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Clinical Decision System

Mariana V Meireles, Ana Roberta P Pascom, Elisabeth C Duarte
OBJECTIVE: To identify clinical, sociodemographic and treatment-related factors associated with early virological response in HIV-infected adults starting antiretroviral treatment (ART) in Brazil in 2014-2015. METHODS: Data from four information systems from the Brazilian AIDS Program were combined to create a historical cohort. Unconditional logistic regression models were used to assess the likelihood of not achieving virological suppression (VLS), defined as having either a viral load count (VL) >200 copies/mL or an aids-related death recorded within 180±90 days after treatment initiation...
March 19, 2018: Journal of Acquired Immune Deficiency Syndromes: JAIDS
Christopher Vernazza, Lauren Anderson, Andrew Ian Hunter, Helen Christine Leck, Stephen Daniel O'Connor, Gillian Rose Smith, Richard Joseph Stokes, Sarah Rolland
Introduction: Given the limited evidence about the benefits of orthodontic treatment, many health care systems have rationed access to orthodontic care with the Index of Orthodontic Treatment Need (IOTN) being one tool used to attempt to allocate resources based on need. However, it is not clear whether patient and public valuations of different levels of need (as described by the IOTN) reflect the resource allocation decisions. The aim of this project was therefore to determine the values parents placed on correction of malocclusions at different IOTN levels using the willingness to pay (WTP) technique...
April 1, 2018: JDR Clinical and Translational Research
Xiaosong He, Danielle S Bassett, Ganne Chaitanya, Michael R Sperling, Lauren Kozlowski, Joseph I Tracy
Temporal lobe epilepsy tends to reshape the language system causing maladaptive reorganization that can be characterized by task-based functional MRI, and eventually can contribute to surgical decision making processes. However, the dynamic interacting nature of the brain as a complex system is often neglected, with many studies treating the language system as a static monolithic structure. Here, we demonstrate that as a specialized and integrated system, the language network is inherently dynamic, characterized by rich patterns of regional interactions, whose transient dynamics are disrupted in patients with temporal lobe epilepsy...
March 15, 2018: Brain: a Journal of Neurology
Musallam Abukhalil, Osama Mehjez, Mohammed Aladdam, Bettina Bottcher, Sobhi Skaik, Mohammed Matter
BACKGROUND: In 2013, al-Shifa Hospital, the largest hospital in the Gaza Strip, introduced an assessment programme for potential kidney donors on the basis of medical and radiological evaluation. The aims of this study and an associated clinical audit were to examine the final outcome of the potential live kidney donors assessment programme, to review the findings and determine the level of accuracy of the radiological evaluations, to assess the completeness and standard of radiological record keeping, and to evaluate adherence to guidelines...
February 21, 2018: Lancet
Nikhil Satchidanand, Timothy J Servoss, Ranjit Singh, Angela M Bosinski, Penny Tirpak, Linda L Horton, Bruce J Naughton
BACKGROUND: Early, data-driven discussion surrounding palliative care can improve care delivery and patient experience. OBJECTIVE: To develop a 30-day mortality prediction tool for older patients in intensive care unit (ICU) with pneumonia that will initiate palliative care earlier in hospital course. DESIGN: Retrospective Electronic Health Record (EHR) review. SETTING: Four urban and suburban hospitals in a Western New York hospital system...
January 1, 2018: American Journal of Hospice & Palliative Care
Jun-Hua Zhang, You-Ping Li, Bo-Li Zhang
The introduction and popularization of evidence-based medicine has opened up a new research field of clinical efficacy evaluation of traditional Chinese medicine(TCM), produced new research ideas and methods, and promoted the progress of clinical research of TCM. After about 20 years assiduous study and earnest practice, the evidence based evaluation method and technique, which conforms to the characteristics of TCM theory and practice, has been developing continuously. Evidence-based Chinese medicine (EBCM) has gradually formed and become an important branch of evidence-based medicine...
January 2018: Zhongguo Zhong Yao za Zhi, Zhongguo Zhongyao Zazhi, China Journal of Chinese Materia Medica
Hui Li, Miguel Castro, Pascal Haigron, Jean-Philippe Verhoye, Vito Giovanni Ruggieri
PURPOSE: Minimally invasive aortic valve replacement (MIAVR) procedures remain more complex and technically challenging compared to conventional full sternotomy surgery. This technique involves a restricted surgical field and a limited workspace, which is, at present, strictly reserved for the most experienced surgeons. The MIAVR clinical outcomes are strongly dependent on the appropriate choice of the thoracic incision. This work presents a decision support system to optimize, through an interactive visualization interface, the exposure of the target structure in a limited field of view...
