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Expert disagreement

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https://www.readbyqxmd.com/read/28188689/sentinel-node-biopsy-for-prostate-cancer-report-from-a-consensus-panel-meeting
#1
Henk G van der Poel, Esther M Wit, Cenk Acar, Nynke S van den Berg, Fijs W B van Leeuwen, Renato A Valdes Olmos, Alexander Winter, Friedhelm Wawroschek, Fredrik Liedberg, Steven Maclennan, Thomas Lam
OBJECTIVE: To explore the evidence and knowledge gaps in sentinel node biopsy (SNB) in prostate cancer by a consensus panel of experts. METHODS: A two-round Delphi survey among experts was followed by a consensus panel meeting of 16 experts in February 2016. Agreement voting was performed using the RAND/University of California, Los Angeles Appropriateness Methodology on 150 statements in 9 domains. The disagreement index based on the interpercentile range-adjusted for symmetry score was used to assess consensus and non-consensus among panel members RESULTS: Consensus was obtained on 91 of 150 (61%) statements...
February 10, 2017: BJU International
https://www.readbyqxmd.com/read/28145427/variability-in-assigning-pathogenicity-to-incidental-findings-insights-from-ldlr-sequence-linked-to-the-electronic-health-record-in-1013-individuals
#2
Maya S Safarova, Eric W Klee, Linnea M Baudhuin, Erin M Winkler, Michelle L Kluge, Suzette J Bielinski, Janet E Olson, Iftikhar J Kullo
Knowledge of variant pathogenicity is key to implementing genomic medicine. We describe variability between expert reviewers in assigning pathogenicity to sequence variants in LDLR, the causal gene in the majority of cases of familial hypercholesterolemia. LDLR was sequenced on the Illumina HiSeq platform (average read depth >200 × ) in 1013 Mayo Biobank participants recruited from 2012 to 2013. Variants with a minor allele frequency (MAF) <5% predicted to be functional or referenced in HGMD (Human Gene Mutation Database) or NCBI-ClinVar databases were reviewed...
February 1, 2017: European Journal of Human Genetics: EJHG
https://www.readbyqxmd.com/read/28135804/the-interaction-between-equipoise-and-logistics-in-clinical-trials-a-case-study
#3
Meredith G Warshaw, Vincent J Carey, Elizabeth J McFarland, Liza Dawson, Elaine Abrams, Ann Melvin, Lee Fairlie, Hans Spiegel, Jonathan Jay, Allison L Agwu
INTRODUCTION: Equipoise is usually discussed as an ethical issue in clinical trials. However, it also has practical implications. BACKGROUND: Clinical equipoise is usually construed to mean uncertainty or disagreement among the expert clinician community. However, an individual physician's sense of equipoise may vary by location, based on the local standard of care or availability of specific treatment options, and these differences can affect providers' willingness to enroll participants into clinical trials...
January 1, 2017: Clinical Trials: Journal of the Society for Clinical Trials
https://www.readbyqxmd.com/read/28113887/aggnet-deep-learning-from-crowds-for-mitosis-detection-in-breast-cancer-histology-images
#4
Shadi Albarqouni, Christoph Baur, Felix Achilles, Vasileios Belagiannis, Stefanie Demirci, Nassir Navab
The lack of publicly available ground-truth data has been identified as the major challenge for transferring recent developments in deep learning to the biomedical imaging domain. Though crowdsourcing has enabled annotation of large scale databases for real world images, its application for biomedical purposes requires a deeper understanding and hence, more precise definition of the actual annotation task. The fact that expert tasks are being outsourced to non-expert users may lead to noisy annotations introducing disagreement between users...
February 11, 2016: IEEE Transactions on Medical Imaging
https://www.readbyqxmd.com/read/28101941/key-messages-for-communicating-information-about-brca1-and-brca2-to-women-with-breast-or-ovarian-cancer-consensus-across-health-professionals-and-service-users
#5
Chris Jacobs, Gabriella Pichert, Jackie Harris, Kathy Tucker, Susan Michie
OBJECTIVES: Genetic testing of cancer predisposing genes will increasingly be needed in oncology clinics in order to target cancer treatment. This Delphi study aimed to identify areas of agreement and disagreement between genetics and oncology health professionals and service users about the key messages required by women with breast/ovarian cancer who undergo BRCA1/BRCA2 genetic testing and the optimal timing of communicating key messages. METHODS: Participants were 16 expert health professionals specialising in oncology/genetics and 16 service users with breast/ovarian cancer and a pathogenic BRCA1/BRCA2 variant...
