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Clinical Decision System

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https://www.readbyqxmd.com/read/29778017/the-preconception-care-experiences-of-women-with-epilepsy-on-sodium-valproate
#1
Lorna Lawther, Helen Dolk, Marlene Sinclair, Jim Morrow
PURPOSE: To understand the preconception experiences of women with epilepsy who have been taking the teratogenic drug valproate. METHODS: Seven women were recruited, three from a preconception clinic and four from an antenatal clinic in a region of the UK. All had taken valproate preconceptionally. Three preconception clinic encounters were observed and audio-recorded. Interviews with all women were analysed using Interpretative Phenomenological Analysis (IPA). RESULTS: Women experienced a "trajectory of balance"...
May 16, 2018: Seizure: the Journal of the British Epilepsy Association
https://www.readbyqxmd.com/read/29777325/developing-an-interactive-data-visualization-tool-to-assess-the-impact-of-decision-support-on-clinical-operations
#2
Timothy C Huber, Arun Krishnaraj, Dayna Monaghan, Cree M Gaskin
Due to mandates from recent legislation, clinical decision support (CDS) software is being adopted by radiology practices across the country. This software provides imaging study decision support for referring providers at the point of order entry. CDS systems produce a large volume of data, providing opportunities for research and quality improvement. In order to better visualize and analyze trends in this data, an interactive data visualization dashboard was created using a commercially available data visualization platform...
May 18, 2018: Journal of Digital Imaging: the Official Journal of the Society for Computer Applications in Radiology
https://www.readbyqxmd.com/read/29776758/using-preference-learning-for-detecting-inconsistencies-in-clinical-practice-guidelines-methods-and-application-to-antibiotherapy
#3
Rosy Tsopra, Jean-Baptiste Lamy, Karima Sedki
Clinical practice guidelines provide evidence-based recommendations. However, many problems are reported, such as contradictions and inconsistencies. For example, guidelines recommend sulfamethoxazole/trimethoprim in child sinusitis, but they also state that there is a high bacteria resistance in this context. In this paper, we propose a method for the semi-automatic detection of inconsistencies in guidelines using preference learning, and we apply this method to antibiotherapy in primary care. The preference model was learned from the recommendations and from a knowledge base describing the domain...
May 15, 2018: Artificial Intelligence in Medicine
https://www.readbyqxmd.com/read/29776002/the-chaos-of-hospitalisation-for-patients-with-critical-limb-ischaemia-approaching-major-amputation
#4
Susan Monaro, Sandra West, Jana Pinkova, Janice Gullick
AIMS AND OBJECTIVES: To illuminate the hospital experience for patients and families when major amputation has been advised for critical limb ischaemia (CLI). BACKGROUND: CLI creates significant burden to the health system and the family, particularly as the person with CLI approaches amputation. Major amputation is often offered as a late intervention for CLI in response to the marked deterioration of an ischaemic limb, and functional decline from reduced mobility, intractable pain, infection and/or toxaemia...
May 18, 2018: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/29775771/a-detailed-analysis-of-the-arden-syntax-expression-grammar
#5
Stefan Kraus, Marc Rosenbauer, Lutz Schröder, Thomas Bürkle, Klaus-Peter Adlassnig, Dennis Toddenroth
OBJECTIVE: The Arden Syntax for Medical Logic Systems is a standard for encoding and sharing medical knowledge in the form of Medical Logic Modules. To improve accessibility for clinicians, the originators of the standard deliberately designed Arden Syntax expressions to resemble natural language, and parentheses around operands are not generally required. For certain patterns of nested expressions, however, the use of parentheses is mandatory, otherwise they are not accepted by an Arden Syntax environment...
May 15, 2018: Journal of Biomedical Informatics
https://www.readbyqxmd.com/read/29775092/a-prospective-multi-centre-us-clinical-trial-to-determine-accuracy-of-febridx-point-of-care-testing-for-acute-upper-respiratory-infections-with-and-without-a-confirmed-fever
#6
Nathan I Shapiro, Wesley H Self, Jeffrey Rosen, Stephan C Sharp, Michael R Filbin, Peter C Hou, Amisha D Parekh, Michael C Kurz, Robert Sambursky
BACKGROUND: FebriDx is a 10-minute disposable point-of-care test designed to identify clinically significant systemic host immune responses and aid in the differentiation of bacterial and viral respiratory infection by simultaneously detecting C-reactive protein (CRP) and myxovirus resistance protein A (MxA) from a fingerstick blood sample. FebriDx diagnostic accuracy was evaluated in the emergency room and urgent care setting. METHODS: A prospective, multicentre, observational cohort study of acute upper respiratory tract infections (URIs), with and without a confirmed fever at the time of enrolment, was performed to evaluate the diagnostic accuracy of FebriDx to identify clinically significant bacterial infection with host response and acute pathogenic viral infection...
