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Clinical Decision System

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https://www.readbyqxmd.com/read/27933569/decision-making-in-clinical-practice-oral-anticoagulant-therapy-in-patients-with-non-valvular-atrial-fibrillation-and-a-single-additional-stroke-risk-factor
#1
REVIEW
Tatjana S Potpara, Nikolaos Dagres, Nebojša Mujović, Dragan Vasić, Milika Ašanin, Milan Nedeljkovic, Francisco Marin, Laurent Fauchier, Carina Blomstrom-Lundqvist, Gregory Y H Lip
Approximately 1 in 3-4 patients presenting with an ischemic stroke will also have atrial fibrillation (AF), and AF-related strokes can be effectively prevented using oral anticoagulant therapy (OAC), either with well-controlled vitamin K antagonists (VKAs) or non-vitamin K antagonist oral anticoagulants (NOACs). In addition, OAC use (both VKAs and NOACs) is associated with a 26% reduction in all-cause mortality (VKAs) or an additional 10% mortality reduction with NOACs relative to VKAs. The decision to use OAC in individual AF patient is based on the estimated balance of the benefit from ischemic stroke reduction against the risk of major OAC-related bleeding [essentially intracranial hemorrhage (ICH)]...
December 8, 2016: Advances in Therapy
https://www.readbyqxmd.com/read/27933399/implementation-of-clinical-decision-support-in-young-children-with-acute-gastroenteritis-a-randomized-controlled-trial-at-the-emergency-department
#2
Dorien Geurts, Evelien de Vos-Kerkhof, Suzanne Polinder, Ewout Steyerberg, Johan van der Lei, Henriëtte Moll, Rianne Oostenbrink
: Acute gastroenteritis (AGE) is one of the most frequent reasons for young children to visit emergency departments (EDs). We aimed to evaluate (1) feasibility of a nurse-guided clinical decision support system for rehydration treatment in children with AGE and (2) the impact on diagnostics, treatment, and costs compared with usual care by attending physician. A randomized controlled trial was performed in 222 children, aged 1 month to 5 years at the ED of the Erasmus MC-Sophia Children's hospital in The Netherlands ( 2010-2012)...
December 8, 2016: European Journal of Pediatrics
https://www.readbyqxmd.com/read/27932197/crucial-role-of-carotid-ultrasound-for-the-rapid-diagnosis-of-hyperacute-aortic-dissection-complicated-by-cerebral-infarction-a-case-report-and-literature-review
#3
Eglė Sukockienė, Kristina Laučkaitė, Antanas Jankauskas, Dalia Mickevičienė, Giedrė Jurkevičienė, Antanas Vaitkus, Edgaras Stankevičius, Kęstutis Petrikonis, Daiva Rastenytė
Aortic dissection is a life-threatening rare condition that may virtually present by any organ system dysfunction, the nervous system included. Acute cerebral infarction among multiple other neurological and non-neurological presentations is part of this acute aortic syndrome. Rapid and correct diagnosis is of extreme importance keeping in mind the possibility of thrombolytic treatment if a patient with a suspected ischemic stroke arrives to the Emergency Department within a 4.5-h window after symptom onset...
November 19, 2016: Medicina
https://www.readbyqxmd.com/read/27931698/the-effectiveness-of-nurse-led-preoperative-assessment-clinics-for-patients-receiving-elective-orthopaedic-surgery-a-systematic-review
#4
Chan Sau-Man Conny, Ip Wan-Yim
PURPOSE: Nurse-led preoperative assessment clinics (POAC) have been introduced in different specialty areas to assess and prepare patients preoperatively in order to avoid last-minute surgery cancellations. Not all patients are referred to POACs before surgery, and the benefits of nurse-led POACs are not well documented in Hong Kong. The purpose of this systemic review was to identify the best available research evidence to inform current clinical practice, guide health care decision making and promote better care...
December 2016: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
https://www.readbyqxmd.com/read/27930361/determining-the-appropriate-model-complexity-for-patient-specific-advice-on-mechanical-ventilation
#5
Stephen E Rees, Dan S Karbing
Mathematical physiological models can be applied in medical decision support systems. To do so requires consideration of the necessary model complexity. Models that simulate changes in the individual patient are required, meaning that models should have a complexity where parameters can be uniquely identified at the bedside from clinical data and where the models adequately represent the individual patient's (patho)physiology. This paper describes the models included in a system for providing decision support for mechanical ventilation...
