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Clinical Decision System

Jamie Ross, Fiona Stevenson, Rosa Lau, Elizabeth Murray
BACKGROUND: There is a significant potential for e-health to deliver cost-effective, quality health care, and spending on e-health systems by governments and healthcare systems is increasing worldwide. However, there remains a tension between the use of e-health in this way and implementation. Furthermore, the large body of reviews in the e-health implementation field, often based on one particular technology, setting or health condition make it difficult to access a comprehensive and comprehensible summary of available evidence to help plan and undertake implementation...
October 26, 2016: Implementation Science: IS
Barbara Pfistermeister, Brita Sedlmayr, Andrius Patapovas, Gerald Suttner, Ozan Tektas, Aleksey Tarkhov, Johannes Kornhuber, Martin F Fromm, Thomas Bürkle, Hans-Ulrich Prokosch, Renke Maas
BACKGROUND: A well-known problem in current clinical decision support systems (CDSS) is the high number of alerts, which are often medically incorrect or irrelevant. This may lead to the so-called alert fatigue, an overriding of alerts, including those that are clinically relevant, and underuse of CDSS in general. OBJECTIVES: The aim of our study was to develop and to apply a standardized tool that allows its users to evaluate the quality of system-generated drug alerts...
October 26, 2016: Methods of Information in Medicine
Yeliz Karaca, Yudong Zhang, Carlo Cattani
Our purpose is to develop a clinical decision support system to classify the patients' diagnostics based on features gathered from Magnetic Resonance Imaging (MRI) and Expanded Disability Status Scale (EDSS). We studied 120 patients and 19 healthy individuals (not afflicted with MS) have been studied for this study. Healthy individuals in the control group do not have any complaint or drug use history. For the kernel trick, efficient performance in non-linear classification, the Convex Combination of Infinite Kernels model was developed to measure the health status of patients based on features gathered from MRI and EDSS...
October 24, 2016: CNS & Neurological Disorders Drug Targets
Randall C Edgell, Ahmed E Sarhan, Jazba Soomro, Collin Einertson, Joanna Kemp, Peyman Shirani, Theodore K Malmstrom, Jeroen Coppens
BACKGROUND: Central nervous system vasculitis (CNSV) is a rare disorder, the pathophysiology of which is not fully understood. It involves a combination of inflammation and thrombosis. CNSV is most commonly associated with headache, gradual changes in mental status, and focal neurological symptoms. Diagnosis requires the effective use of history, laboratory testing, imaging, and biopsy. Catheter angiography can be a powerful tool in the diagnosis when common and low-frequency angiographic manifestations of CNSV are considered...
September 2016: Interventional Neurology
Benjamin A Steinberg
Atrial fibrillation (AF) is the most common cardiac arrhythmia, and conveys a significant risk of morbidity and mortality due to related stroke and systemic embolism. Oral anticoagulation (OAC) is the mainstay of thromboembolism prevention and management of anticoagulation can be challenging. For patients without significant valvular disease, decisions around anticoagulation therapy are first based on the presence of additional stroke risk factors, as measured by the CHA2DS2-VASc score. Patients with increased CHA2DS2-VASc scores (by regional guidelines) should next be evaluated to determine if they are candidates for non-vitamin K antagonist oral anticoagulant (NOAC) therapy...
October 25, 2016: Blood
Faina Linkov, Benita Valappil, Jacob McAfee, Sharon L Goughnour, Douglas M Hildrew, Andrew A McCall, Igor Linkov, Barry Hirsch, Carl Snyderman
OBJECTIVE: To integrate multiple sources of clinical information with patient feedback to build evidence-based decision support model to facilitate treatment selection for patients suffering from vestibular schwannomas (VS). METHODS: This was a mixed methods study utilizing focus group and survey methodology to solicit feedback on factors important for making treatment decisions among patients. Two 90-minute focus groups were conducted by an experienced facilitator...
September 30, 2016: American Journal of Otolaryngology
Amanda Elton, Christopher T Smith, Michael H Parrish, Charlotte A Boettiger
Excessively choosing immediate over larger future rewards, or delay discounting (DD), associates with multiple clinical conditions. Individual differences in DD likely depend on variations in the activation of and functional interactions between networks, representing possible endophenotypes for associated disorders, including alcohol use disorders. Numerous fMRI studies have probed the neural bases of DD, but investigations of large-scale networks remain scant. We addressed this gap by testing whether activation within large-scale networks during Now/Later decision-making predicts individual differences in DD...
