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Clinical Decision System

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https://www.readbyqxmd.com/read/29334119/evaluation-of-four-variants-of-the-thyroid-imaging-reporting-and-data-system-tirads-classification-in-patients-with-multinodular-goiter
#1
Bartosz Migda, Michal Migda, Anna Marta Migda, Jacek Bierca, Jadwiga Slowniska-Srzednicka, Wieslaw Jakubowski, Rafal Zenon Slapa
Purpose The goal this study was to evaluate the utility of four variants of the Thyroid Imaging Reporting and Data System (TIRADS) in the differentiation of focal lesions in individuals with multinodular goiter. Materials and Methods The study was approved by the Local Bioethical Committee. Each patient gave informed consent before enrolment. A total of 163 nodules in 124 patients with multinodular goiter were evaluated by ultrasound. B-mode and PD imaging and strain elastography were performed. Archived images were evaluated via retrospective analysis using four different proposed TIRADS classifications Results Sensitivity and specificity of the Horvath, Park, Kwak, and Russ classifications were 0...
January 15, 2018: Endokrynologia Polska
https://www.readbyqxmd.com/read/29333145/moving-toward-standardization-of-urine-albumin-measurements
#2
Jesse C Seegmiller, W Greg Miller, Lorin M Bachmann
Measurement of urine albumin is important for detecting and monitoring kidney disease. At the present time, measurement of urine albumin is not standardized due to the lack of a reference system, which includes both a reference measurement procedure and certified reference materials. Developing a reference system will provide a means for clinical laboratory measurement procedures to become standardized and will enable successful use of uniform clinical decision points. Currently, urine albumin results vary in excess of 40% depending on which commercially available measurement procedure is utilized for measurement...
December 2017: EJIFCC
https://www.readbyqxmd.com/read/29332975/enhancing-the-clinical-value-of-medical-laboratory-testing
#3
REVIEW
Kenneth A Sikaris
The value of medical laboratory testing is often directed to the cost of testing however the clinical benefits of these tests are at least as important. Laboratory testing has an acknowledged widespread role in clinical decision making, and therefore a role in determining clinical outcome. Consequently, the value of laboratory testing should be considered in its role in affecting beneficial actions and outcomes. This includes both the requesting phase of choosing tests which will influence clinical decision making as well as the reporting phase in a way that guides clinical decisions and actions...
November 2017: Clinical Biochemist. Reviews
https://www.readbyqxmd.com/read/29332020/predictors-of-improvements-in-mental-health-from-mindfulness-meditation-in-stressed-older-adults
#4
Barry S Oken, Elena Goodrich, Daniel Klee, Tabatha Memmott, Jeffrey Proulx
Context • The benefits of a mindfulness meditation (MM) intervention are most often evidenced by improvements in self-rated stress and mental health. Given the physiological complexity of the psychological stress system, it is likely that some people benefit significantly, whereas others do not. Clinicians and researchers could benefit from further exploration to determine which baseline factors can predict clinically significant improvements from MM. Objectives • The study intended to determine (1) whether the baseline measures for participants who significantly benefitted from MM training were different from the baseline measures of participants who did not, and (2) whether a classification analysis using a decision-tree, machine-learning approach could be useful in predicting which individuals would be most likely to improve...
January 2018: Alternative Therapies in Health and Medicine
https://www.readbyqxmd.com/read/29331967/understanding-frailty-a-qualitative-study-of-european-healthcare-policy-makers-approaches-to-frailty-screening-and-management
#5
Holly Gwyther, Rachel Shaw, Eva-Amparo Jaime Dauden, Barbara D'Avanzo, Donata Kurpas, Maria Bujnowska-Fedak, Tomasz Kujawa, Maura Marcucci, Antonio Cano, Carol Holland
OBJECTIVE: To elicit European healthcare policy-makers' views, understanding and attitudes about the implementation of frailty screening and management strategies and responses to stakeholders' views. DESIGN: Thematic analysis of semistructured qualitative interviews. SETTING: European healthcare policy departments. PARTICIPANTS: Seven European healthcare policy-makers representing the European Union (n=2), UK (n=2), Italy (n=1), Spain (n=1) and Poland (n=1)...
