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Clinical prediction rule

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https://www.readbyqxmd.com/read/29150390/pulmonary-embolism-rule-out-criteria-perc-rule-in-european-patients-with-low-implicit-clinical-probability-percepic-a-multicentre-prospective-observational-study
#1
Andrea Penaloza, Caroline Soulié, Thomas Moumneh, Quentin Delmez, Alexandre Ghuysen, Dominique El Kouri, Christian Brice, Nicolas S Marjanovic, Jacques Bouget, Fares Moustafa, Albert Trinh-Duc, Catherine Le Gall, Lionel Imsaad, Jean-Marie Chrétien, Béatrice Gable, Philippe Girard, Olivier Sanchez, Jeannot Schmidt, Grégoire Le Gal, Guy Meyer, Nicolas Delvau, Pierre-Marie Roy
BACKGROUND: The ability of the pulmonary embolism rule-out criteria (PERC) to exclude pulmonary embolism without further testing remains debated outside the USA, especially in the population with suspected pulmonary embolism who have a high prevalence of the condition. Our main objective was to prospectively assess the predictive value of negative PERC to rule out pulmonary embolism among European patients with low implicit clinical probability. METHODS: We did a multicentre, prospective, observational study in 12 emergency departments in France and Belgium...
November 14, 2017: Lancet Haematology
https://www.readbyqxmd.com/read/29148021/routine-adoption-of-timp2-and-igfbp7-biomarkers-in-cardiac-surgery-for-early-identification-of-acute-kidney-injury
#2
Chiara Levante, Fiorenza Ferrari, Chiara Manenti, Faeq Husain-Syed, Marta Scarpa, Tommaso Hinna Danesi, Massimo De Cal, Valentina Corradi, Grazia M Virzì, Alessandra Brendolan, Federico Nalesso, Pércia Bezerra, Salvador Lopez-Giacoman, Sara Samoni, Mara Senzolo, Davide Giavarina, Loris Salvador, Raffaele Bonato, Silvia De Rosa, Enrico Rettore, Claudio Ronco
BACKGROUND AND PURPOSE: Acute Kidney Injury (AKI) is a severe complication affecting many hospitalized patients after cardiac surgery, with negative impacts on short- and long-term clinical outcomes and on healthcare costs. Recently, clinical interest has been aimed at defining and classifying AKI, identifying risk factors and developing diagnostic strategies to identify patients at risk early on. Achieving an early and accurate diagnosis of AKI is a crucial issue, because prevention and timely detection may help to prevent negative clinical outcomes and avoid AKI-associated costs...
November 16, 2017: International Journal of Artificial Organs
https://www.readbyqxmd.com/read/29143253/ruling-out-clinically-significant-prostate-cancer-with-negative-multi-parametric-mri
#3
Julie Y An, Abhinav Sidana, Sarah A Holzman, Joseph A Baiocco, Sherif Mehralivand, Peter L Choyke, Bradford J Wood, Baris Turkbey, Peter A Pinto
PURPOSE: To evaluate the negative predictive value (NPV) of a negative prostate multi-parametric magnetic resonance imaging (mpMRI) in ruling out clinically significant prostate upon 12-core systematic biopsy. METHODS: We retrospectively reviewed 114 men evaluated at our institution who underwent systematic 12-core biopsy within 1 year of a negative prostate mpMRI. Clinicopathologic features were evaluated and NPV was calculated for detection of clinically significant (Gleason ≥ 7) cancer...
November 15, 2017: International Urology and Nephrology
https://www.readbyqxmd.com/read/29141400/antifungal-treatment-with-echinocandins-a-10-year-clinical-experience
#4
R Poves-Alvarez, B Cano-Hernández, S Balbás-Alvarez, P Román-García, M Heredia-Rodríguez, E Gómez-Sánchez, E Gómez-Pesquera, M Lorenzo-López, B Martínez-Rafael, M F Muñoz-Moreno, J M Eiros, E Tamayo
OBJECTIVE: The number of studies evaluating the use of echinocandins, whether or not its indication meets international guidelines, in clinical practice is limited. The objective of the present study was to determine the use of echinocandins in a tertiary Spanish hospital in 10 years of clinical practice, and to evaluate its impact on prognosis. METHODS: This retrospective study involved adult nonneutropenic ill patients with suspicion of fungal invasion who started treatment with echinocandins between 2006 and 2015...
