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Clinical prediction rules

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https://www.readbyqxmd.com/read/28550759/venous-thromboembolism-in-the-elderly-a-narrative-review
#1
REVIEW
T Tritschler, D Aujesky
Persons aged ≥65years not only account for over 60% of venous thromboembolism (VTE) events, they have also a higher mortality and VTE-related morbidity than younger patients, including anticoagulation-related bleeding and the postthrombotic syndrome. However, only few studies have focused specifically on VTE in older persons and practice guidelines commonly extrapolate study results from younger healthier patients to the multimorbid elderly. Evidence suggests that the clinical presentation is more subtle in the elderly with VTE and that commonly used diagnostic modalities, including clinical prediction rules, D-dimer tests, and planar ventilation-perfusion scans are less specific and efficient in older persons...
May 17, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28549148/risk-factors-for-invasive-fungal-disease-in-pediatric-cancer-and-hematopoietic-stem-cell-transplantation-a-systematic-review
#2
Brian T Fisher, Paula D Robinson, Thomas Lehrnbecher, William J Steinbach, Theoklis E Zaoutis, Bob Phillips, Lillian Sung
Background.: Although a number of risk factors have been associated with invasive fungal disease (IFD), a systematic review of the literature to document pediatric-specific factors has not been performed. Methods.: We used the Ovid SP platform to search Medline, Medline In-Process, and Embase for studies that identified risk factors for IFD in children with cancer or those who undergo hematopoietic stem cell transplantation (HSCT). We included studies if they consisted of children or adolescents (<25 years) who were receiving treatment for cancer or undergoing HSCT and if the study evaluated risk factors among patients with and those without IFD...
May 26, 2017: Journal of the Pediatric Infectious Diseases Society
https://www.readbyqxmd.com/read/28545097/an-integrated-risk-predictor-for-pulmonary-nodules
#3
Paul Kearney, Stephen W Hunsucker, Xiao-Jun Li, Alex Porter, Steven Springmeyer, Peter Mazzone
It is estimated that over 1.5 million lung nodules are detected annually in the United States. Most of these are benign but frequently undergo invasive and costly procedures to rule out malignancy. A risk predictor that can accurately differentiate benign and malignant lung nodules could be used to more efficiently route benign lung nodules to non-invasive observation by CT surveillance and route malignant lung nodules to invasive procedures. The majority of risk predictors developed to date are based exclusively on clinical risk factors, imaging technology or molecular markers...
2017: PloS One
https://www.readbyqxmd.com/read/28544100/undetectable-concentrations-of-an-fda-approved-high-sensitivity-cardiac-troponin-t-assay-to-rule-out-acute-myocardial-infarction-at-emergency-department-arrival
#4
Andrew D McRae, Grant Innes, Michelle Graham, Eddy Lang, James E Andruchow, Yunqi Ji, Shabnam Vatanpour, Tasnima Abedin, Hong Yang, Danielle A Southern, Dongmei Wang, Isolde Seiden-Long, Lawrence DeKoning, Peter Kavsak
BACKGROUND: The objective of this study was to quantify the sensitivity of very low concentrations of high-sensitivity cardiac troponin T (hsTnT) at ED arrival for acute myocardial infarction (AMI) in a large cohort of chest pain patients evaluated in real-world clinical practice. METHODS: This retrospective study included consecutive ED patients with suspected cardiac chest pain evaluated in four urban EDs were, excluding those with ST-elevation AMI, cardiac arrest or abnormal kidney function...
May 19, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28539077/clinical-utility-of-the-mbias-and-nsi-validity-10-to-detect-symptom-over-reporting-following-mild-tbi-a-multicenter-investigation-with-military-service-members
#5
Patrick Armistead-Jehle, Douglas B Cooper, Chad E Grills, Wesley R Cole, Sara M Lippa, Robert L Stegman, Rael T Lange
Self-report measures are commonly relied upon in military healthcare environments to assess service members following a mild traumatic brain injury (mTBI). However, such instruments are susceptible to over-reporting and rarely include validity scales. This study evaluated the utility of the mild Brain Injury Atypical Symptoms scale (mBIAS) and the Neurobehavioral Symptom Inventory Validity-10 scale to detect symptom over-reporting. A total of 359 service members with a reported history of mTBI were separated into two symptom reporting groups based on MMPI-2-RF validity scales (i...