January 13, 2018: BMJ Open
https://www.readbyqxmd.com/read/29331966/effectiveness-and-safety-of-oral-sedation-in-adult-patients-undergoing-dental-procedures-protocol-for-a-systematic-review
#6
Jimmy de Oliveira Araújo, Rogério Heládio Lopes Motta, Cristiane de Cássia Bergamaschi, Caio Chaves Guimarães, Juliana Cama Ramacciato, Natalia Karol de Andrade, Mabel Fernandes Fiqueiró, Luciane Cruz Lopes
INTRODUCTION: The management of anxious patients undergoing dental procedures is still a challenge in clinical practice. Despite a wide variety of drugs for oral sedation in adult patients, there are relatively few systematic reviews that compare the effectiveness and safety of different drugs administered via this route. Thus, this study will evaluate the effectiveness and safety of oral sedation with benzodiazepines and other agents to patients undergoing dental surgical procedures...
January 13, 2018: BMJ Open
https://www.readbyqxmd.com/read/29331965/right-iliac-fossa-pain-treatment-rift-study-protocol-for-an-international-multicentre-prospective-observational-study
#7
Dmitri Nepogodiev
INTRODUCTION: Patients presenting with right iliac fossa (RIF) pain are a common challenge for acute general surgical services. Given the range of potential pathologies, RIF pain creates diagnostic uncertainty and there is subsequent variation in investigation and management. Appendicitis is a diagnosis which must be considered in all patients with RIF pain; however, over a fifth of patients undergoing appendicectomy, in the UK, have been proven to have a histologically normal appendix (negative appendicectomy)...
January 13, 2018: BMJ Open
https://www.readbyqxmd.com/read/29331259/public-and-physician-s-expectations-and-ethical-concerns-about-electronic-health-record-benefits-outweigh-risks-except-for-information-security
#8
Eleni Entzeridou, Evgenia Markopoulou, Vasiliki Mollaki
INTRODUCTION: Electronic Health Record systems (EHRs) offer numerous benefits in health care but also pose certain risks. As we progress toward the implementation of EHRs, a more in-depth understanding of attitudes that influence overall levels of EHR support is required. OBJECTIVES: To record public and physicians' awareness, expectations for, and ethical concerns about the use of EHRs. METHODS: A convenience sample was surveyed for both the public and physicians...
February 2018: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/29331253/evaluation-of-three-machine-learning-models-for-self-referral-decision-support-on-low-back-pain-in-primary-care
#9
Wendy Oude Nijeweme-d'Hollosy, Lex van Velsen, Mannes Poel, Catharina G M Groothuis-Oudshoorn, Remko Soer, Hermie Hermens
BACKGROUND: Most people experience low back pain (LBP) at least once in their life and for some patients this evolves into a chronic condition. One way to prevent acute LBP from transiting into chronic LBP, is to ensure that patients receive the right interventions at the right moment. We started research in the design of a clinical decision support system (CDSS) to support patients with LBP in their self-referral to primary care. For this, we explored the possibilities of using supervised machine learning...
February 2018: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/29331072/transcranial-ultrasonographic-image-analysis-system-for-decision-support-in-parkinson-disease
#10
Andrius Sakalauskas, Vita Špečkauskienė, Kristina Laučkaitė, Rytis Jurkonis, Daiva Rastenytė, Arūnas Lukoševičius
OBJECTIVES: Transcranial ultrasonography (US) is a relatively new neuroimaging modality proposed for early diagnostics of Parkinson disease (PD). The main limitation of transcranial US image-based diagnostics is a high degree of subjectivity caused by low quality of the transcranial images. The article presents a developed image analysis system and evaluates the potential of automated image analysis on transcranial US. METHODS: The system consists of algorithms for the segmentation and assessment of informative brain regions (midbrain and substantia nigra) and a decision support subsystem, which is equipped with 64 classification algorithms...
January 13, 2018: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
https://www.readbyqxmd.com/read/29330992/client-satisfaction-and-decision-making-amongst-females-visiting-family-planning-clinics-in-hyderabad-pakistan
#11
Arbia Memon, Saima Hamid, Ramesh Kumar
BACKGROUND: Family Planning is the basic right of the human being. It involves decision regarding the number of children and desired space between children by the couple themselves. Quality services involving multiple dimensions build the confidence of the clients and lack of quality is one of the constraints behind incomplete coverage of family planning. Objectives of the current study were to determine the client satisfaction, decision-making process and various influences on clients in adopting family planning methods...
