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Clinical decision making

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https://www.readbyqxmd.com/read/29168910/parental-immunisation-needs-and-attitudes-survey-in-paediatric-hospital-clinics-and-community-maternal-and-child-health-centres-in-melbourne-australia
#1
Jessica C Costa-Pinto, Harold W Willaby, Julie Leask, Monsurul Hoq, Tibor Schuster, Alice Ghazarian, Jacinta O'Keefe, Margie H Danchin
AIM: Despite Australia's high vaccination rates, an estimated 3.3% of children are under-vaccinated due to vaccine refusal and the proportion of parents with concerns is unclear. Amongst Australian parents, we aimed to determine the prevalence of vaccine concerns, resources and health-care providers (HCPs) accessed and satisfaction with these resources in two different settings. We also aimed to identify relationships between the level of vaccine concern, socio-economic status and vaccine uptake...
November 23, 2017: Journal of Paediatrics and Child Health
https://www.readbyqxmd.com/read/29168669/awake-craniotomy-versus-craniotomy-under-general-anesthesia-for-the-surgical-treatment-of-insular-glioma-choices-and-outcomes
#2
B Y Gravesteijn, M E Keizer, A J P E Vincent, J W Schouten, R J Stolker, M Klimek
OBJECTIVE: To investigate differences in outcomes in patients who underwent surgery for insular glioma using an awake craniotomy (AC) vs. a craniotomy under general anesthesia (GA). METHODS: Data from patients treated at our hospital between 2005 and 2015 were analyzed retrospectively. The preoperative, intraoperative, postoperative, and longer term follow-up characteristics and outcomes of patients who underwent surgery for primary insular glioma using either an AC or GA were compared...
November 23, 2017: Neurological Research
https://www.readbyqxmd.com/read/29168041/making-sense-of-snps-women-s-understanding-and-experiences-of-receiving-a-personalized-profile-of-their-breast-cancer-risks
#3
Mary-Anne Young, Laura Elenor Forrest, Victoria-Mae Rasmussen, Paul James, Gillian Mitchell, Sarah Dilys Sawyer, Katrina Reeve, Nina Hallowell
Genome wide association studies have identified a number of common genetic variants - single nucleotide polymorphisms (SNPs) - that combine to increase breast cancer risk. SNP profiling may enhance the accuracy of risk assessment and provides a personalized risk estimate. SNP testing for breast cancer risks may supplement other genetic tests in the future, however, before it can be implemented in the clinic we need to know how it will be perceived and received. Semi-structured qualitative interviews were conducted with 39 women who had previously had a breast cancer diagnosis and undergone BRCA1/2 testing, participated in the Variants in Practice (ViP) study and received personalized risk (SNP) profiles...
November 22, 2017: Journal of Genetic Counseling
https://www.readbyqxmd.com/read/29167907/definitive-tests-for-dengue-fever-when-and-which-should-i-use
#4
Hui Bin Yvonne Chan, Choon How How, Chung Wai Mark Ng
Dengue is a mosquito-borne viral disease that has established itself globally in both endemic and epidemic transmission cycles. While diagnostic decision-making for dengue is often guided by clinical judgement, definitive laboratory tests, including rapid point-of-care tests, have many advantages in the primary care setting. These include providing epidemiological data and diagnostic clarity for atypical cases, as well as contributing to patient education and compliance. This article discussed the types of diagnostic methods for dengue, when to use them and the appropriateness of each test...
November 2017: Singapore Medical Journal
https://www.readbyqxmd.com/read/29167776/prognosis-and-early-diagnosis-of-ductal-and-lobular-type-in-breast-cancer-patient
#5
Houriyeh Ehtemam, Mitra Montazeri, Reza Khajouei, Raziyeh Hosseini, Ali Nemati, Vahid Maazed
Background: Breast cancer is one of the most common cancers with a high mortality rate among women. Prognosis and early diagnosis of breast cancer among women society reduce considerable rate of their mortality. Nowadays, due to this illness, try to be setting up intelligent systems, which can predict and early diagnose this cancer, and reduce mortality of women society. Methods: Overall, 208 samples were collected from 2014 to 2015 from two oncologist offices and Javadalaemeh Clinic in Kerman, southeastern Iran...