December 8, 2016: Biomedizinische Technik. Biomedical Engineering
https://www.readbyqxmd.com/read/27930279/use-of-a-novel-accounting-and-grouping-method-for-major-trunk-injuryanalysis-of-data-from-a-statewide-trauma-financial-survey
#6
Kyla D Joubert, Charles D Mabry, Kyle J Kalkwarf, Richard D Betzold, Horace J Spencer, Kara M Spinks, Austin Porter, Saleema Karim, Ronald D Robertson, Michael J Sutherland, Robert T Maxson
Major trunk trauma is common and costly, but comparisons of costs between trauma centers (TCs) are rare. Understanding cost is essential to improve quality, manage trauma service lines, and to facilitate institutional commitment for trauma. We have used results of a statewide trauma financial survey of Levels I to IV TC to develop a useful grouping method for costs and clinical characteristics of major trunk trauma. The trauma financial survey collected billing and clinical data on 75 per cent of the state trauma registry patients for fiscal year 2012...
September 2016: American Surgeon
https://www.readbyqxmd.com/read/27929493/application-programming-in-c-environment-with-recorded-user-software-interactions-and-its-application-in-autopilot-of-vmat-imrt-treatment-planning
#7
Henry Wang, Lei Xing
An autopilot scheme of volumetric-modulated arc therapy (VMAT)/intensity-modulated radiation therapy (IMRT) planning with the guidance of prior knowl-edge is established with recorded interactions between a planner and a commercial treatment planning system (TPS). Microsoft (MS) Visual Studio Coded UI is applied to record some common planner-TPS interactions as subroutines. The TPS used in this study is a Windows-based Eclipse system. The interactions of our application program with Eclipse TPS are realized through a series of subrou-tines obtained by prerecording the mouse clicks or keyboard strokes of a planner in operating the TPS...
November 8, 2016: Journal of Applied Clinical Medical Physics
https://www.readbyqxmd.com/read/27928255/analyzing-gensini-score-as-a-semi-continuous-outcome
#8
Homa Kashani, Hojjat Zeraati, Kazem Mohammad, Hamidreza Goodarzynejad, Mahmood Mahmoudi, Saeed Sadeghian, Mohammadali Boroumand
Background: Investigators frequently encounter continuous outcomes with plenty of values clumped at zero called semi-continuous outcomes. The Gensini score, one of the most widely used scoring systems for expressing coronary angiographic results, is of this type. The aim of this study was to apply two statistical approaches based on the categorization and original scale of the Gensini score to simultaneously assess the association between covariates and the presence and severity of coronary artery disease (CAD)...
April 13, 2016: Journal of Tehran Heart Center
https://www.readbyqxmd.com/read/27927502/observational-analysis-of-changing-trends-in-level-of-evidence-of%C3%A2-scoliosis-research-society-annual-meeting-podium-presentations-in%C3%A2-the-new-millennium-2001-2013
#9
Nanjundappa S Harshavardhana, John P Dormans
STUDY DESIGN: Observational quantitative evaluation of all Scoliosis Research Society annual meeting (SRS-AM) podium presentations over a 6-year period in the new millennium for changing trends in Level of Evidence (LoE). OBJECTIVES: To report the LoE of SRS-AM podium presentations over a 13-year period in the new millennium and to compare the trends in LoE over a 3-year period between the two decades, that is, 2001-2003 versus 2011-2013. SUMMARY OF BACKGROUND DATA: LoE is a rating system introduced by the American Academy of Orthopaedic Surgeons (AAOS) in 2003 to reflect the quality of clinical studies...