May 18, 2018: Annals of Medicine
https://www.readbyqxmd.com/read/29774168/evaluating-the-potential-for-maximized-t-cell-redistribution-entropy-to-improve-abscopal-responses-to-radiotherapy
#7
Rachel Walker, Jonathan D Schoenfeld, Shari Pilon-Thomas, Jan Poleszczuk, Heiko Enderling
The potential for local radiation therapy to elicit systemic (abscopal) anti-tumor immune responses has been receiving a significant amount of attention over the last decade. We recently developed a mathematical framework designed to simulate the systemic dissemination of activated T cells among multiple metastatic sites. This framework allowed the identification of non-intuitive patterns of T cell redistribution after localized therapy, and offered suggestions as to the optimal site to irradiate in order to increase the magnitude of an immune-mediated abscopal response...
September 2017: Convergent Science Physical Oncology
https://www.readbyqxmd.com/read/29773274/scleroderma-in-children
#8
REVIEW
Francesco Zulian
Juvenile scleroderma with its two varieties, juvenile localized scleroderma and systemic sclerosis (SSc), represents the third most frequent rheumatic disease in childhood. In juvenile SSc, new developments have been recently reported in the fields of classification and monitoring. The introduction of new classification criteria for adult SSc has stimulated new ideas on how to improve the performance of the provisional 2007 PRES/ACR/EULAR pediatric criteria. The introduction of a multidimensional severity score, named "J4S," which includes parameters on growth, skin, and internal organ involvement, has improved the approach to the patients in the daily practice to guide decision-making...
August 2017: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/29772102/novel-nomograms-for-castration-resistant-prostate-cancer-and-survival-outcome-in-patients-with-de-novo-bone-metastatic-prostate-cancer
#9
Jinge Zhao, Guangxi Sun, Banghua Liao, Xingming Zhang, Cameron M Armstrong, Xiaoxue Yin, Jiandong Liu, Junru Chen, Yaojing Yang, Peng Zhao, Qidun Tang, Zhenghao Wang, Zhibin Chen, Xiong Li, Qiang Wei, Xiang Li, Ni Chen, Allen C Gao, Pengfei Shen, Hao Zeng
OBJECTIVES: To develop nomograms predicting the incidence of castration resistant prostate cancer (CRPC) and overall survival (OS) for de novo metastatic prostate cancer (mPCa). MATERIALS AND METHODS: Data from 449 de novo mPCa patients were retrospectively analyzed. Patients were randomly divided into the training (n=314, 70%) and validation cohort (n=135, 30%). Predictive factors were selected by Cox-proportional model and further used for building predictive models...
May 17, 2018: BJU International
https://www.readbyqxmd.com/read/29771897/is-general-practice-identification-of-prior-cardiovascular-disease-at-the-time-of-cvd-risk-assessment-accurate-and-does-it-matter
#10
Sue Wells, Katrina Poppe, Vanessa Selak, Andrew Kerr, Romana Pylypchuk, Billy Wu, Wing Cheuk Chan, Corina Grey, Suneela Mehta, Dudley Gr Gentles, Rod Jackson
AIMS: To determine the accuracy of general practice recording of prior cardiovascular disease (CVD) at the time of CVD risk assessment and whether recording impacts on CVD management. METHODS: Prior CVD status entered at the time of a first CVD risk assessment from 2002-2015 was compared to prior ischaemic CVD hospitalisations from national datasets using anonymous linkage with an encrypted National Health Index identifier. Clinical factors associated with inaccurate recording of prior events were identified using multivariable logistic regression...
