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Clinical decision making

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https://www.readbyqxmd.com/read/28343164/a-quantitative-concordance-measure-for-comparing-and-combining-treatment-selection-markers
#1
Zhiwei Zhang, Shujie Ma, Lei Nie, Guoxing Soon
Motivated by an HIV example, we consider how to compare and combine treatment selection markers, which are essential to the notion of precision medicine. The current literature on precision medicine is focused on evaluating and optimizing treatment regimes, which can be obtained by dichotomizing treatment selection markers. In practice, treatment decisions are based not only on efficacy but also on safety, cost and individual preference, making it difficult to choose a single cutoff value for all patients in all settings...
March 25, 2017: International Journal of Biostatistics
https://www.readbyqxmd.com/read/28342989/patient-engagement-and-study-design-of-prop-up-a-multi-site-patient-centered-prospective-observational-study-of-patients-undergoing-hepatitis-c-treatment
#2
Donna M Evon, Carol E Golin, Paul Stewart, Michael W Fried, Shani Alston, Bryce Reeve, Anna S Lok, Richard K Sterling, Joseph K Lim, Nancy Reau, Souvik Sarkar, David R Nelson, K Rajender Reddy, Adrian M Di Bisceglie
BACKGROUND: New highly efficacious direct-acting antiviral (DAA) therapies are available to treat chronic hepatitis C viral (HCV) infection. Real-world, patient-centered data on harms and benefits associated with these therapies are needed. METHODS: PROP UP is a multi-center prospective observational study that plans to enroll 1600 patients starting treatment with recently-approved DAA regimens. Informed by extensive input from a HCV patient engagement group who prioritized outcomes most important to them, patient-reported outcomes will be characterized using surveys at five time points: Baseline (T1), treatment week 4 (T2), end of treatment (T3), 12weeks post-treatment (T4), 12months post-treatment (T5)...
March 22, 2017: Contemporary Clinical Trials
https://www.readbyqxmd.com/read/28342681/understanding-the-usefulness-of-prognostic-models-in-clinical-decision-making
#3
Adrian C Traeger, Markus Hübscher, James H McAuley
No abstract text is available yet for this article.
March 14, 2017: Journal of Physiotherapy
https://www.readbyqxmd.com/read/28340046/validation-of-a-screening-risk-index-for-serious-prescription-opioid-induced-respiratory-depression-or-overdose-in-a-us-commercial-health-plan-claims-database
#4
Barbara K Zedler, William B Saunders, Andrew R Joyce, Catherine C Vick, E Lenn Murrelle
Objective.:  To validate a risk index that estimates the likelihood of overdose or serious opioid-induced respiratory depression (OIRD) among medical users of prescription opioids. Subjects and Methods.:  A case-control analysis of 18,365,497 patients with an opioid prescription from 2009 to 2013 in the IMS PharMetrics Plus commercially insured health plan claims database (CIP). An OIRD event occurred in 7,234 cases. Four controls were selected per case. Validity of the Risk Index for Overdose or Serious Opioid-induced Respiratory Depression (RIOSORD), developed previously using Veterans Health Administration (VHA) patient data, was assessed...
March 6, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28339729/how-to-monitor-safety-and-efficacy-of-biologic-treatment-in-rare-therapy-refractory-immune-mediated-inflammatory-diseases-making-the-right-clinical-decisions-for-rare-diseases-with-the-right-tools
#5
https://www.readbyqxmd.com/read/28339692/decrease-in-unnecessary-vitamin-d-testing-using-clinical-decision-support-tools-making-it-harder-to-do-the-wrong-thing
#6
Andrew H Felcher, Rachel Gold, David M Mosen, Ashley B Stoneburner
Objective: To evaluate the impact of clinical decision support (CDS) tools on rates of vitamin D testing. Screening for vitamin D deficiency has increased in recent years, spurred by studies suggesting vitamin D's clinical benefits. Such screening, however, is often unsupported by evidence and can incur unnecessary costs. Materials and Methods: We evaluated how rates of vitamin D screening changed after we implemented 3 CDS tools in the electronic health record (EHR) of a large health plan: (1) a new vitamin D screening guideline, (2) an alert that requires clinician acknowledgement of current guidelines to continue ordering the test (a "hard stop"), and (3) a modification of laboratory ordering preference lists that eliminates shortcuts...