November 2017: Iranian Journal of Public Health
https://www.readbyqxmd.com/read/29167657/choices-regarding-thrombolysis-are-modified-by-the-way-to-transfer-the-messages
#6
Jingjing Gong, Yan Zhang, Hongyan Gao, Wei Wei, Jing Lv, Hongyun Liu, Yonghua Huang
Although thrombolysis is the most effective medical treatment for acute ischemic stroke, many stroke patients eligible for thrombolysis miss this treatment as a result of delay or refusal by the patients and/or their proxies. To explore the influences of prognostic information for different intervals from stroke onset to the start of thrombolytic treatment (OTT) and other factors on the preferences of patients/proxies regarding thrombolytic therapy, a cross-sectional, discrete-choice experiment was performed between August 2013 and September 2014...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/29167146/impact-of-educational-intervention-on-management-of-periprocedural-anticoagulation
#7
Amy L Awker, Melissa A Bell, Megan McGraw, Mark A Klein
PURPOSE: The effect of education regarding new evidence in periprocedural anticoagulation, with a focus on reducing use in patients at only moderate thromboembolic risk, is presented. METHODS: A retrospective cohort analysis and quasiexperimental design were used. The initial review identified the current state of practice regarding bridging anticoagulation. Education was then provided to primary care providers and pharmacists on recent evidence. A subsequent review was completed to assess the impact of this education on clinical decision-making...
December 1, 2017: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/29167071/therapeutic-response-analysis-in-dogs-with-naturally-occurring-osteoarthritis
#8
Alexandre Gagnon, Dominique Brown, Maxim Moreau, Bertrand Lussier, Colombe Otis, Eric Troncy
OBJECTIVE: Reporting the rate of positive (+) and negative (-) responders based on an objective outcome measure of pain-related functional disability/lameness in dogs with naturally occurring osteoarthritis (OA), and the relationship between initial lameness severity and the odds of being a (+) responder. STUDY DESIGN: Retrospective analysis of published peer-reviewed clinical trials in dogs with naturally occurring OA. ANIMALS: Dogs (n = 213) with hip and/or stifle afflicted-joints...
September 15, 2017: Veterinary Anaesthesia and Analgesia
https://www.readbyqxmd.com/read/29164601/clinical-decision-analysis-in-perinatology
#9
Rohan D'Souza, Prakesh S Shah, Beate Sander
Clinical decision-making in perinatology involves tradeoffs between two intricately related individuals - mother and fetus. Decision-making in perinatology is challenging due to competing interests of the mother and the fetus. Although decision analytic methods are increasingly used to develop processes for clinical and cost-effectiveness analyses in perinatology, there are no guidelines on the conduct and reporting of decision analysis studies that takes into account the complexities of the mother-fetus dyad...
November 21, 2017: Acta Obstetricia et Gynecologica Scandinavica
https://www.readbyqxmd.com/read/29164170/impact-of-procalcitonin-guided-antibiotic-management-on-antibiotic-exposure-and-outcomes-real-world-evidence
#10
Michael R Broyles
Background: Delayed pathogen identification and nonspecific clinical findings make definitive decisions regarding antibiotics challenging. The stimuli of bacterial toxins and inflammation make procalcitonin (PCT) unique in its ability to differentiate bacterial infection from other causes of inflammation, and thus it is useful for antibiotic management. The objective of our study was to evaluate the impact of a PCT algorithm (PCT-A) on current practice. Methods: A single-center, retrospective cohort study was conducted to evaluate the impact of adding PCT-A to stewardship practices...
2017: Open Forum Infectious Diseases
https://www.readbyqxmd.com/read/29164166/juvenile-osteochondritis-dissecans-of-the-knee-does-magnetic-resonance-imaging-instability-correlate-with-the-need-for-surgical-intervention
#11
Simon Haeri Hendy, Darren de Sa, Kelly Ainsworth, Olufemi R Ayeni, Nicole Simunovic, Devin Peterson
Background: Several magnetic resonance imaging (MRI) classification systems have been developed to determine the degree of instability of juvenile osteochondritis dissecans (JOCD) lesions. Our current practice involves correlating the patients' symptoms with their MRI findings, but there are many cases in which this correlation is poor and results in incorrect classification of the stability of a JOCD lesion. Purpose: To determine whether certain MRI findings of JOCD instability are associated with the necessity for arthroscopic intervention to assess lesion stability...