May 18, 2018: New Zealand Medical Journal
https://www.readbyqxmd.com/read/29771251/-ebm-guidelines-protocols-knowledge-attitudes-and-utilization-in-the-era-of-law-on-professional-responsibility-and-safety-of-health-care
#11
Silvia Minozzi, Francesca Ruggiero, Matteo Capobussi, Marien González-Lorenzo, Micaela La Regina, Alessandro Squizzato, Lorenzo Moja, Francesco Orlandini
INTRODUCTION: <AbstractText Label="INTRODUCTION" NlmCategory="BACKGROUND">The knowledge of principles and methods of Evidence Based Medicine (EBM) and the use of Clinical Practice Guidelines to inform clinical decisions are recognised as key instruments to improve the quality of care. In Italy the Parliament has revised the legal system that rules the responsibilities of health professionals and health care safety, prescribing health professionals to adhere to guidelines and good practice recommendations...
May 2018: Recenti Progressi in Medicina
https://www.readbyqxmd.com/read/29771247/-innovative-medicinal-products-the-new-criteria-of-the-italian-medicines-agency
#12
Federica Mammarella, Giovanni Tafuri
The Italian Medicines Agency (AIFA), which has the dual function of a regulatory and a reimbursement authority, has recently established new criteria to define innovative medicinal products. Indeed, the decision making process to grant the innovative status is based on the evaluation of the unmet medical need, the added therapeutic value compared to existing therapeutic options and the overall quality of clinical evidence, which is assessed based on the GRADE system. Following this evaluation, if a medicinal product is granted the status of "full innovativeness" for a specific therapeutic indication, its manufacturer can access dedicated yearly funds amounting to 500 million Euros each, depending on the type of medicine (one fund for oncology, the other for all other innovative medicinal products)...
May 2018: Recenti Progressi in Medicina
https://www.readbyqxmd.com/read/29771203/understanding-how-nurses-ration-care
#13
Clare Lynette Harvey, Shona Thompson, Eileen Willis, Alannah Meyer, Maria Pearson
Purpose The purpose of this paper is to explore how nurses make decisions to ration care or leave it undone within a clinical environment that is controlled by systems level cost containment. The authors wanted to find out what professional, personal and organisational factors contribute to that decision-making process. This work follows previous international research that explored missed nursing care using Kalisch and Williams' MISSCARE survey. Design/methodology/approach The authors drew on the care elements used by Kalisch and Williams, asking nurses to tell us how they decided what care to leave out, the conduits for which could include delaying care during a shift, delegating care to another health professional on the same shift, handing care over to staff on the next shift or leaving care undone...
May 21, 2018: Journal of Health Organization and Management
https://www.readbyqxmd.com/read/29770210/identification-of-publicly-available-data-sources-to-inform-the-conduct-of-health-technology-assessment-in-india
#14
Laura Downey, Neethi Rao, Lorna Guinness, Miqdad Asaria, Shankar Prinja, Anju Sinha, Rajni Kant, Arvind Pandey, Francoise Cluzeau, Kalipso Chalkidou
Background: Health technology assessment (HTA) provides a globally-accepted and structured approach to synthesising evidence for cost and clinical effectiveness alongside ethical and equity considerations to inform evidence-based priorities. India is one of the most recent countries to formally commit to institutionalising HTA as an integral component of the heath resource allocation decision-making process. The effective conduct of HTA depends on the availability of reliable data.   Methods : We draw from our experience of collecting, synthesizing, and analysing health-related datasets in India and internationally, to highlight the complex requirements for undertaking HTA, and explore the availability of such data in India...
2018: F1000Research
https://www.readbyqxmd.com/read/29770129/cutaneous-papillomaviruses-and-non-melanoma-skin-cancer-causal-agents-or-innocent-bystanders
#15
REVIEW
Daniel Hasche, Sabrina E Vinzón, Frank Rösl
There is still controversy in the scientific field about whether certain types of cutaneous human papillomaviruses (HPVs) are causally involved in the development of non-melanoma skin cancer (NMSC). Deciphering the etiological role of cutaneous HPVs requires - besides tissue culture systems - appropriate preclinical models to match the obtained results with clinical data from affected patients. Clear scientific evidence about the etiology and underlying mechanisms involved in NMSC development is fundamental to provide reasonable arguments for public health institutions to classify at least certain cutaneous HPVs as group 1 carcinogens...