February 19, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28339561/computational-models-used-to-assess-us-tobacco-control-policies
#7
Shari P Feirman, Allison M Glasser, Shyanika Rose, Ray Niaura, David B Abrams, Lyubov Teplitskaya, Andrea C Villanti
Introduction: Simulation models can be used to evaluate existing and potential tobacco control interventions, including policies. The purpose of this systematic review was to synthesize evidence from computational models used to project population-level effects of tobacco control interventions. We provide recommendations to strengthen simulation models that evaluate tobacco control interventions. Methods: Studies were eligible for review if they employed a computational model to predict the expected effects of a non-clinical US-based tobacco control intervention...
January 21, 2017: Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco
https://www.readbyqxmd.com/read/28337731/arthroplasty-registries-around-the-world-valuable-sources-of-hip-implant-revision-risk-data
#8
REVIEW
Richard E Hughes, Aditi Batra, Brian R Hallstrom
PURPOSE OF REVIEW: National and regional arthroplasty registries have proliferated since the Swedish Knee Arthroplasty Register was started in 1975. Registry reports typically present implant-specific estimates of revision risk and patient- and technique-related factors that can inform clinical decision-making about implants and techniques. However, annual registry reports are long and it is difficult for clinicians to extract comparable revision risk data. Since implants may appear in multiple registry reports, it is even more difficult to gather relevant data for clinical decision-making about implant selection...
March 23, 2017: Current Reviews in Musculoskeletal Medicine
https://www.readbyqxmd.com/read/28337730/current-concepts-of-shared-decision-making-in-orthopedic-surgery
#9
REVIEW
Kevin Klifto, Christopher Klifto, James Slover
PURPOSE OF REVIEW: The Shared Decision Making (SDM) model, a collaborative decision making process between the physician and patient to make an informed clinical decision that enhances the chance of treatment success as defined by each patient's preferences and values, has become a new and promising tool in the healthcare process; however, minimal data exists on its application in the orthopedic surgical specialty. Increasing evidence has demonstrated that this once novel idea can be implemented successfully in the orthopedic setting to improve patient outcomes...
March 23, 2017: Current Reviews in Musculoskeletal Medicine
https://www.readbyqxmd.com/read/28337167/research-recommendations-for-improving-measurement-of-treatment-effectiveness-in-depression
#10
Kaloyan Kamenov, María Cabello, Mónica Nieto, Renaldo Bernard, Elisabeth Kohls, Christine Rummel-Kluge, José L Ayuso-Mateos
Background: Despite the steadily escalating psychological and economic burden of depression, there is a lack of evidence for the effectiveness of available interventions on functioning areas beyond symptomatology. Therefore, the main objective of this study was to give an insight into the current measurement of treatment effectiveness in depression and to provide recommendations for its improvement. Materials and Methods: The study was based on a multi-informant approach, comparing data from a systematic literature review, an expert survey with representatives from clinical practice (130), and qualitative interviews with patients (11) experiencing depression...
2017: Frontiers in Psychology
https://www.readbyqxmd.com/read/28336740/towards-personalised-intra-arterial-treatment-of-patients-with-acute-ischaemic-stroke-a-study-protocol-for-development-and-validation-of-a-clinical-decision-aid
#11
Maxim J H L Mulder, Esmee Venema, Bob Roozenbeek, Joseph P Broderick, Sharon D Yeatts, Pooja Khatri, Olvert A Berkhemer, Yvo B W E M Roos, Charles B L M Majoie, Robert J van Oostenbrugge, Wim H van Zwam, Aad van der Lugt, Ewout W Steyerberg, Diederik W J Dippel, Hester F Lingsma
INTRODUCTION: Overall, intra-arterial treatment (IAT) proved to be beneficial in patients with acute ischaemic stroke due to a proximal occlusion in the anterior circulation. However, heterogeneity in treatment benefit may be relevant for personalised clinical decision-making. Our aim is to improve selection of patients for IAT by predicting individual treatment benefit or harm. METHODS AND ANALYSIS: We will use data collected in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) trial to analyse the effect of baseline characteristics on outcome and treatment effect...