May 25, 2017: Journal of Clinical and Experimental Neuropsychology
https://www.readbyqxmd.com/read/28538606/assessing-severity-in-pediatric-pneumonia-predictors-of-the-need-for-major-medical-interventions
#6
Are Stuwitz Berg, Christopher Stephen Inchley, Hans Olav Fjaerli, Truls Michael Leegaard, Britt Nakstad
OBJECTIVE: The aim of this study was to determine potential predictors of the need for major medical interventions in the context of assessing severity in pediatric pneumonia. METHODS: This was a prospective, cohort study of previously healthy children and adolescents younger than 18 years presenting to the pediatric emergency room with clinically suspected pneumonia and examining both the full cohort and those with radiologically confirmed pneumonia. The presence of hypoxemia (peripheral oxygen saturation ≤92%), age-specific tachypnea, high temperature (≥38...
May 23, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28535410/effect-of-enzyme-inhibition-on-perampanel-pharmacokinetics-why-study-design-matters
#7
Barry E Gidal, Rama Maganti, Antonio Laurenza, Haichen Yang, David A Verbel, Edgar Schuck, Jim Ferry
OBJECTIVES: Perampanel, a selective, noncompetitive AMPA receptor antagonist, is indicated as adjunctive therapy for the treatment of partial seizures with or without secondarily generalized seizures and primary generalized tonic-clonic seizures in patients with epilepsy aged 12years and older. In vitro studies and Phase I trials indicate that perampanel is metabolized almost exclusively by CYP3A, with an elimination half-life (t1/2) averaging approximately 105h. Understanding of pharmacokinetic (PK) interactions-enzyme inhibition or induction-and anticipating their occurrence are important for management of patients with epilepsy...
April 26, 2017: Epilepsy Research
https://www.readbyqxmd.com/read/28534694/the-heart-score-for-early-rule-out-of-acute-coronary-syndromes-in-the-emergency-department-a-systematic-review-and-meta-analysis
#8
Patricia Van Den Berg, Richard Body
AIMS: The objective of this systematic review was to summarise the current evidence on the diagnostic accuracy of the HEART score for predicting major adverse cardiac events in patients presenting with undifferentiated chest pain to the emergency department. METHODS AND RESULTS: Two investigators independently searched Medline, Embase and Cochrane databases between 2008 and May 2016 identifying eligible studies providing diagnostic accuracy data on the HEART score for predicting major adverse cardiac events as the primary outcome...
May 1, 2017: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/28533062/predicting-inpatient-delirium-the-awol-delirium-risk-stratification-score-in-clinical-practice
#9
Ethan G Brown, S Andrew Josephson, Noriko Anderson, Mary Reid, Melissa Lee, Vanja C Douglas
Inpatient delirium improves with multicomponent interventions by hospital staff, though the resources needed are often limited. Risk-stratification to predict delirium is a useful first step to help triage resources, but the performance of risk-stratification as part of a functioning multicomponent pathway has not been assessed. We retrospectively studied the performance of a validated delirium prediction rule, the AWOL score, as a part of a multicomponent delirium care pathway in practice on a university hospital ward...
May 19, 2017: Geriatric Nursing
https://www.readbyqxmd.com/read/28533000/clinical-immunological-and-microbiological-predictors-of-poor-outcome-in-clostridium-difficile-infection
#10
E Reigadas, L Alcalá, M Marín, A Martín, E Bouza
BACKGROUND: Clostridium difficile infection (CDI) causes increased morbidity and mortality. Clinical data cannot clearly predict poor CDI outcome. Data on the value of microbiological predictors is scarce. OBJECTIVE: To identify early predictors of poor outcome of CDI. METHODS: We prospectively included patients with CDI aged >2years. Clinical, immunological (Toxin B IgG/Ig A and Toxin A IgG/Ig A), microbiological factors (bacterial load, toxin quantification, sporulation, germination, and metronidazole susceptibility) were evaluated to identify early independent predictors of poor outcome...