November 10, 2017: Revista Española de Quimioterapia: Publicación Oficial de la Sociedad Española de Quimioterapia
https://www.readbyqxmd.com/read/29135771/detecting-lung-and-colorectal-cancer-recurrence-using-structured-clinical-administrative-data-to-enable-outcomes-research-and-population-health-management
#5
Michael J Hassett, Hajime Uno, Angel M Cronin, Nikki M Carroll, Mark C Hornbrook, Debra Ritzwoller
INTRODUCTION: Recurrent cancer is common, costly, and lethal, yet we know little about it in community-based populations. Electronic health records and tumor registries contain vast amounts of data regarding community-based patients, but usually lack recurrence status. Existing algorithms that use structured data to detect recurrence have limitations. METHODS: We developed algorithms to detect the presence and timing of recurrence after definitive therapy for stages I-III lung and colorectal cancer using 2 data sources that contain a widely available type of structured data (claims or electronic health record encounters) linked to gold-standard recurrence status: Medicare claims linked to the Cancer Care Outcomes Research and Surveillance study, and the Cancer Research Network Virtual Data Warehouse linked to registry data...
December 2017: Medical Care
https://www.readbyqxmd.com/read/29134674/experimental-validation-of-two-dual-energy-ct-methods-for-proton-therapy-using-heterogeneous-tissue-samples
#6
Esther Bär, Arthur Lalonde, Rongxiao Zhang, Kyung-Wook Jee, Kai Yang, Gregory Sharp, Bob Liu, Gary Royle, Hugo Bouchard, Hsiao-Ming Lu
PURPOSE: The purpose of this work is to evaluate the performance of dual-energy CT (DECT) for determining proton stopping power ratios (SPRs) in an experimental environment and to demonstrate its potential advantages over conventional single-energy CT (SECT) in clinical conditions. METHODS: Water equivalent range (WER) measurements of 12 tissue-equivalent plastic materials and 12 fresh animal tissue samples are performed in a 195 MeV broad proton beam using the dose extinction method...
November 14, 2017: Medical Physics
https://www.readbyqxmd.com/read/29133490/auscultation-while-standing-a-basic-and-reliable-method-to-rule-out-a-pathologic-heart-murmur-in-children
#7
Bruno Lefort, Elodie Cheyssac, Nathalie Soulé, Jacques Poinsot, Marie-Catherine Vaillant, Alaeddin Nassimi, Alain Chantepie
PURPOSE: The distinction between physiologic (innocent) and pathologic (organic) heart murmurs is not always easy in routine practice, leading too often to unnecessary cardiology referrals and expensive investigations. We aimed to test the hypothesis that the complete disappearance of murmur on standing can exclude cardiac disease in children. METHODS: From January 2014 to January 2015, we prospectively included 194 consecutive children aged 2 to 18 years who were referred for heart murmur evaluation to pediatric cardiologists at 2 French medical centers...
November 2017: Annals of Family Medicine
https://www.readbyqxmd.com/read/29133377/information-provided-by-diagnostic-and-screening-tests-improving-probabilities
#8
REVIEW
Mark Weatherall
Uncertainty in clinical encounters is inevitable and despite this uncertainty clinicians must still work with patients to make diagnostic and treatment decisions. Explicit diagnostic reasoning based on probabilities will optimise information in relation to uncertainty. In clinical diagnostic encounters, there is often pre-existing information that reflects the probability any particular patient has a disease. Diagnostic testing provides extra information that refines diagnostic probabilities. However, in general diagnostic tests will be positive in most, but not all cases of disease (sensitivity) and may not be negative in all cases of disease absence (specificity)...
November 13, 2017: Postgraduate Medical Journal
https://www.readbyqxmd.com/read/29133071/red-blood-cell-distribution-width-is-associated-with-mortality-in-elderly-patients-with-sepsis
#9
An-Yi Wang, Hon-Ping Ma, Wei-Fong Kao, Shin-Han Tsai, Cheng-Kuei Chang
INTRODUCTION: RDW is a prognostic biomarker and associated with mortality in cardiovascular disease, stroke and metabolic syndrome. For elderly patients, malnutrition and multiple comorbidities exist, which could affect the discrimination ability of RDW in sepsis. The main purpose of our study was to evaluate the prognostic value of RDW in sepsis among elderly patients. METHODS: This was a retrospective cohort study conducted in emergency department intensive care units (ED-ICU) between April 2015 and November 2015...
November 10, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29132904/straight-leg-elevation-to-rule-out-pelvic-injury
#10
Caroline Bolt, Francis O'Keeffe, Pete Finnegan, Kristofer Dickson, De Villiers Smit, Mark C Fitzgerald, Biswadev Mitra
OBJECTIVE: Pelvic x-ray is frequently used as a screening tool during initial assessment of injured patients. However routine use in the awake and alert blunt trauma patient may be questioned due to low yield. We propose a clinical tool that may avoid unnecessary imaging by examining whether the ability to straight leg raise, without pain, can rule out pelvic injury. METHODS: We conducted a prospective cohort study with the exposure variables of ability to straight leg raise and presence of pain on doing so, and presence of pelvic fracture on x-ray as the primary outcome variable...