January 18, 2017: Psycho-oncology
https://www.readbyqxmd.com/read/28087236/determination-of-the-feasibility-of-a-multicomponent-intervention-program-to-prevent-delirium-in-the-intensive-care-unit-a-modified-rand-delphi-study
#6
Annelies Wassenaar, Mark van den Boogaard, Underpin-Icu Study Group, Lisette Schoonhoven, Peter Pickkers
BACKGROUND: Delirium is common in Intensive Care Unit (ICU) patients and associated with poor outcome. In non-ICU patients a multicomponent intervention program with non-pharmacological interventions has shown to reduce delirium. Currently, there is insufficient evidence regarding the effects of such a program in ICU patients. We developed a draft program based on a review. As most studies were conducted in non-ICU patients, the feasibility of the program in ICU patients needs to be assessed before investigating its effectiveness...
January 10, 2017: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
https://www.readbyqxmd.com/read/28076488/use-of-tranexamic-acid-in-trauma-patients-an-analysis-of-cost-effectiveness-for-use-in-brazil
#7
Marcelo A Pinto, Jair G da Silva, Aljamir D Chedid, Marcio F Chedid
Introduction: Use of tranexamic acid (TXA) in trauma has been the subject of growing interest by researchers and health professionals. However, there are still several open questions regarding its use. In some aspects medical literature is controversial. The points of disagreement among experts include questions such as: Which patients should receive TXA in trauma? Should treatment be performed in the pre-hospital environment? Is there any need for laboratory parameters before starting TXA treatment? What is the drug safety profile? The main issue on which there is still no basis in literature is: What is the indication for treatment within massive transfusion protocols? Objective: Answer the questions proposed based on critical evaluation of the evidence gathered so far and carry out a study of cost-effectiveness of TXA use in trauma adapted to the Brazilian reality...
November 2016: Arquivos Brasileiros de Cirurgia Digestiva: ABCD, Brazilian Archives of Digestive Surgery
https://www.readbyqxmd.com/read/28063844/automatic-3d-aortic-annulus-sizing-by-computed-tomography-in-the-planning-of-transcatheter-aortic-valve-implantation
#8
Sandro Queirós, Christophe Dubois, Pedro Morais, Tom Adriaenssens, Jaime C Fonseca, João L Vilaça, Jan D'hooge
BACKGROUND: Accurate imaging assessment of aortic annulus (AoA) dimension is paramount to decide on the correct transcatheter heart valve (THV) size for patients undergoing transcatheter aortic valve implantation (TAVI). We evaluated the feasibility and accuracy of a novel automatic framework for multidetector row computed tomography (MDCT)-based TAVI planning. METHODS: Among 122 consecutive patients undergoing TAVI and retrospectively reviewed for this study, 104 patients with preoperative MDCT of sufficient quality were enrolled and analyzed with the proposed software...
January 2017: Journal of Cardiovascular Computed Tomography
https://www.readbyqxmd.com/read/28045922/defending-against-advanced-persistent-threats-using-game-theory
#9
Stefan Rass, Sandra König, Stefan Schauer
Advanced persistent threats (APT) combine a variety of different attack forms ranging from social engineering to technical exploits. The diversity and usual stealthiness of APT turns them into a central problem of contemporary practical system security, since information on attacks, the current system status or the attacker's incentives is often vague, uncertain and in many cases even unavailable. Game theory is a natural approach to model the conflict between the attacker and the defender, and this work investigates a generalized class of matrix games as a risk mitigation tool for an advanced persistent threat (APT) defense...
2017: PloS One
https://www.readbyqxmd.com/read/28036154/identifying-barriers-to-the-care-of-the-rheumatoid-hand-in-china-comparing-attitudes-of-rheumatologists-and-hand-surgeons
#10
Lauren E Franzblau, Keming Wang, Xuebing Liang, Yang Guo, Yingni Li, Yu-Chieh Jay Lin, Sunghee Lee, Beth-Ellen Pennell, Melissa J Shauver, Kevin C Chung
AIM: In China, hand surgeons treat fewer rheumatoid arthritis (RA) patients compared to other countries. We investigated whether physician and surgeon knowledge, attitudes and practices regarding RA hand deformities reflect current evidence and may contribute to the low utilization of surgery. METHOD: We surveyed hand surgeons and rheumatologists at three tertiary hospitals in Beijing, China. Questionnaires were developed from literature and expert review to assess their knowledge, attitudes and practice patterns related to rheumatoid hand surgery...
