evidence, using a standardised framework. A more detailed description of how BestBETs for Vets are produced was published in a previous issue of Veterinary Record (VR, April 4, 2015, pp 354-356).
December 10, 2016: Veterinary Record
https://www.readbyqxmd.com/read/27932552/microfluidic-analysis-of-oocyte-and-embryo-biomechanical-properties-to-improve-outcomes-in-assisted-reproductive-technologies
#14
REVIEW
Livia Z Yanez, David B Camarillo
Measurement of oocyte and embryo biomechanical properties has recently emerged as an exciting new approach to obtain a quantitative, objective estimate of developmental potential. However, many traditional methods for probing cell mechanical properties are time consuming, labor intensive and require expensive equipment. Microfluidic technology is currently making its way into many aspects of assisted reproductive technologies (ART), and is particularly well suited to measure embryo biomechanics due to the potential for robust, automated single-cell analysis at a low cost...
December 8, 2016: Molecular Human Reproduction
https://www.readbyqxmd.com/read/27932533/preoperative-proteinuria-and-reduced-glomerular-filtration-rate-predicts-renal-replacement-therapy-in-patients-supported-with-continuous-flow-left-ventricular-assist-devices
#15
Veli K Topkara, Ellie J Coromilas, Arthur Reshad Garan, Randall C Li, Francesco Castagna, Douglas L Jennings, Melana Yuzefpolskaya, Koji Takeda, Hiroo Takayama, Robert N Sladen, Donna M Mancini, Yoshifumi Naka, Jai Radhakrishnan, Paolo C Colombo
BACKGROUND: Renal failure requiring renal replacement therapy (RRT) has detrimental effects on quality of life and survival of patients with continuous-flow left ventricular assist devices (CF-LVADs). Current guidelines do not offer a decision-making algorithm for CF-LVAD candidates with poor baseline renal function. Objective of this study was to identify risk factors associated with RRT after CF-LVAD implantation. METHODS AND RESULTS: Three hundred and eighty-nine consecutive patients underwent contemporary CF-LVAD implantation at the Columbia University Medical Center between January 2004 and August 2015...
December 2016: Circulation. Heart Failure
https://www.readbyqxmd.com/read/27932341/older-patient-considering-treatment-for-advanced-renal-disease-protocol-for-a-scoping-review-of-the-information-available-for-shared-decision-making
#16
Rajesh Raj, Kiran D K Ahuja, Mai Frandsen, Matthew Jose
INTRODUCTION: Older adults constitute the largest group of patients on dialysis in most parts of the world. Management of advanced renal disease in the older adult is complex; treatment outcomes and prognosis can be markedly different from younger patients. Clinical teams caring for such patients are often called on to provide information regarding prognosis and outcomes with treatment-particularly, the comparison between having dialysis treatment versus not having dialysis. These discussions can be difficult for clinicians because they have to contend with incomplete or nascent data regarding prognosis and outcomes in this age group...
December 8, 2016: BMJ Open
https://www.readbyqxmd.com/read/27932337/development-of-a-critical-appraisal-tool-to-assess-the-quality-of-cross-sectional-studies-axis
#17
Martin J Downes, Marnie L Brennan, Hywel C Williams, Rachel S Dean
OBJECTIVES: The aim of this study was to develop a critical appraisal (CA) tool that addressed study design and reporting quality as well as the risk of bias in cross-sectional studies (CSSs). In addition, the aim was to produce a help document to guide the non-expert user through the tool. DESIGN: An initial scoping review of the published literature and key epidemiological texts was undertaken prior to the formation of a Delphi panel to establish key components for a CA tool for CSSs...
December 8, 2016: BMJ Open
https://www.readbyqxmd.com/read/27931698/the-effectiveness-of-nurse-led-preoperative-assessment-clinics-for-patients-receiving-elective-orthopaedic-surgery-a-systematic-review
#18
Chan Sau-Man Conny, Ip Wan-Yim
PURPOSE: Nurse-led preoperative assessment clinics (POAC) have been introduced in different specialty areas to assess and prepare patients preoperatively in order to avoid last-minute surgery cancellations. Not all patients are referred to POACs before surgery, and the benefits of nurse-led POACs are not well documented in Hong Kong. The purpose of this systemic review was to identify the best available research evidence to inform current clinical practice, guide health care decision making and promote better care...
December 2016: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
https://www.readbyqxmd.com/read/27931466/evidence-based-clinical-practice-guideline-for-the-use-of-pit-and-fissure-sealants
#19
(no author information available yet)
BACKGROUND: This article presents evidence-based clinical recommendations for the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars in children and adolescents. A guideline panel convened by the American Dental Association (ADA) Council on Scientific Affairs and the American Academy of Pediatric Dentistry conducted a systematic review and formulated recommendations to address clinical questions in relation to the efficacy, retention, and potential side effects of sealants to prevent dental caries; their efficacy compared with fluoride varnishes; and a head-to-head comparison of the different types of sealant material used to prevent caries on pits-and-fissures of occlusal surfaces...
October 2016: Pediatric Dentistry
https://www.readbyqxmd.com/read/27931238/elaboration-of-a-nomogram-to-predict-nonsentinel-node-status-in-breast-cancer-patients-with-positive-sentinel-node-intraoperatively-assessed-with-one-step-nucleic-amplification-retrospective-and-validation-phase
#20
Franco Di Filippo, Simona Di Filippo, Anna Maria Ferrari, Raffaele Antonetti, Alessandro Battaglia, Francesca Becherini, Laia Bernet, Renzo Boldorini, Catherine Bouteille, Simonetta Buglioni, Paolo Burelli, Rafael Cano, Vincenzo Canzonieri, Pierluigi Chiodera, Alfredo Cirilli, Luigi Coppola, Stefano Drago, Luca Di Tommaso, Privato Fenaroli, Roberto Franchini, Andrea Gianatti, Diana Giannarelli, Carmela Giardina, Florence Godey, Massimo M Grassi, Giuseppe B Grassi, Siobhan Laws, Samuele Massarut, Giuseppe Naccarato, Maria Iole Natalicchio, Sergio Orefice, Fabrizio Palmieri, Tiziana Perin, Manuela Roncella, Massimo G Roncalli, Antonio Rulli, Angelo Sidoni, Corrado Tinterri, Maria C Truglia, Isabella Sperduti
BACKGROUND: Tumor-positive sentinel lymph node (SLN) biopsy results in a risk of non sentinel node metastases in micro- and macro-metastases ranging from 20 to 50%, respectively. Therefore, most patients underwent unnecessary axillary lymph node dissections. We have previously developed a mathematical model for predicting patient-specific risk of non sentinel node (NSN) metastases based on 2460 patients. The study reports the results of the validation phase where a total of 1945 patients were enrolled, aimed at identifying a tool that gives the possibility to the surgeon to choose intraoperatively whether to perform or not axillary lymph node dissection (ALND)...
December 8, 2016: Journal of Experimental & Clinical Cancer Research: CR
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