October 25, 2016: Journal of Cognitive Neuroscience
Kun Zhong, Wei Wang, Chuanbao Zhang, Falin He, Shuai Yuan, Zhiguo Wang
BACKGROUND: Clinical laboratory tests are important for clinicians to make diagnostic decisions, but discrepancies may directly lead to incorrect diagnosis. We would like to introduce some statistical methods to evaluate the comparability of chemistry analytes while comparing the performances of different measurement systems. METHODS: We used a panel of 10 fresh-frozen single donation serum samples to assess assays for the measurement of glucose and other 13 analytes...
2016: SpringerPlus
Karsten A van Loon, Pim W Teunissen, Erik W Driessen, Fedde Scheele
BACKGROUND : Entrustable professional activities (EPAs) seek to translate essential physician competencies into clinical practice. Until now, it is not known whether EPA-based curricula offer enhanced assessment and feedback to trainees. OBJECTIVE : This study examined program directors' and senior residents' justifications for entrustment decisions and what role generic, cross-specialty competencies (such as communication skills, collaboration, and understanding health care systems) play in these decisions...
October 2016: Journal of Graduate Medical Education
Marlies Decleer, Andreja Rajkovic, Benedikt Sas, Annemieke Madder, Sarah De Saeger
Rapid and accurate UPLC-MS/MS methods for the simultaneous determination of beauvericin and the related enniatins (A, A1, B, B1), together with cereulide were successfully developed and validated in cereal and cereal-based food matrices such as wheat, maize, rice and pasta. Although these emerging foodborne toxins are of different microbial origin, the similar structural, toxicological and food safety features provided rationale for their concurrent detection in relevant food matrices. A Waters Acquity UPLC system coupled to a Waters Quattro Premier XE™ Mass Spectrometer operating in ESI+ mode was employed...
October 4, 2016: Journal of Chromatography. A
Christopher R Friese, Yun Li, Irina Bondarenko, Timothy P Hofer, Kevin C Ward, Ann S Hamilton, Dennis Deapen, Allison W Kurian, Steven J Katz
BACKGROUND: The 21-gene recurrence score (RS) assay stratifies early-stage, estrogen receptor-positive breast cancer by recurrence risk. Few studies have examined the ways in which physicians use the RS to recommend adjuvant systemic chemotherapy or patients' experiences with testing and decision making. METHODS: This study surveyed 3880 women treated for breast cancer in 2013-2014; they were identified from the Los Angeles County and Georgia Surveillance, Epidemiology, and End Results registries (response rate, 71%)...
October 24, 2016: Cancer
Matthew A Jarrett, Anna Van Meter, Eric A Youngstrom, Dane C Hilton, Thomas H Ollendick
Guidelines exist for the assessment of attention deficit/hyperactivity disorder (ADHD), but they are often unclear as to how a clinician should consider multiple informants, methods, and co-occurring symptoms to reach an overall diagnostic probability for an individual patient. The current study used receiver operating characteristic analyses and evidence-based medicine methods to evaluate the Achenbach System of Empirically Based Assessment measures and the Conners' Continuous Performance Test for ADHD diagnosis in youth...
October 24, 2016: Journal of Clinical Child and Adolescent Psychology
Neil M D'Souza, Penny Fang, Jennifer Logan, Jinzhong Yang, Wen Jiang, Jing Li
Malignancies of the central nervous system (CNS), particularly glioblastoma and brain metastases from a variety of disease sites, are difficult to treat despite advances in multimodality approaches consisting of surgery, chemotherapy, and radiation therapy (RT). Recent successes of immunotherapeutic strategies including immune checkpoint blockade (ICB) via anti-PD-1 and anti-CTLA-4 antibodies against aggressive cancers, such as melanoma, non-small cell lung cancer, and renal cell carcinoma, have presented an exciting opportunity to translate these strategies for CNS malignancies...