December 30, 2016: International Journal of Rheumatic Diseases
https://www.readbyqxmd.com/read/28029570/validation-of-the-norwegian-version-of-mappin-sdm-an-observation-based-instrument-to-measure-shared-decision-making-in-clinical-encounters
#11
Simone Kienlin, Maria Kristiansen, Eirik Ofstad, Katrin Liethmann, Friedemann Geiger, Pål Joranger, Sidsel Tveiten, Jürgen Kasper
OBJECTIVE: To validate the Norwegian version of MAPPIN'SDM observer scales with regard to reliability, accuracy and the extent to which the scales include the essentials of the shared decision-making concept. METHODS: Three MAPPIN'SDM scales, focusing on the skills of doctor, patient and dyad, were applied to audiovisual records of 35 decision sequences. Inter-rater reliabilities were determined based on kappa coefficients. Sensitivities and specificities were calculated with regard to an expert reference standard...
October 26, 2016: Patient Education and Counseling
https://www.readbyqxmd.com/read/28029551/recommendations-for-the-use-of-ultrasound-and-magnetic-resonance-in-patients-with-rheumatoid-arthritis
#12
Ingrid Möller, Estibaliz Loza, Jacqueline Uson, Carlos Acebes, Jose Luis Andreu, Enrique Batlle, Ángel Bueno, Paz Collado, Juan Manuel Fernández-Gallardo, Carlos González, Mercedes Jiménez Palop, María Pilar Lisbona, Pilar Macarrón, Joan Maymó, Jose Antonio Narváez, Victoria Navarro-Compán, Jesús Sanz, M Piedad Rosario, Esther Vicente, Esperanza Naredo
OBJECTIVE: To develop evidence-based recommendations on the use of ultrasound (US) and magnetic resonance imaging (MRI) in patients with rheumatoid arthritis (RA). METHODS: Recommendations were generated following a nominal group technique. A panel of experts, consisting of 15 rheumatologists and 3 radiologists, was established in the first panel meeting to define the scope and purpose of the consensus document, as well as chapters, potential recommendations and systematic literature reviews (we used and updated those from previous EULAR documents)...
October 28, 2016: Reumatología Clinica
https://www.readbyqxmd.com/read/27899889/anodal-tdcs-to-right-dorsolateral-prefrontal-cortex-facilitates-performance-for-novice-jazz-improvisers-but-hinders-experts
#13
David S Rosen, Brian Erickson, Youngmoo E Kim, Daniel Mirman, Roy H Hamilton, John Kounios
Research on creative cognition reveals a fundamental disagreement about the nature of creative thought, specifically, whether it is primarily based on automatic, associative (Type-1) or executive, controlled (Type-2) processes. We hypothesized that Type-1 and Type-2 processes make differential contributions to creative production that depend on domain expertise. We tested this hypothesis with jazz pianists whose expertise was indexed by the number of public performances given. Previous fMRI studies of musical improvisation have reported that domain expertise is characterized by deactivation of the right-dorsolateral prefrontal cortex (r-DLPFC), a brain area associated with Type-2 executive processing...
2016: Frontiers in Human Neuroscience
https://www.readbyqxmd.com/read/27870084/a-response-to-commentaries
#14
I Glenn Cohen, Holly Fernandez Lynch, Christopher R Deubert
Our article "NFL Player Health Care: Addressing Club Doctors' Conflicts of Interests and Promoting Player Trust" focused on an inherent structural conflict that faces club doctors in the National Football League. The conflict stems from club doctors' dual role of providing medical care to players and providing strategic advice to clubs. We recommended assigning these roles to different individuals, with the medical staff members who are responsible for providing player care being chosen and subject to review and termination by a committee of medical experts selected equally by the NFL and the NFL Players Association...
November 2016: Hastings Center Report
https://www.readbyqxmd.com/read/27856381/what-questionnaires-to-use-when-measuring-quality-of-life-in-sacral-tumor-patients-the-updated-sacral-tumor-survey
#15
Olivier D R van Wulfften Palthe, Stein J Janssen, Jay S Wunder, Peter C Ferguson, Guo Wei, Peter S Rose, Micheal J Yaszemski, Franklin H Sim, Patrick J Boland, John H Healey, Francis J Hornicek, Joseph H Schwab
BACKGROUND CONTEXT: Patient-reported outcomes are becoming increasingly important when investigating results of patient and disease management. In sacral tumor, the symptoms of patients can vary substantially; therefore, no single questionnaire can adequately account for the full spectrum of symptoms and disability. PURPOSE: The purpose of this study is to analyze redundancy within the current sacral tumor survey and make a recommendation for an updated version based on the results and patient and expert opinions...