November 2017: Orthopaedic Journal of Sports Medicine
https://www.readbyqxmd.com/read/29164163/neurocognitive-deficits-of-concussed-adolescent-athletes-at-self-reported-symptom-resolution-in-the-zurich-guidelines-era
#12
Peter K Kriz, Rebekah Mannix, Alex M Taylor, Danielle Ruggieri, William P Meehan
Background: Previous studies have evaluated high school and collegiate athletes in the pre-Zurich guidelines era; whether adolescent athletes demonstrate similar neurocognitive decrements in the current concussion management era remains unclear. Purpose: To assess for the presence of neurocognitive deficits in adolescents with a sport-related concussion at the time of self-reported symptom resolution. Study Design: Cross-sectional study; Level of evidence, 3...
November 2017: Orthopaedic Journal of Sports Medicine
https://www.readbyqxmd.com/read/29164057/diagnostic-and-prognostic-significance-of-methionine-uptake-and-methionine-positron-emission-tomography-imaging-in-gliomas
#13
REVIEW
Kamalakannan Palanichamy, Arnab Chakravarti
The present most common image diagnostic tracer in clinical practice for glioma is (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) for brain tumors diagnosis and prognosis. PET is a promising molecular imaging technique, which provides real-time information on the metabolic behavior of the tracer. The diffusive nature of glioblastoma (GBM) and heterogeneity often make the radiographic detection by FDG-PET inaccurate, and there is no gold standard. FDG-PET often leads to several controversies in making clinical decisions due to their uptake by normal surrounding tissues, and pose a challenge in delineating treatment-induced necrosis, edema, inflammation, and pseudoprogression...
2017: Frontiers in Oncology
https://www.readbyqxmd.com/read/29164037/guidelines-for-the-management-of-degenerative-cervical-myelopathy-and-acute-spinal-cord-injury-development-process-and-methodology
#14
Lindsay A Tetreault, Andrea C Skelly, Joseph R Dettori, Jefferson R Wilson, Allan R Martin, Michael G Fehlings
The Institute of Medicine defines clinical practice guidelines as "statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options." Guidelines help clinicians implement best evidence into practice and encourage informed shared decision making with patients. Guidelines are intended to enhance the quality of patient care by discouraging ineffective and potentially harmful interventions and standardizing practice...
September 2017: Global Spine Journal
https://www.readbyqxmd.com/read/29164036/a-clinical-practice-guideline-for-the-management-of-acute-spinal-cord-injury-introduction-rationale-and-scope
#15
Michael G Fehlings, Lindsay A Tetreault, Jefferson R Wilson, Brian K Kwon, Anthony S Burns, Allan R Martin, Gregory Hawryluk, James S Harrop
Acute spinal cord injury (SCI) is a traumatic event that results in disturbances to normal sensory, motor, or autonomic function and ultimately affects a patient's physical, psychological, and social well-being. The management of patients with SCI has drastically evolved over the past century as a result of increasing knowledge on injury mechanisms, disease pathophysiology, and the role of surgery. There still, however, remain controversial areas surrounding available management strategies for the treatment of SCI, including the use of corticosteroids such as methylprednisolone sodium succinate, the optimal timing of surgical intervention, the type and timing of anticoagulation prophylaxis, the role of magnetic resonance imaging, and the type and timing of rehabilitation...