October 9, 2017: Injury
https://www.readbyqxmd.com/read/29132624/the-value-of-ehr-based-assessment-of-physician-competency-an-investigative-effort-with-internal-medicine-physicians
#11
Kimberly Venta, Erin Baker, Cali Fidopiastis, Kay Stanney
OBJECTIVE: The purpose of this study was to investigate the potential of developing an EHR-based model of physician competency, named the Skill Deficiency Evaluation Toolkit for Eliminating Competency-loss Trends (Skill-DETECT), which presents the opportunity to use EHR-based models to inform selection of Continued Medical Education (CME) opportunities specifically targeted at maintaining proficiency. METHODS: The IBM Explorys platform provided outpatient Electronic Health Records (EHRs) representing 76 physicians with over 5000 patients combined...
December 2017: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/29127224/clinical-prediction-rule-for-neurological-sequelae-due-to-acute-encephalopathy-a-medical-community-based-validation-study-in-harima-japan
#12
Kaori Sasaki, Hiroaki Nagase, Azusa Maruyama, Kyoko Fujita, Masahiro Nishiyama, Tsukasa Tanaka, Sadayuki Nukina, Toru Takumi, Kanae Takenaka, Yoshinobu Oyazato, Atsushi Nishiyama, Tomoko Kawata, Keisuke Saeki, Yuichi Takami, Eriko Satake-Inoue, Kazumoto Iijima, Ichiro Morioka, Yoshiyuki Uetani
OBJECTIVES: This study aimed to verify the screening performance of our clinical prediction rule for neurological sequelae due to acute encephalopathy (NSAE-CPR), which previously identified the following three variables as predictive of poor outcomes: (1) refractory status epilepticus; (2) consciousness disturbance and/or hemiplegia at 6 hours from onset and (3) aspartate aminotransferase >90 IU/L within 6 hours of onset. DESIGN: Medical community-based multicentre retrospective cohort study...
November 9, 2017: BMJ Open
https://www.readbyqxmd.com/read/29126226/optimizing-tuberculosis-diagnosis-in-hiv-infected-inpatients-meeting-the-criteria-of-seriously-ill-in-the-who-algorithm
#13
Rulan Griesel, Annemie Stewart, Helen van der Plas, Welile Sikhondze, Molebogeng X Rangaka, Mark P Nicol, Andre P Kengne, Marc Mendelson, Gary Maartens
BACKGROUND: The WHO algorithm for the diagnosis of tuberculosis in seriously ill HIV-infected patients lacks a firm evidence base. We aimed to develop a clinical prediction rule for the diagnosis of tuberculosis and to determine the diagnostic utility of the Xpert MTB/RIF assay in seriously ill HIV-infected patients. METHODS: We conducted a prospective study among HIV-infected inpatients with any cough duration and WHO-defined danger signs. Culture-positive tuberculosis from any site was the reference standard...
November 6, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/29122932/diagnostic-performance-of-an-acoustic-based-system-for-coronary-artery-disease-risk-stratification
#14
Simon Winther, Louise Nissen, Samuel Emil Schmidt, Jelmer Sybren Westra, Laust Dupont Rasmussen, Lars Lyhne Knudsen, Lene Helleskov Madsen, Jane Kirk Johansen, Bjarke Skogstad Larsen, Johannes Jan Struijk, Lars Frost, Niels Ramsing Holm, Evald Høj Christiansen, Hans Erik Botker, Morten Bøttcher
OBJECTIVE: Diagnosing coronary artery disease (CAD) continues to require substantial healthcare resources. Acoustic analysis of transcutaneous heart sounds of cardiac movement and intracoronary turbulence due to obstructive coronary disease could potentially change this. The aim of this study was thus to test the diagnostic accuracy of a new portable acoustic device for detection of CAD. METHODS: We included 1675 patients consecutively with low to intermediate likelihood of CAD who had been referred for cardiac CT angiography...
November 9, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/29121105/economic-evaluation-of-the-one-hour-rule-out-and-rule-in-algorithm-for-acute-myocardial-infarction-using-the-high-sensitivity-cardiac-troponin-t-assay-in-the-emergency-department
#15
Apoorva Ambavane, Bertil Lindahl, Evangelos Giannitis, Julie Roiz, Joan Mendivil, Lutz Frankenstein, Richard Body, Michael Christ, Roland Bingisser, Aitor Alquezar, Christian Mueller
BACKGROUND: The 1-hour (h) algorithm triages patients presenting with suspected acute myocardial infarction (AMI) to the emergency department (ED) towards "rule-out," "rule-in," or "observation," depending on baseline and 1-h levels of high-sensitivity cardiac troponin (hs-cTn). The economic consequences of applying the accelerated 1-h algorithm are unknown. METHODS AND FINDINGS: We performed a post-hoc economic analysis in a large, diagnostic, multicenter study of hs-cTnT using central adjudication of the final diagnosis by two independent cardiologists...