March 17, 2018: International Journal of Computer Assisted Radiology and Surgery
Priscila Pini Zenatti, Natacha Azussa Migita, Nathália Moreno Cury, Rosângela Aparecida Mendes-Silva, Fabio Cesar Gozzo, Pedro Otavio de Campos-Lima, José Andrés Yunes, Silvia Regina Brandalise
The drug l-asparaginase is a cornerstone in the treatment of acute lymphoblastic leukemia (ALL). The native E. colil-asparaginase used in Brazil until recently has been manufactured by Medac/Kyowa. Then a decision was taken by the Ministry of Health in 2017 to supply the National Health System with a cheaper alternative l-asparaginase manufactured by Beijing SL Pharmaceutical, called Leuginase®. As opposed to Medac, the asparaginase that has been in use in Brazil under the trade name of Aginasa®, it was not possible to find a single entry with the terms Leuginase in the Pubmed repository...
March 9, 2018: EBioMedicine
Wan Song, Seok Hwan Bang, Hwang Gyun Jeon, Byong Chang Jeong, Seong Il Seo, Seong Soo Jeon, Han Yong Choi, Chan Kyo Kim, Hyun Moo Lee
INTRODUCTION: The objective of this study was to investigate the effect of Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) on prediction of postoperative Gleason score (GS) upgrading for patients with biopsy GS 6 prostate cancer. PATIENTS AND METHODS: We retrospectively reviewed 443 patients who underwent magnetic resonance imaging (MRI) and radical prostatectomy for biopsy-proven GS 6 prostate cancer between January 2011 and December 2013. Preoperative clinical variables and pathologic GS were examined, and all MRI findings were assessed with PI-RADSv2...
February 23, 2018: Clinical Genitourinary Cancer
Rebecca J Mullen, James Duhig, Andrea Russell, Linda Scarazzini, Fabio Lievano, Michael S Wolf
OBJECTIVE: To present evidence supporting best-practices for prescription drug labeling and educational materials. METHODS: Articles were selected from three online databases (PubMed, Embase, CINAHL). Eligible manuscripts were: 1) English-language, 2) randomized, controlled trials, and 3) focused on improving prescription drug labeling practices. RESULTS: Forty-nine articles were reviewed, and included both regulated label materials and pharmacy or health systems-generated tools...
March 8, 2018: Patient Education and Counseling
Callum G Fraser
Colonoscopy is a relatively scarce resource in many countries, including Scotland, and a simple investigation which would aid general practitioners in particular in decision-making as to which patients presenting with lower bowel symptoms warranted referral would be of much help. Faecal immunochemical tests for haemoglobin (FIT) have many advantageous characteristics and are now proven to be of considerable value in the timely assessment of patients with symptoms of lower bowel disease. Quantitative FIT provide numerical estimates of faecal haemoglobin concentration (f-Hb) and, at low f-Hb cut-off, FIT have high sensitivity for colorectal cancer (CRC) and could be used as a rule-in test to stimulate rapid referral, especially when symptoms are suggestive of serious bowel disease...
March 13, 2018: Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
Terhi Toivo, Maarit Dimitrow, Juha Puustinen, Eeva Savela, Katariina Pelkonen, Valtteri Kiuru, Tuula Suominen, Sirkka Kinnunen, Mira Uunimäki, Sirkka-Liisa Kivelä, Saija Leikola, Marja Airaksinen
BACKGROUND: The magnitude of safety risks related to medications of the older adults has been evidenced by numerous studies, but less is known of how to manage and prevent these risks in different health care settings. The aim of this study was to coordinate resources for prospective medication risk management of home care clients ≥ 65 years in primary care and to develop a study design for demonstrating effectiveness of the procedure. METHODS: Health care units involved in the study are from primary care in Lohja, Southern Finland: home care (191 consented clients), the public healthcare center, and a private community pharmacy...
March 16, 2018: BMC Geriatrics
Bisher Sawaf, Fatima Abbas, Amr Idris, Tareq Al Saadi, Nazir Ibrahim
BACKGROUND: Little research addresses how medical students develop their choice of specialty training in crisis and resource-poor settings. The newly graduated medical students determine the future of the healthcare system. This study aims to elucidate the factors influencing Syrian medical students' specialty selection and students' intentions to study abroad. METHODS: A cross-sectional study carried out at the universities of Damascus, Al-Kalamoon and the Syrian Private University in Syria using self-administered questionnaire to investigate medical students' specialty preferences and plans for career future...