March 22, 2017: BMJ Open
https://www.readbyqxmd.com/read/28336504/mhealth-for-clinical-decision-making-in-sub-saharan-africa-a-scoping-review
#12
Ibukun-Oluwa Omolade Adepoju, Bregje Joanna Antonia Albersen, Vincent De Brouwere, Jos van Roosmalen, Marjolein Zweekhorst
BACKGROUND: In a bid to deliver quality health services in resource-poor settings, mobile health (mHealth) is increasingly being adopted. The role of mHealth in facilitating evidence-based clinical decision-making through data collection, decision algorithms, and evidence-based guidelines, for example, is established in resource-rich settings. However, the extent to which mobile clinical decision support systems (mCDSS) have been adopted specifically in resource-poor settings such as Africa and the lessons learned about their use in such settings are yet to be established...
March 23, 2017: JMIR MHealth and UHealth
https://www.readbyqxmd.com/read/28336485/low-dose-computed-tomography-for-lung-cancer-screening-clinical-and-coding-considerations
#13
REVIEW
Yiwey Shieh, Martin Bohnenkamp
Lung cancer screening with low-dose computed tomography (LDCT) was shown to reduce lung cancer mortality in the National Lung Screening Trial, a large randomized-controlled trial of high-risk current and former smokers. Despite ongoing uncertainty over the effectiveness of LDCT in the real-world setting, the Centers for Medicare and Medicaid Services (CMS) decided to cover LDCT as a preventive service. As part of its national coverage determination, CMS set forth a series of requirements for reimbursement of LDCT, including a counseling and shared decision-making visit prior to a LDCT being ordered...
March 21, 2017: Chest
https://www.readbyqxmd.com/read/28335889/human-papillomavirus-as-prognostic-marker-with-rising-prevalence-in-neck-squamous-cell-carcinoma-of-unknown-primary-a-retrospective-multicentre-study
#14
Lea Schroeder, Paolo Boscolo-Rizzo, Elisa Dal Cin, Salvatore Romeo, Lorena Baboci, Gerhard Dyckhoff, Jochen Hess, Carlota Lucena-Porcel, Anne Byl, Nikolaus Becker, Laia Alemany, Xavier Castellsagué, Miquel Quer, Xavier León, Manuel Wiesenfarth, Michael Pawlita, Dana Holzinger
Patients with neck squamous cell carcinomas of unknown primary tumour (NSCCUP) present with lymph node metastasis without evidence for a primary tumour. Most patients undergo an aggressive multimodal treatment, which induces severe, potentially unnecessary toxicity. Primary tumours of NSCCUP can be hidden in the oropharynx. Human papillomavirus (HPV) is causally involved in a subgroup of oropharyngeal squamous cell carcinomas (OPSCC) associated with early lymph node metastasis and good prognosis. Detection of markers for HPV transformation in NSCCUP could allow focussing on the oropharynx in primary tumour search and could be of value for choice and extent of treatment...
March 2017: European Journal of Cancer
https://www.readbyqxmd.com/read/28335700/cochlear-implants-in-the-management-of-hearing-loss-in-neurofibromatosis-type-2
#15
Frances Harris, James R Tysome, Neil Donnelly, Juliette Durie-Gair, Gemma Crundwell, Yu Chuen Tam, Richard D Knight, Zebunnisa H Vanat, Nicola Folland, Patrick Axon
OBJECTIVE: Review of cochlear implant (CI) outcomes in patients with Neurofibromatosis Type 2 (NF2), implanted in the presence of an ipsilateral vestibular schwannoma (VS). Hearing restoration was combined in some cases with a Bevacizumab regime. METHOD: Retrospective review of 12 patients, managed over the period 2009-2016, at a tertiary referral multidisciplinary NF2 clinic. The patients are grouped by hearing outcomes to explore likely protective factors, and to generate a proposed decision-making tool for the selection of either CI or Auditory Brainstem Implant (ABI)...