May 2016: Spine Deformity
https://www.readbyqxmd.com/read/27926626/frailty-assessed-by-the-forecast-is-a-valid-tool-to-predict-short-term-outcome-after-transcatheter-aortic-valve-replacement
#10
Adrian R Kobe, Alexander Meyer, Hassan Elmubarak, Jörg Kempfert, Jovana Pavicevic, Francesco Maisano, Thomas Walther, Volkmar Falk, Simon H Sündermann
OBJECTIVE: The term frailty is frequently used during decision-making in transcatheter heart valve procedures. Nevertheless, frailty is still measured by eyeballing rather than by using standardized frailty assessments. In a previous study, we developed a frailty score in a cardiac surgical patient population including patients, who underwent transcatheter aortic valve replacement (TAVR). Here, we present the results from the subsequent validation study focusing on the TAVR cohort. METHODS: One hundred thirty patients underwent TAVR...
December 6, 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/27926592/development-of-a-tobacco-cessation-clinical-decision-support-system-for-pediatric-emergency-nurses
#11
(no author information available yet)
No abstract text is available yet for this article.
December 2016: Computers, Informatics, Nursing: CIN
https://www.readbyqxmd.com/read/27925425/preventing-acute-care-associated-venous-thromboembolism-in-adult-and-pediatric-patients-across-a-large-healthcare-system
#12
REVIEW
Timothy I Morgenthaler, Vilmarie Rodriguez
BACKGROUND: Although effective methods for venous thromboembolism prophylaxis (VTE-P) have been known for decades, reliable implementation has been challenging. OBJECTIVE: Develop reliable VTE-P systems for adult and for pediatric patients to reduce preventable venous thromboembolism (VTE). DESIGN: We used a discovery and diffusion system to first develop an effective system in 1 hospital location, and then spread the principle best practices across the entire 22-hospital system...
December 2016: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/27925180/a-16-yin-yang-gene-expression-ratio-signature-for-er-node-breast-cancer
#13
Wayne Xu, Gaofeng Jia, Nianguang Cai, Shujun Huang, James R Davie, Marshall Pitz, Shantanu Banerji, Leigh Murphy
Breast cancer is one of the leading causes of cancer death in women. It is a complex and heterogeneous disease with different clinical outcomes. Stratifying patients into subgroups with different outcomes could help guide clinical decision making. In this study, we used two opposing groups of genes, Yin and Yang, to develop a prognostic expression ratio signature. Using the METABRIC cohort we identified a16-gene signature capable of stratifying breast cancer patients into four risk levels with intention that low-risk patients would not undergo adjuvant systemic therapy, intermediate-low-risk patients will be treated with hormonal therapy only, and intermediate-high- and high-risk groups will be treated by chemotherapy in addition to the hormonal therapy...
December 7, 2016: International Journal of Cancer. Journal International du Cancer
https://www.readbyqxmd.com/read/27925054/prone-position-in-patients-with-acute-respiratory-distress-syndrome
#14
Mariano Setten, Gustavo Adrián Plotnikow, Matías Accoce
Acute respiratory distress syndrome occupies a great deal of attention in intensive care units. Despite ample knowledge of the physiopathology of this syndrome, the focus in intensive care units consists mostly of life-supporting treatment and avoidance of the side effects of invasive treatments. Although great advances in mechanical ventilation have occurred in the past 20 years, with a significant impact on mortality, the incidence continues to be high. Patients with acute respiratory distress syndrome, especially the most severe cases, often present with refractory hypoxemia due to shunt, which can require additional treatments beyond mechanical ventilation, among which is mechanical ventilation in the prone position...
December 1, 2016: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/27924347/preprocessing-structured-clinical-data-for-predictive-modeling-and-decision-support-a-roadmap-to-tackle-the-challenges
#15
José Carlos Ferrão, Mónica Duarte Oliveira, Filipe Janela, Henrique M G Martins
BACKGROUND: EHR systems have high potential to improve healthcare delivery and management. Although structured EHR data generates information in machine-readable formats, their use for decision support still poses technical challenges for researchers due to the need to preprocess and convert data into a matrix format. During our research, we observed that clinical informatics literature does not provide guidance for researchers on how to build this matrix while avoiding potential pitfalls...