March 16, 2018: BMC Medical Education
Suzanne Grant, Bruce Guthrie
Patient safety is an increasing concern for health systems internationally. The majority of administrative work in UK general practice takes place in the context of organisational routines such as repeat prescribing and test results handling, where high workloads and increased clinician dependency on administrative staff have been identified as an emerging safety issue. Despite this trend, most research to date has focused on the redistribution of the clinical workload between doctors, nurses and allied health professionals within individual care settings...
March 2, 2018: Social Science & Medicine
Raphaël Le Bouc, Mathias Pessiglione
Motivation can be defined as the function that orients and activates the behavior. Motivation deficits such as apathy are pervasive in both neurological and psychiatric diseases, and are currently assessed with clinical scales that do not give any mechanistic insight. Here, we present another approach that consists in phenotyping the behaviour of patients in motivation tests, using computational models. These formal models impose a precise and operational definition of motivation that is embedded in decision theory...
March 2018: Médecine Sciences: M/S
Barbara J Howard, Raymond Sturner
Purpose of review: To describe benefits and problems with screening and addressing developmental and behavioral problems in primary care and using an online clinical process support system as a solution. Recent findings: Screening has been found to have various implementation barriers including time costs, accuracy, workflow and knowledge of tools. In addition, training of clinicians in dealing with identified issues is lacking. Patients disclose more to and prefer computerized screening...
December 2017: Current Developmental Disorders Reports
Hannah Major-Monfried, Anne S Renteria, Attaphol Pawarode, Pavan Reddy, Francis Ayuk, Ernst Holler, Yvonne A Efebera, William J Hogan, Matthias Wölfl, Muna Qayed, Elizabeth O Hexner, Kitsada Wudhikarn, Rainer Ordemann, Rachel Young, Jay Shah, Matthew J Hartwell, Mohammed Chaudhry, Mina Aziz, Aaron Etra, Gregory A Yanik, Nicolaus Kröger, Daniela Weber, Yi-Bin Chen, Ryotaro Nakamura, Wolf Rösler, Carrie L Kitko, Andrew C Harris, Michael Pulsipher, Ran Reshef, Steven Kowalyk, George Morales, Ivan Torres, Umut Özbek, James L M Ferrara, John E Levine
Acute graft versus host disease (GVHD) is treated with systemic corticosteroid immunosuppression. Clinical response after one week of therapy often guides further treatment decisions, but long term outcomes vary widely between centers and more accurate predictive tests are urgently needed. We analyzed clinical data and blood samples taken after one week of systemic treatment for GVHD from 507 patients from 17 centers of the Mount Sinai Acute GVHD International Consortium (MAGIC), dividing them into test (n=236) and two validation cohorts separated in time (n = 142 and 129, respectively)...
March 15, 2018: Blood
Aida Kamišalić, David Riaño, Tatjana Welzer
BACKGROUND: In medical practice, long term interventions are common and they require timely planning of the involved processes. Unfortunately, evidence-based statements about time are hard to find in Clinical Practice Guidelines (CPGs) and in other sources of medical knowledge. At the same time, health care centers use medical records and information systems to register data about clinical processes and patients, including time information about the encounters, prescriptions, and other clinical actions...
May 2018: Computer Methods and Programs in Biomedicine
Lee-Fay Low, Margaret McGrath, Kate Swaffer, Henry Brodaty
The aim of this study is to systematically review practitioners' practices and attitudes in regards to communicating a diagnosis of dementia. A systematic search was conducted of Scopus, Web of Science and PubMed for English language original empirical papers. A sequential explanatory mixed studies analysis approach was used. Twenty-five quantitative descriptive, two intervention, six mixed methods descriptive and 21 qualitative studies were included. Pooled analysis showed that 34% of GPs and 48% of specialists usually/routinely tell the person with dementia their diagnosis, and 89% of GPs and 97% specialists usually/routinely tell the family the diagnosis...
January 1, 2018: Dementia
G H Renier Botha, Grant Theron, Rob Warren, Marisa Klopper, Kheertan Dheda, Paul van Helden, Thomas R Niesler
Globally, tuberculosis (TB) remains one of the most deadly diseases. Although several effective diagnosis methods exist, in lower income countries clinics may not be in a position to afford expensive equipment and employ the trained experts needed to interpret results. In these situations, symptoms including cough are commonly used to identify patients for testing. However, self-reported cough has suboptimal sensitivity and specificity, which may be improved by digital detection. This study investigates a simple and easily applied method for TB screening based on the automatic analysis of coughing sounds...
March 15, 2018: Physiological Measurement
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