November 14, 2016: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/27830242/building-a-privacy-ethics-and-data-access-framework-for-real-world-computerised-medical-record-system-data-a-delphi-study-contribution-of-the-primary-health-care-informatics-working-group
#16
H Liyanage, S-T Liaw, C T Di Iorio, C Kuziemsky, R Schreiber, A L Terry, S de Lusignan
BACKGROUND: Privacy, ethics, and data access issues pose significant challenges to the timely delivery of health research. Whilst the fundamental drivers to ensure that data access is ethical and satisfies privacy requirements are similar, they are often dealt with in varying ways by different approval processes. OBJECTIVE: To achieve a consensus across an international panel of health care and informatics professionals on an integrated set of privacy and ethics principles that could accelerate health data access in data-driven health research projects...
November 10, 2016: Yearbook of Medical Informatics
https://www.readbyqxmd.com/read/27821081/management-of-controversial-gastroenteropancreatic-neuroendocrine-tumour-clinical-situations-with-somatostatin-analogues-results-of-a-delphi-questionnaire-panel-from-the-netpraxis-program
#17
Isabel Sevilla, Ángel Segura, Jaume Capdevila, Carlos López, Rocío García-Carbonero, Enrique Grande
BACKGROUND: There are clinical situations (CS) in which the use of somatostatin analogs (SSAs) in patients with neuroendocrine tumors (NET) is controversial due to lack of evidence. A Delphi study was conducted to develop common treatment guidelines for these CS, based on clinical practice and expert opinion of Spanish oncologists. METHODS: A scientific committee identified 5 CS with a common core (c-c) [non-functioning NET, not susceptible of surgery/locoregional therapy, Ki67 < 10 % (except for CS5: >10 %), ECOG ≤ 2], and controversy regarding use of SSAs, and prepared a Delphi questionnaire of 48 treatment statements...
November 7, 2016: BMC Cancer
https://www.readbyqxmd.com/read/27804005/palliative-care-quality-indicators-for-patients-with-end-stage-liver-disease-due-to-cirrhosis
#18
A M Walling, S C Ahluwalia, N S Wenger, M Booth, C P Roth, K Lorenz, F Kanwal, S Dy, S M Asch
BACKGROUND AND AIMS: There are guidelines for the medical management of cirrhosis and associated quality indicators (QIs), but QIs focusing on standards for palliative aspects of care are needed. METHODS: We convened a 9-member, multidisciplinary expert panel and used RAND/UCLA modified Delphi methods to develop palliative care quality indicators for patients with cirrhosis. Experts were provided with a report based on a systematic review of the literature that contained evidence concerning the proposed candidate QIs...
November 1, 2016: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/27798797/many-miles-to-go-a-systematic-review-of-the-state-of-cost-utility-analyses-in-brazil
#19
REVIEW
Alessandro G Campolina, Luciana M Rozman, Tassia C Decimoni, Roseli Leandro, Hillegonda M D Novaes, Patrícia Coelho De Soárez
BACKGROUND: Little is known about the quality and quantity of cost-utility analyses (CUAs) in Brazil. OBJECTIVE: The objective of this study was to provide a systematic review of published CUAs of healthcare technologies in Brazil. METHODS: We performed a systematic review of economic evaluations studies published in MEDLINE, EMBASE, LILACS (Latin American and Caribbean Health Sciences Literature), SciELO (Scientific Electronic Library Online), NHS EED (National Health Service Economic Evaluation Database), HTA (Health Technology Assessment) Database, Web of Science, Scopus, Bireme (Biblioteca Regional de Medicina), BVS ECOS (Health Economics database of the Brazilian Virtual Library of Health), and SISREBRATS (Sistema de Informação da Rede Brasileira de Avaliação de Tecnologias em Saúde [Brazilian Network for the Evaluation of Health Technologies]) from 1980 to 2013...
October 31, 2016: Applied Health Economics and Health Policy
https://www.readbyqxmd.com/read/27772557/effectiveness-of-cognitive-behavioral-therapy-for-the-treatment-of-fatigue-in-patients-with-multiple-sclerosis-a-systematic-review-and-meta-analysis
#20
Lizanne Eva van den Akker, Heleen Beckerman, Emma Hubertine Collette, Isaline Catharine Josephine Maria Eijssen, Joost Dekker, Vincent de Groot
BACKGROUND: Fatigue is a frequently occurring symptom of multiple sclerosis (MS) that limits social participation. OBJECTIVE: To systematically determine the short and long-term effects of cognitive behavioral therapy (CBT) for the treatment of MS-related fatigue. DATA SOURCES: Pubmed, Cochrane, EMBASE, Psychology and Behavioral Sciences Collection, ERIC, PsychINFO, Cinahl, PsycARTICLES, and relevant trial registers were searched up to February 2016...
November 2016: Journal of Psychosomatic Research
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