2017: PloS One
https://www.readbyqxmd.com/read/29117964/clinical-characteristics-of-children-evaluated-for-suspected-pulmonary-embolism-with-d-dimer-testing
#16
Jessica Kanis, Jonathan Pike, Cassandra L Hall, Jeffrey A Kline
BACKGROUND: We sought to determine clinical variables in children tested for suspected pulmonary embolism (PE) that predict PE+ outcome for the development of paediatric PE prediction rule. METHODS: Data were collected by query of a laboratory database for D-dimer from January 2004 to December 2014 for a large multicentre hospital system and the radiology database for pulmonary vascular imaging in children aged 5-17. Using explicit, predefined methods, trained abstractors, determined if D-dimer was sent in the evaluation of PE and then recorded predictor data which was tested for association with PE+ outcome using univariate techniques...
November 8, 2017: Archives of Disease in Childhood
https://www.readbyqxmd.com/read/29117411/assessing-the-likely-effect-of-posterior-corneal-curvature-on-toric-iol-calculation-for-iols-of-2-50-d-or-greater-cylinder-power
#17
Benjamin R LaHood, Michael Goggin, Adrian Esterman
PURPOSE: To establish whether average refractive overcorrection or undercorrection of corneal astigmatism based on the orientation (rule) of the astigmatism occurs if toric intraocular lenses (IOLs) are calculated on the basis of anterior corneal measurements in eyes requiring toric IOL cylinder power of 2.50 diopters (D) or greater. METHODS: One hundred thirteen consecutive eyes with anterior corneal keratometric astigmatism requiring IOL cylinder power of 2.50 D or greater underwent phacoemulsification with IOL powers calculated using anterior corneal curvature data alone...
November 1, 2017: Journal of Refractive Surgery
https://www.readbyqxmd.com/read/29107623/early-symptom-improvement-at-10-sessions-as-a-predictor-of-rtms-treatment-outcome-in-major-depression
#18
Kfir Feffer, Hyewon Helen Lee, Farrokh Mansouri, Peter Giacobbe, Fidel Vila-Rodriguez, Sidney H Kennedy, Zafiris J Daskalakis, Daniel M Blumberger, Jonathan Downar
BACKGROUND: Predicting rTMS nonresponse could be helpful in sparing patients from futile treatment, and in improving use of limited rTMS resources. While several predictive biomarkers have been proposed, few are accurate for individual-level prediction; none have entered routine use. An alternative approach in pharmacotherapy predicts outcome from early response; patients showing minimal (e.g., ≤20%) improvement at 2 weeks can be predicted as nonresponders with negative predictive values (NPV) > 80-90%...
October 19, 2017: Brain Stimulation
https://www.readbyqxmd.com/read/29103551/decision-support-tools-in-low-back-pain
#19
REVIEW
Veerle M H Coupé, Miranda L van Hooff, Marinus de Kleuver, Ewout W Steyerberg, Raymond W J G Ostelo
Information from individual classification systems or clinical prediction rules that aim to facilitate stratified care in low back pain is important but often not comprehensive enough to be used to support clinical decision-making. The development and implementation of a clinically useful decision support tool (DST) that considering all key features is a challenging enterprise, requiring a multidisciplinary approach. Key features are inclusion of all relevant treatment options, patient characteristics, and benefits and harms and presentation as an accessible and easy to use toolkit...
December 2016: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/29103159/model-based-optimization-of-g-csf-treatment-during-cytotoxic-chemotherapy
#20
Sibylle Schirm, Christoph Engel, Sibylle Loibl, Markus Loeffler, Markus Scholz
PURPOSE: Although G-CSF is widely used to prevent or ameliorate leukopenia during cytotoxic chemotherapies, its optimal use is still under debate and depends on many therapy parameters such as dosing and timing of cytotoxic drugs and G-CSF, G-CSF pharmaceuticals used and individual risk factors of patients. METHODS: We integrate available biological knowledge and clinical data regarding cell kinetics of bone marrow granulopoiesis, the cytotoxic effects of chemotherapy and pharmacokinetics and pharmacodynamics of G-CSF applications (filgrastim or pegfilgrastim) into a comprehensive model...
November 4, 2017: Journal of Cancer Research and Clinical Oncology
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