October 2017: Journal of Ayub Medical College, Abbottabad: JAMC
https://www.readbyqxmd.com/read/29330835/international-guidelines-for-groin-hernia-management
#12
(no author information available yet)
INTRODUCTION: Worldwide, more than 20 million patients undergo groin hernia repair annually. The many different approaches, treatment indications and a significant array of techniques for groin hernia repair warrant guidelines to standardize care, minimize complications, and improve results. The main goal of these guidelines is to improve patient outcomes, specifically to decrease recurrence rates and reduce chronic pain, the most frequent problems following groin hernia repair. They have been endorsed by all five continental hernia societies, the International Endo Hernia Society and the European Association for Endoscopic Surgery...
January 12, 2018: Hernia: the Journal of Hernias and Abdominal Wall Surgery
https://www.readbyqxmd.com/read/29330755/-lymphoma-in-rheumatic-diseases
#13
REVIEW
A Rubbert-Roth, J T Bittenbring, G Assmann
Various systemic inflammatory diseases, such as rheumatoid arthritis (RA), Sjögren's syndrome and systemic lupus erythematosus (SLE) are associated with an increased risk for the development of lymphomas. Studies on patients with RA and Sjögren's syndrome have shown that there is a clear association of the incidence of lymphoma with the severity and activity of the disease and lymphomas in particular are diseases which preferentially occur in immunosuppressed patients; therefore, knowledge of the different lymphoma subtypes, their prognosis and treatment options are important for rheumatologists...
October 2017: Zeitschrift Für Rheumatologie
https://www.readbyqxmd.com/read/29330714/evidence-based-recommendations-to-improve-the-safe-use-of-drugs-in-patients-with-liver-cirrhosis
#14
Rianne A Weersink, Margriet Bouma, David M Burger, Joost P H Drenth, S Froukje Harkes-Idzinga, Nicole G M Hunfeld, Herold J Metselaar, Margje H Monster-Simons, Katja Taxis, Sander D Borgsteede
INTRODUCTION: The presence of liver cirrhosis can have a major impact on pharmacodynamics and pharmacokinetics, but guidance for prescribing is lacking. OBJECTIVE: The aim of this study is to provide an overview of evidence-based recommendations developed for the safe use of drugs in liver cirrhosis. METHODS: Recommendations were based on a systematic literature search combined with expert opinion from a panel of 10 experts. The safety of each drug was classified as safe, no additional risks known, additional risks known, unsafe, unknown or the safety class was dependent on the severity of liver cirrhosis (Child-Pugh classification)...
January 12, 2018: Drug Safety: An International Journal of Medical Toxicology and Drug Experience
https://www.readbyqxmd.com/read/29330336/risk-factors-for-survival-in-patients-with-von-hippel-lindau-disease
#15
Jiang-Yi Wang, Shuang-He Peng, Teng Li, Xiang-Hui Ning, Sheng-Jie Liu, Bao-An Hong, Jia-Yuan Liu, Peng-Jie Wu, Bo-Wen Zhou, Jing-Cheng Zhou, Nie-Nie Qi, Xiang Peng, Jiu-Feng Zhang, Kai-Fang Ma, Lin Cai, Kan Gong
BACKGROUND: Historically, von Hippel-Lindau (VHL) disease is characterised by a poor survival. Although genotype-phenotype correlation has been described in many studies, the risk factors for VHL survival remain unclear. This study aims to evaluate the median survival of Chinese patients with VHL disease and explore whether VHL survival is influenced by genetic and clinical factors. METHODS: In this retrospective study, we recruited 340 patients from 127 VHL families...