September 2017: Global Spine Journal
https://www.readbyqxmd.com/read/29164035/a-clinical-practice-guideline-for-the-management-of-patients-with-degenerative-cervical-myelopathy-recommendations-for-patients-with-mild-moderate-and-severe-disease-and-nonmyelopathic-patients-with-evidence-of-cord-compression
#16
Michael G Fehlings, Lindsay A Tetreault, K Daniel Riew, James W Middleton, Bizhan Aarabi, Paul M Arnold, Darrel S Brodke, Anthony S Burns, Simon Carette, Robert Chen, Kazuhiro Chiba, Joseph R Dettori, Julio C Furlan, James S Harrop, Langston T Holly, Sukhvinder Kalsi-Ryan, Mark Kotter, Brian K Kwon, Allan R Martin, James Milligan, Hiroaki Nakashima, Narihito Nagoshi, John Rhee, Anoushka Singh, Andrea C Skelly, Sumeet Sodhi, Jefferson R Wilson, Albert Yee, Jeffrey C Wang
Study Design: Guideline development. Objectives: The objective of this study is to develop guidelines that outline how to best manage (1) patients with mild, moderate, and severe myelopathy and (2) nonmyelopathic patients with evidence of cord compression with or without clinical symptoms of radiculopathy. Methods: Five systematic reviews of the literature were conducted to synthesize evidence on disease natural history; risk factors of disease progression; the efficacy, effectiveness, and safety of nonoperative and surgical management; the impact of preoperative duration of symptoms and myelopathy severity on treatment outcomes; and the frequency, timing, and predictors of symptom development...
September 2017: Global Spine Journal
https://www.readbyqxmd.com/read/29164034/guidelines-for-the-management-of-degenerative-cervical-myelopathy-and-spinal-cord-injury-an-introduction-to-a-focus-issue
#17
Michael G Fehlings, Brian K Kwon, Lindsay A Tetreault
Study Design: Introduction to a guidelines project. Objectives: The objective of this focus issue is to present guidelines that outline how to best manage patients with degenerative cervical myelopathy (DCM) and spinal cord injury (SCI). Topics addressed in this focus issue include: 1) management strategies for patients with mild, moderate and severe DCM; and 2a) timing of surgical decompression; b) the use of methylprednisolone sodium succinate; c) the type and timing of anticoagulation strategies; d) the role of magnetic resonance imaging in clinical decision making and outcome prediction; and e) the type and timing of rehabilitation in patients with SCI...
September 2017: Global Spine Journal
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
#18
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/29164028/a-clinical-practice-guideline-for-the-management-of-patients-with-acute-spinal-cord-injury-recommendations-on-the-role-of-baseline-magnetic-resonance-imaging-in-clinical-decision-making-and-outcome-prediction
#19
Michael G Fehlings, Allan R Martin, Lindsay A Tetreault, Bizhan Aarabi, Paul Anderson, Paul M Arnold, Darrel Brodke, Anthony S Burns, Kazuhiro Chiba, Joseph R Dettori, Julio C Furlan, Gregory Hawryluk, Langston T Holly, Susan Howley, Tara Jeji, Sukhvinder Kalsi-Ryan, Mark Kotter, Shekar Kurpad, Brian K Kwon, Ralph J Marino, 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, James S Harrop
Introduction: The objective of this guideline is to outline the role of magnetic resonance imaging (MRI) in clinical decision making and outcome prediction in patients with traumatic spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions related to the use of MRI in patients with traumatic SCI. This review focused on longitudinal studies that controlled for baseline neurologic status. A multidisciplinary Guideline Development Group (GDG) used this information, their clinical expertise, and patient input to develop recommendations on the use of MRI for SCI patients...
September 2017: Global Spine Journal
https://www.readbyqxmd.com/read/29164027/a-clinical-practice-guideline-for-the-management-of-degenerative-cervical-myelopathy-introduction-rationale-and-scope
#20
Michael G Fehlings, Lindsay A Tetreault, K Daniel Riew, James W Middleton, Jeffrey C Wang
Degenerative cervical myelopathy (DCM) is a progressive spine disease and the most common cause of spinal cord dysfunction in adults worldwide. Patients with DCM may present with common signs and symptoms of neurological dysfunction, such as paresthesia, abnormal gait, decreased hand dexterity, hyperreflexia, increased tone, and sensory dysfunction. Clinicians across several specialties encounter patients with DCM, including primary care physicians, rehabilitation specialists, therapists, rheumatologists, neurologists, and spinal surgeons...
September 2017: Global Spine Journal
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