May 11, 2017: Diagnostic Microbiology and Infectious Disease
https://www.readbyqxmd.com/read/28517021/low-discriminating-power-of-the-modified-ottawa-vte-risk-score-in-a-cohort-of-patients-with-cancer-from-the-riete-registry
#11
Adriano Alatri, Lucia Mazzolai, Carme Font, Alfonso Tafur, Reina Valle, Pablo Javier Marchena, Aitor Ballaz, Eros Tiraferri, Llorenç Font, Manuel Monreal
Treatment of patients with cancer-associated venous thromboembolism (VTE) remains a major challenge. The modified Ottawa score is a clinical prediction rule evaluating the risk of VTE recurrences during the first six months of anticoagulant treatment in patients with cancer-related VTE. We aimed to validate the Ottawa score using data from the RIETE registry. A total of 11,123 cancer patients with VTE were included in the analysis. According to modified Ottawa score, 2,343 (21 %) were categorised at low risk for VTE recurrences, 4,525 (41 %) at intermediate risk, and 4,255 (38 %) at high risk...
May 18, 2017: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/28512853/derivation-and-validation-of-the-append-score-an-acute-appendicitis-clinical-prediction-rule
#12
Hinetamatea Mikaere, Irene Zeng, Melanie Lauti, Malsha Kularatna, Andrew D MacCormick
BACKGROUND: Although many clinical prediction rules (CPRs) for appendicitis exist, none have been developed for a New Zealand population presenting with right iliac fossa (RIF) pain. The aim of this study was to derive and validate an appendicitis CPR for our population. METHOD: This is a retrospective review of all patients from December 2010 to February 2012 of at least 15 years of age presenting to the general surgery service with RIF pain. Patient data were divided into derivation and validation groups...
May 16, 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/28506137/elevation-of-serum-park7-and-il-8-levels-is-associated-with-acute-lung-injury-in-patients-with-severe-sepsis-septic-shock
#13
Xiao-Wei Liu, Tao Ma, Quan Cai, Li Wang, Hong-Wei Song, Zhi Liu
OBJECTIVE: Methods containing only clinical information fail to meet the needs of prediction of acute lung injury (ALI) because of the relatively low positive predictive value. This study aimed to investigate the feasibility of using biomarkers as predictors of ALI in populations with severe sepsis/septic shock and to explore difference among biomarkers after adjustment for potential confounders. METHODS: Serum specimens were collected from patients with severe sepsis/septic shock (n = 172) presented to the emergency department...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28503347/wasting-of-extensor-digitorum-brevis-as-a-decisive-preoperative-clinical-indicator-of-lumbar-canal-stenosis-a-single-center-prospective-cohort-study
#14
S Munakomi, B M Kumar
BACKGROUND: The dilemma in managing patients with low back ache lies in differentiating radiculopathy from lumbar canal stenosis. This has a huge bearing in patients being planned for surgical intervention as underperforming leads to failed back syndrome whereas over-doing leads to instability. There still remains a loophole in clinically diagnosing lumbar canal stenosis. AIM: We opt to utilize a simple bedside clinical examination in routinely assessing patients presenting with low back ache in ruling out underlying canal stenosis...
September 2016: Annals of Medical and Health Sciences Research
https://www.readbyqxmd.com/read/28501724/different-manifestations-of-pulmonary-embolism-in-younger-compared-to-older-patients-clinical-presentation-prediction-rules-and-long-term-outcomes
#15
Izabela E Kiluk, Agnieszka Krajewska, Urszula Kosacka, Agnieszka Tycińska, Robert Milewski, Włodzimierz Musiał, Bożena Sobkowicz
PURPOSE: Data concerning specific manifestations of pulmonary embolism (PE) among younger patients are scarce. We aimed to evaluate differences in clinical presentation, PE prediction rules, thrombolytic treatment use and PE outcomes in younger (<50 years of age) compared to older patients. MATERIAL/METHODS: We studied 238 consecutive patients with proven PE who were retrospectively categorized into three PE probability subgroups according to the revised Geneva score (RGS) and Wells score (WS)...