January 12, 2018: Journal of Medical Genetics
https://www.readbyqxmd.com/read/29329301/estimated-mortality-on-hiv-treatment-among-active-patients-and-patients-lost-to-follow-up-in-4-provinces-of-zambia-findings-from-a-multistage-sampling-based-survey
#16
Charles B Holmes, Izukanji Sikazwe, Kombatende Sikombe, Ingrid Eshun-Wilson, Nancy Czaicki, Laura K Beres, Njekwa Mukamba, Sandra Simbeza, Carolyn Bolton Moore, Cardinal Hantuba, Peter Mwaba, Caroline Phiri, Nancy Padian, David V Glidden, Elvin Geng
BACKGROUND: Survival represents the single most important indicator of successful HIV treatment. Routine monitoring fails to capture most deaths. As a result, both regional assessments of the impact of HIV services and identification of hotspots for improvement efforts are limited. We sought to assess true mortality on treatment, characterize the extent under-reporting of mortality in routine health information systems in Zambia, and identify drivers of mortality across sites and over time using a multistage, regionally representative sampling approach...
January 2018: PLoS Medicine
https://www.readbyqxmd.com/read/29325160/implementing-electronic-health-record-default-settings-to-reduce-opioid-overprescribing-a-pilot-study
#17
Kara Zivin, Jessica O White, Sandra Chao, Anna L Christensen, Luke Horner, Dana M Petersen, Morgan R Hobbs, Grace Capreol, Kevin A Halbritter, Christopher M Jones
Objective: To pilot test the effectiveness, feasibility, and acceptability of instituting a 15-pill quantity default in the electronic health record for new Schedule II opioid prescriptions. Design: A mixed-methods pilot study in two health systems, including pre-post analysis of prescribed opioid quantity and focus groups or interviews with prescribers and health system administrators. Methods: We implemented a 15-pill electronic health record default for new Schedule II opioids and assessed opioid quantity before and after implementation using electronic health record data on 6,390 opioid prescriptions from 448 prescribers...
January 9, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/29324970/watson-for-oncology-and-breast-cancer-treatment-recommendations-agreement-with-an-expert-multidisciplinary-tumor-board
#18
S P Somashekhar, M-J Sepúlveda, S Puglielli, A D Norden, E H Shortliffe, C Rohit Kumar, A Rauthan, N Arun Kumar, P Patil, K Rhee, Y Ramya
Background: Breast cancer oncologists are challenged to personalize care with rapidly changing scientific evidence, drug approvals, and treatment guidelines. Artificial intelligence (AI) clinical decision-support systems (CDSSs) have the potential to help address this challenge. We report here the results of examining the level of agreement (concordance) between treatment recommendations made by the AI CDSS Watson for Oncology (WFO) and a multidisciplinary tumor board for breast cancer...
January 9, 2018: Annals of Oncology: Official Journal of the European Society for Medical Oncology
https://www.readbyqxmd.com/read/29324535/evaluating-the-role-of-f-18-fluorodeoxyglucose-positron-emission-tomography-computed-tomography-scanning-in-the-staging-of-patients-with-stage-iiib-cervical-carcinoma-and-the-impact-on-treatment-decisions
#19
Marguerite Morkel, Annare Ellmann, James Warwick, Hannah Simonds
OBJECTIVE: FIGO (International Federation of Gynaecology and Obstetrics) staging is currently the most widely used clinical staging system for cervical cancer; however, this staging system has many shortcomings. One of these shortcomings is that lymph nodal status, specifically the para-aortic lymph nodal status, does not get taken into account. It is known that metabolic changes occur before changes are seen on anatomical imaging, and it is therefore possible to detect metastases earlier with the help of fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT)...
January 10, 2018: International Journal of Gynecological Cancer
https://www.readbyqxmd.com/read/29322820/reevaluation-of-the-critically-ill-patients-with-nonconvulsive-status-epilepticus-by-using-salzburg-consensus-criteria
#20
Ozlem Gungor Tuncer, Ebru Altindag, Sevda Ozel Yildiz, Mecbure Nalbantoglu, Mehmet Eren Acik, Sedef Tavukcu Ozkan, Betul Baykan
OBJECTIVE: We aimed to assess the usefulness of the Salzburg Consensus Criteria (SCC) for determining the prognosis of critically ill patients with nonconvulsive status epilepticus (NCSE). METHODS: We retrospectively reviewed consecutive patients with unconsciousness followed up in the intensive care unit (ICU). Three clinical neurophysiologists, one of them blinded to clinical and laboratory data, reevaluated all EEG data independently and determined NCSE according to SCC...
January 1, 2018: Clinical EEG and Neuroscience: Official Journal of the EEG and Clinical Neuroscience Society (ENCS)
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