December 7, 2016: Applied Clinical Informatics
https://www.readbyqxmd.com/read/27922167/cost-effectiveness-of-primarily-surgical-versus-primarily-conservative-treatment-of-acute-and-subacute-radiculopathies-due-to-intervertebral-disc-herniation-from-the-swiss-perspective
#16
Zanfina Ademi, Viktoria Gloy, Dominik Glinz, Heike Raatz, Joris Van Stiphout, Heiner C Bucher, Matthias Schwenkglenks
AIMS OF THE STUDY: To assess the cost-effectiveness of primarily surgical treatment (PST) versus primarily conservative treatment (PCT) in adults with intermediate severity, acute or subacute, lumbar radicular syndrome due to intervertebral disc herniation. METHODS: A decision analytic model from healthcare system and societal perspectives was used to compare outcomes and costs of PST with those of PCT (physiotherapy, epidural injection and medication). Treatment pathways and quality of life were obtained from published clinical trials...
2016: Swiss Medical Weekly
https://www.readbyqxmd.com/read/27920082/doctors-perspectives-on-psa-testing-illuminate-established-differences-in-prostate-cancer-screening-rates-between-australia-and-the-uk-a-qualitative-study
#17
Kristen Pickles, Stacy M Carter, Lucie Rychetnik, Vikki A Entwistle
OBJECTIVES: To examine how general practitioners (GPs) in the UK and GPs in Australia explain their prostate-specific antigen (PSA) testing practices and to illuminate how these explanations are similar and how they are different. DESIGN: A grounded theory study. SETTING: Primary care practices in Australia and the UK. PARTICIPANTS: 69 GPs in Australia (n=40) and the UK (n=29). We included GPs of varying ages, sex, clinical experience and patient populations...
December 5, 2016: BMJ Open
https://www.readbyqxmd.com/read/27919397/a-national-standards-based-assessment-on-functionality-of-electronic-medical-records-systems-used-in-kenyan-public-sector-health-facilities
#18
REVIEW
Samuel Kang'a, Nancy Puttkammer, Steven Wanyee, Davies Kimanga, Jason Madrano, Veronica Muthee, Patrick Odawo, Anjali Sharma, Tom Oluoch, Katherine Robinson, James Kwach, William B Lober
BACKGROUND: Variations in the functionality, content and form of electronic medical record systems (EMRs) challenge national roll-out of these systems as part of a national strategy to monitor HIV response. To enforce the EMRs minimum requirements for delivery of quality HIV services, the Kenya Ministry of Health (MoH) developed EMRs standards and guidelines. The standards guided the recommendation of EMRs that met a preset threshold for national roll-out. METHODS: Using a standards-based checklist, six review teams formed by the MoH EMRs Technical Working Group rated a total of 17 unique EMRs in 28 heath facilities selected by individual owners for their optimal EMR implementation...
January 2017: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/27919385/usability-problems-do-not-heal-by-themselves-national-survey-on-physicians-experiences-with-ehrs-in-finland
#19
Johanna Kaipio, Tinja Lääveri, Hannele Hyppönen, Suvi Vainiomäki, Jarmo Reponen, Andre Kushniruk, Elizabeth Borycki, Jukka Vänskä
PURPOSE: Survey studies of health information systems use tend to focus on availability of functionalities, adoption and intensity of use. Usability surveys have not been systematically conducted by any healthcare professional groups on a national scale on a repeated basis. This paper presents results from two cross-sectional surveys of physicians' experiences with the usability of currently used EHR systems in Finland. The research questions were: To what extent has the overall situation improved between 2010 and 2014? What differences are there between healthcare sectors? METHODS: In the spring of 2014, a survey was conducted in Finland using a questionnaire that measures usability and respondents' user experiences with electronic health record (EHR) systems...
January 2017: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/27919382/a-clinical-decision-support-system-for-prediction-of-pregnancy-outcome-in-pregnant-women-with-systemic-lupus-erythematosus
#20
Khadijeh Paydar, Sharareh R Niakan Kalhori, Mahmoud Akbarian, Abbas Sheikhtaheri
OBJECTIVE: Pregnancy among systemic lupus erythematosus (SLE)-affected women is highly associated with poor obstetric outcomes. Predicting the risk of foetal outcome is essential for maximizing the success of pregnancy. This study aimed to develop a clinical decision support system (CDSS) to predict pregnancy outcomes among SLE-affected pregnant women. METHODS: We performed a retrospective analysis of 149 pregnant women with SLE, who were followed at Shariati Hospital (104 pregnancies) and a specialized clinic (45 pregnancies) from 1982 to 2014...
January 2017: International Journal of Medical Informatics
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