2016: Frontiers in Oncology
Robert A Jenders, Klaus-Peter Adlassnig, Karsten Fehre, Peter Haug
BACKGROUND: The initial version of the Arden Syntax for Medical Logic Systems was created to facilitate explicit representation of medical logic in a form that could be easily composed and interpreted by clinical experts in order to facilitate clinical decision support (CDS). Because of demand from knowledge engineers and programmers to improve functionality related to complex use cases, the Arden Syntax evolved to include features typical of general programming languages but that were specialized to meet the needs of the clinical decision support environment, including integration into a clinical information system architecture...
August 11, 2016: Artificial Intelligence in Medicine
Vijay Christopher Kannan, Nicole Hodgson, Andrew Lau, Kate Goodin, Andrea Freyer Dugas, Frank LoVecchio
STUDY OBJECTIVE: We seek to use a novel layered-surveillance approach to localize influenza clusters within an acute care population. The first layer of this system is a syndromic surveillance screen to guide rapid polymerase chain reaction testing. The second layer is geolocalization and cluster analysis of these patients. We posit that any identified clusters could represent at-risk populations who could serve as high-yield targets for preventive medical interventions. METHODS: This was a prospective observational surveillance study...
November 2016: Annals of Emergency Medicine
Mary Anne Purtzer, Carol J Hermansen-Kobulnicky
PURPOSE/OBJECTIVES: To investigate oncology professionals' perspectives about, experience with, and envisioned feasibility of incorporating patient self-monitoring as a patient-centered practice. 
. RESEARCH APPROACH: An interpretive, descriptive study.
. SETTING: Four health systems and five cancer centers in three states. 
. PARTICIPANTS: 38 nurses, nurse practitioners, oncologists, physician assistants, and radiation therapists...
November 1, 2016: Oncology Nursing Forum
Marcos Augusto Bastos Dias, Rosa Maria Soares Madeira Domingues, Arthur Orlando Corrêa Schilithz, Marcos Nakamura-Pereira, Maria do Carmo Leal
BACKGROUND: The rate of cesarean delivery (CD) in Brazil has increased over the past 40 years. The CD rate in public services is three times above the World Health Organization recommended values. Among strategies to reduce CD, the most important is reduction of primary cesarean. This study aimed to describe factors associated with CD during labor in primiparous women with a single cephalic pregnancy assisted in the Brazilian Public Health System (SUS). METHODS: This study is part of the Birth in Brazil survey, a national hospital-based study of 23,894 postpartum women and their newborns...
October 17, 2016: Reproductive Health
Alistair E W Johnson, Mohammad M Ghassemi, Shamim Nemati, Katherine E Niehaus, David A Clifton, Gari D Clifford
Clinical data management systems typically provide caregiver teams with useful information, derived from large, sometimes highly heterogeneous, data sources that are often changing dynamically. Over the last decade there has been a significant surge in interest in using these data sources, from simply re-using the standard clinical databases for event prediction or decision support, to including dynamic and patient-specific information into clinical monitoring and prediction problems. However, in most cases, commercial clinical databases have been designed to document clinical activity for reporting, liability and billing reasons, rather than for developing new algorithms...
February 2016: Proceedings of the IEEE
Jason W Beckstead
BACKGROUND: Brunswik's Lens Model and lens model equation (LME) have been applied extensively in medical decision making. Clinicians often face the dual challenge of formulating a judgment of patient risk for some adverse outcome and making a yes or no decision regarding a particular risk-reducing treatment option. OBJECTIVE: In this article, I examine the correlation between clinical risk judgments and treatment-related decisions, referring to this linkage as "cohesion"...
October 20, 2016: Medical Decision Making: An International Journal of the Society for Medical Decision Making
Sofian Berrouiguet, Maria Luisa Barrigón, Sara A Brandt, Santiago Ovejero-García, Raquel Álvarez-García, Juan Jose Carballo, Philippe Lenca, Philippe Courtet, Enrique Baca-García
PURPOSE: The emergence of electronic prescribing devices with clinical decision support systems (CDSS) is able to significantly improve management pharmacological treatments. We developed a web application available on smartphones in order to help clinicians monitor prescription and further propose CDSS. METHOD: A web application ( was developed to assess patients and collect data regarding gender, age, diagnosis and treatment. We analyzed antipsychotic prescriptions in 4345 patients attended in five Psychiatric Community Mental Health Centers from June 2014 to October 2014...
2016: PloS One
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