March 24, 2017: Cochlear Implants International
https://www.readbyqxmd.com/read/28334802/engagement-strategies-that-foster-community-self-determination-in-participatory-research-insider-ownership-through-outsider-championship
#16
Jon Salsberg, Soultana Macridis, Enrique Garcia Bengoechea, Ann C Macaulay, Spencer Moore
Background.: In order to maximize the benefits of community-based participatory research, effective ownership over the research process must be at least equally in the hands of the community. A previous social network analysis documented that the participatory research process shifted ownership from academic to community partners, but did not show what actions and strategies fostered this shift. Objectives.: This study follows the trajectory of a community-academic partnership and asks, from the perspective of the project stakeholders, which actions and strategies over the lifespan of the research led to the observed shift in ownership and decision-making from the original external academics to the community stakeholders? Methods...
February 18, 2017: Family Practice
https://www.readbyqxmd.com/read/28334585/uptake-and-utilization-of-practice-guidelines-in-hospitals-in-the-united-states-the-case-of-routine-episiotomy
#17
Katy B Kozhimannil, Pinar Karaca-Mandic, Cori J Blauer-Peterson, Neel T Shah, Jonathan M Snowden
BACKGROUND: The gap between publishing and implementing guidelines differs based on practice setting, including hospital geography and teaching status. On March 31, 2006, a Practice Bulletin published by the American College of Obstetricians and Gynecologists (ACOG) recommended against the routine use of episiotomy and urged clinicians to make judicious decisions to restrict the use of the procedure. OBJECTIVE: This study investigated changes in trends of episiotomy use before and after the ACOG Practice Guideline was issued in 2006, focusing on differences by hospital geographic location (rural/urban) and teaching status...
January 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28334309/long-term-surveillance-following-intralesional-steroid-injection-for-benign-vocal-fold-lesions
#18
Chi-Te Wang, Mei-Shu Lai, Po-Wen Cheng
Importance: The short-term outcomes of vocal fold steroid injection (VFSI) are well documented. However, few studies have reported the long-term outcomes following VFSI. Objective: To investigate the incidence rates of symptom recurrence and secondary interventions following VFSI for benign vocal fold lesions. Design, Setting, and Participants: This prospective cohort study was conducted at a tertiary referral medical center in Taipei, Taiwan...
March 23, 2017: JAMA Otolaryngology—Head & Neck Surgery
https://www.readbyqxmd.com/read/28334018/development-of-an-evidence-evaluation-and-synthesis-system-for-drug-drug-interactions-and-its-application-to-a-systematic-review-of-hiv-and-malaria-co-infection
#19
Kay Seden, Sara Gibbons, Catia Marzolini, Jonathan M Schapiro, David M Burger, David J Back, Saye H Khoo
BACKGROUND: In all settings, there are challenges associated with safely treating patients with multimorbidity and polypharmacy. The need to characterise, understand and limit harms resulting from medication use is therefore increasingly important. Drug-drug interactions (DDIs) are prevalent in patients taking antiretrovirals (ARVs) and if unmanaged, may pose considerable risk to treatment outcome. One of the biggest challenges in preventing DDIs is the substantial gap between theory and clinical practice...
2017: PloS One
https://www.readbyqxmd.com/read/28333829/acute-traumatic-coagulopathy-the-elephant-in-a-room-of-blind-scientists
#20
Michael A Meledeo, Maryanne C Herzig, James A Bynum, Xiaowu Wu, Anand K Ramasubramanian, Daniel N Darlington, Kristin M Reddoch, Andrew P Cap
Acute traumatic coagulopathy (ATC) is the failure of coagulation homeostasis that can rapidly arise following traumatic injury, hemorrhage, and shock; it is associated with higher injury severity, coagulation abnormalities, and increased blood transfusions. ATC has historically been defined by a prolonged prothrombin time (PT), although newer, more informative measurements of hemostatic function have been employed to improve diagnosis and support clinical decision making. The underlying biochemical mechanisms of and best practice therapeutics for ATC remain under active investigation because of its significant correlation to poor outcomes...
March 22, 2017: Journal of Trauma and Acute Care Surgery
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