May 11, 2017: Advances in Medical Sciences
https://www.readbyqxmd.com/read/28500753/a-0h-1h-protocol-for-safe-early-discharge-of-chest-pain-patients
#16
Arash Mokhtari, Bertil Lindahl, Alexandru Schiopu, Troels Yndigegn, Ardavan Khoshnood, Patrik Gilje, Ulf Ekelund
OBJECTIVES: Guidelines recommend a 0h/1h high-sensitivity cardiac troponin T (hs-cTnT) diagnostic strategy in acute chest pain patients. There is however little data on the performance of this strategy when combined with clinical risk stratification. We aimed to evaluate the diagnostic accuracy of an accelerated diagnostic protocol (ADP) using the 0h/1h hs-cTnT strategy together with an adapted Thrombolysis In Myocardial Infarction (TIMI) score and ECG for ruling out major adverse cardiac events (MACE) within 30 days...
May 13, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28495132/predicting-the-effects-of-potentially-therapeutic-modified-peptides-on-polyclonal-t-cell-populations-in-a-mouse-model-of-multiple-sclerosis
#17
Evan L Sauer, Elisabeth Trifilieff, Judith M Greer
Altered peptide ligands (APLs) have routinely been studied in clonal populations of Th cells that express a single T cell receptor (TCR), but results generated in this manner poorly predict the effects of APLs on polyclonal Th cells in vivo, contributing to the failure of phase II clinical trials of APLs in autoimmune diseases such as multiple sclerosis (MS). We have used a panel of APLs derived from an encephalitogenic epitope of myelin proteolipid protein to investigate the relationship between antigen cross-reactivity in a polyclonal environment, encephalitogenicity, and the capacity of an APL to provide protection against experimental autoimmune encephalomyelitis (EAE) in SJL mice...
June 15, 2017: Journal of Neuroimmunology
https://www.readbyqxmd.com/read/28494618/machine-learning-methods-to-predict-diabetes-complications
#18
Arianna Dagliati, Simone Marini, Lucia Sacchi, Giulia Cogni, Marsida Teliti, Valentina Tibollo, Pasquale De Cata, Luca Chiovato, Riccardo Bellazzi
One of the areas where Artificial Intelligence is having more impact is machine learning, which develops algorithms able to learn patterns and decision rules from data. Machine learning algorithms have been embedded into data mining pipelines, which can combine them with classical statistical strategies, to extract knowledge from data. Within the EU-funded MOSAIC project, a data mining pipeline has been used to derive a set of predictive models of type 2 diabetes mellitus (T2DM) complications based on electronic health record data of nearly one thousand patients...
May 1, 2017: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/28491335/the-risk-of-acute-rejection-following-kidney-transplant-by-25-hydroxyvitamin-d-and-1-25-dihydroxyvitamin-d-status-a-prospective-cohort-study
#19
Deborah Zimmerman, Andrew A House, S Joseph Kim, Ronald A Booth, Tinghua Zhang, Tim Ramsay, Greg Knoll
BACKGROUND: Prediction of acute kidney transplant rejection remains imperfect despite several known risk factors. There is an increasing appreciation of the potential importance of the vitamin D pathway in immunological disease and transplantation. OBJECTIVE: The purpose of this study was to determine the association of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D with acute rejection. DESIGN: This was a prospective cohort study. SETTING: Three academic adult kidney transplant programs in Ontario, Canada, were chosen...
2017: Canadian Journal of Kidney Health and Disease
https://www.readbyqxmd.com/read/28490554/feasibility-cluster-randomised-controlled-trial-of-a-within-consultation-intervention-to-reduce-antibiotic-prescribing-for-children-presenting-to-primary-care-with-acute-respiratory-tract-infection-and-cough
#20
Peter S Blair, Sophie Turnbull, Jenny Ingram, Niamh Redmond, Patricia Jane Lucas, Christie Cabral, Sandra Hollinghurst, Padraig Dixon, Tim Peters, Jeremy Horwood, Paul Little, Nick A Francis, Anna Gilbertson, Catherine Jameson, Alastair D Hay
OBJECTIVE: To investigate recruitment and retention, data collection methods and the acceptability of a 'within-consultation' complex intervention designed to reduce antibiotic prescribing. DESIGN: Primary care feasibility cluster randomised controlled trial. SETTING: 32 general practices in South West England recruiting children from October 2014 to April 2015. PARTICIPANTS: Children (aged 3 months to <12 years) with acute cough and respiratory tract infection (RTI)...
May 9, 2017: BMJ Open
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