2018: Frontiers in Microbiology
https://www.readbyqxmd.com/read/29768579/-cost-effectiveness-analysis-of-spontaneous-vaginal-delivery-and-elective-cesarean-for-normal-risk-pregnant-women-in-the-brazilian-unified-national-health-system
#16
Aline Piovezan Entringer, Márcia Pinto, Marcos Augusto Bastos Dias, Maria Auxiliadora de Souza Mendes Gomes
The purpose of this study was to conduct a cost-effectiveness analysis of spontaneous vaginal delivery and elective cesarean (with no clinical indication) for normal risk pregnant women, from the perspective of the Brazilian Unified National Health System. An analytical decision model was developed and included the choice of delivery mode and clinical consequences for mothers and newborns, from admission for delivery to hospital discharge. The reference population consisted of normal risk pregnant women with singleton, at-term gestations in cephalic position, subdivided into primiparas and multiparas with prior uterine scar...
May 10, 2018: Cadernos de Saúde Pública
https://www.readbyqxmd.com/read/29768417/what-are-the-implications-for-practice-that-arise-from-studies-of-medication-taking-a-systematic-review-of-qualitative-research
#17
Mohammed Ahmed Rashid, Nadia Llanwarne, Natalie Heyns, Fiona Walter, Jonathan Mant
BACKGROUND: Despite several decades of evidence supporting the benefits of taking medications in various diseases and healthcare settings, a significant proportion of prescribed treatments are not taken. This review sought to synthesise qualitative research exploring experiences of medication taking around the world, and to determine whether there were consistent messages arising from these studies. METHODS AND FINDINGS: 5 databases (MEDLINE, PsycINFO, EMBASE, SCOPUS, CINAHL) were systematically searched to identify published research papers using qualitative methodologies, which explored medication-taking experiences in patients, citizens, carers, relatives and clinicians...
2018: PloS One
https://www.readbyqxmd.com/read/29766138/risk-stratification-tools-in-emergency-general-surgery
#18
REVIEW
Joaquim Michael Havens, Alexandra B Columbus, Anupamaa J Seshadri, Carlos V R Brown, Gail T Tominaga, Nathan T Mowery, Marie Crandall
The use of risk stratification tools (RST) aids in clinical triage, decision making and quality assessment in a wide variety of medical fields. Although emergency general surgery (EGS) is characterized by a comorbid, physiologically acute patient population with disparately high rates of perioperative morbidity and mortality, few RST have been explicitly examined in this setting. We examined the available RST with the intent of identifying a tool that comprehensively reflects an EGS patients perioperative risk for death or complication...
2018: Trauma surgery & acute care open
https://www.readbyqxmd.com/read/29766136/can-necrotizing-soft-tissue-infection-be-reliably-diagnosed-in-the-emergency-department
#19
Sharon M Henry, Kimberly A Davis, Jonathan J Morrison, Thomas M Scalea
Necrotizing soft tissue infections (NSTIs) are associated with a high mortality and require prompt recognition and treatment, consisting of aggressive surgical debridement and critical care support. Diagnosis is a key step, which is generally made in the operating room (OR), but the decision to debride requires guidance. This is frequently made on clinical grounds, but NSTI can be occult in presentation and several other infective processes can mimic NSTI. It is unknown whether the various scoring systems described in the literature can enable clinicians to reliably diagnose NSTI in the emergency department, rather than the OR...
2018: Trauma Surg Acute Care Open
https://www.readbyqxmd.com/read/29765586/design-of-a-clinical-decision-support-system-for-fracture-prediction-using-imbalanced-dataset
#20
Yung-Fu Chen, Chih-Sheng Lin, Kuo-An Wang, La Ode Abdul Rahman, Dah-Jye Lee, Wei-Sheng Chung, Hsuan-Hung Lin
More than 1 billion people suffer from chronic respiratory diseases worldwide, accounting for more than 4 million deaths annually. Inhaled corticosteroid is a popular medication for treating chronic respiratory diseases. Its side effects include decreased bone mineral density and osteoporosis. The aims of this study are to investigate the association of inhaled corticosteroids and fracture and to design a clinical support system for fracture prediction. The data of patients aged 20 years and older, who had visited healthcare centers and been prescribed with inhaled corticosteroids within 2002-2010, were retrieved from the National Health Insurance Research Database (NHIRD)...
2018: Journal of Healthcare Engineering
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