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https://www.readbyqxmd.com/read/28211064/selecting-postoperative-adjuvant-systemic-therapy-for-early-stage-breast-cancer-a-critical-assessment-of-commercially-available-gene-expression-assays
#1
REVIEW
David M Hyams, Eric Schuur, Javier Angel Aristizabal, Juan Enrique Bargallo Rocha, Cesar Cabello, Roberto Elizalde, Laura García-Estévez, Henry L Gomez, Artur Katz, Aníbal Nuñez De Pierro
Risk stratification of patients with early stage breast cancer may support adjuvant chemotherapy decision-making. This review details the development and validation of six multi-gene classifiers, each of which claims to provide useful prognostic and possibly predictive information for early stage breast cancer patients. A careful assessment is presented of each test's analytical validity, clinical validity, and clinical utility, as well as the quality of evidence supporting its use.
February 17, 2017: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28211017/examining-adaptations-to-water-stress-among-farming-households-in-sri-lanka-s-dry-zone
#2
Nicholas E Williams, Amanda Carrico
Climate change is increasing water scarcity in Sri Lanka. Whether these changes will undermine national-level food security depends upon the ability of the small-scale farmers that dominate rice production and the institutions that support them to overcome the challenges presented by changing water availability. Analyzing household survey data, this research identifies household, institutional, and agroecological factors that influence how water-stressed farmers are working to adapt to changing conditions and how the strategies they employ impact rice yields...
February 16, 2017: Ambio
https://www.readbyqxmd.com/read/28207198/integrated-precision-medicine-the-role-of-electronic-health-records-in-delivering-personalized-treatment
#3
REVIEW
Amy Sitapati, Hyeoneui Kim, Barbara Berkovich, Rebecca Marmor, Siddharth Singh, Robert El-Kareh, Brian Clay, Lucila Ohno-Machado
Precision Medicine involves the delivery of a targeted, personalized treatment for a given patient. By harnessing the power of electronic health records (EHRs), we are increasingly able to practice precision medicine to improve patient outcomes. In this article, we introduce the scientific community at large to important building blocks for personalized treatment, such as terminology standards that are the foundation of the EHR and allow for exchange of health information across systems. We briefly review different types of clinical decision support (CDS) and present the current state of CDS, which is already improving the care patients receive with genetic profile-based tailored recommendations regarding diagnostic and treatment plans...
February 16, 2017: Wiley Interdisciplinary Reviews. Systems Biology and Medicine
https://www.readbyqxmd.com/read/28203277/semantics-based-plausible-reasoning-to-extend-the-knowledge-coverage-of-medical-knowledge-bases-for-improved-clinical-decision-support
#4
Hossein Mohammadhassanzadeh, William Van Woensel, Samina Raza Abidi, Syed Sibte Raza Abidi
BACKGROUND: Capturing complete medical knowledge is challenging-often due to incomplete patient Electronic Health Records (EHR), but also because of valuable, tacit medical knowledge hidden away in physicians' experiences. To extend the coverage of incomplete medical knowledge-based systems beyond their deductive closure, and thus enhance their decision-support capabilities, we argue that innovative, multi-strategy reasoning approaches should be applied. In particular, plausible reasoning mechanisms apply patterns from human thought processes, such as generalization, similarity and interpolation, based on attributional, hierarchical, and relational knowledge...
2017: BioData Mining
https://www.readbyqxmd.com/read/28199835/rapid-automatic-motor-encoding-of-competing-reach-options
#5
Jason P Gallivan, Brandie M Stewart, Lee A Baugh, Daniel M Wolpert, J Randall Flanagan
Mounting neural evidence suggests that, in situations in which there are multiple potential targets for action, the brain prepares, in parallel, competing movements associated with these targets, prior to implementing one of them. Central to this interpretation is the idea that competing viewed targets, prior to selection, are rapidly and automatically transformed into corresponding motor representations. Here, by applying target-specific, gradual visuomotor rotations and dissociating, unbeknownst to participants, the visual direction of potential targets from the direction of the movements required to reach the same targets, we provide direct evidence for this provocative idea...
February 14, 2017: Cell Reports
https://www.readbyqxmd.com/read/28199357/home-detection-of-freezing-of-gait-using-support-vector-machines-through-a-single-waist-worn-triaxial-accelerometer
#6
Daniel Rodríguez-Martín, Albert Samà, Carlos Pérez-López, Andreu Català, Joan M Moreno Arostegui, Joan Cabestany, Àngels Bayés, Sheila Alcaine, Berta Mestre, Anna Prats, M Cruz Crespo, Timothy J Counihan, Patrick Browne, Leo R Quinlan, Gearóid ÓLaighin, Dean Sweeney, Hadas Lewy, Joseph Azuri, Gabriel Vainstein, Roberta Annicchiarico, Alberto Costa, Alejandro Rodríguez-Molinero
Among Parkinson's disease (PD) symptoms, freezing of gait (FoG) is one of the most debilitating. To assess FoG, current clinical practice mostly employs repeated evaluations over weeks and months based on questionnaires, which may not accurately map the severity of this symptom. The use of a non-invasive system to monitor the activities of daily living (ADL) and the PD symptoms experienced by patients throughout the day could provide a more accurate and objective evaluation of FoG in order to better understand the evolution of the disease and allow for a more informed decision-making process in making adjustments to the patient's treatment plan...
2017: PloS One
https://www.readbyqxmd.com/read/28199265/a-decision-support-approach-for-provider-scheduling-in-a-patient-centered-medical-home
#7
Renata Konrad, Sarah Ficarra, Catherine Danko, Rachel Wallace, Cliona Archambeault
The patient-centered medical home (PCMH) has been proposed as a viable and medically effective model of primary care delivery. The fundamental principles of a PCMH address increased access and offer new ways to organize a practice. Creating provider schedules able to satisfy the operational and organizational constraints imposed by this type of delivery model is a challenging, complex, and time-consuming task.This article presents a two-step approach for scheduling providers and prospectively assessing the consequences of various schedules on patient throughput without experimenting on the real-world system...
January 2017: Journal of Healthcare Management / American College of Healthcare Executives
https://www.readbyqxmd.com/read/28197684/definition-of-variables-required-for-comprehensive-description-of-drug-dosage-and-clinical-pharmacokinetics
#8
Anna V Medem, Hanna M Seidling, Hans-Georg Eichler, Jens Kaltschmidt, Michael Metzner, Carina M Hubert, David Czock, Walter E Haefeli
PURPOSE: Electronic clinical decision support systems (CDSS) require drug information that can be processed by computers. The goal of this project was to determine and evaluate a compilation of variables that comprehensively capture the information contained in the summary of product characteristic (SmPC) and unequivocally describe the drug, its dosage options, and clinical pharmacokinetics. METHODS: An expert panel defined and structured a set of variables and drafted a guideline to extract and enter information on dosage and clinical pharmacokinetics from textual SmPCs as published by the European Medicines Agency (EMA)...
February 14, 2017: European Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/28196457/dermal-absorption-of-fumigant-gases-during-hazmat-incident-exposure-scenarios-methyl-bromide-sulfuryl-fluoride-and-chloropicrin
#9
Sharyn Gaskin, Linda Heath, Dino Pisaniello, John W Edwards, Michael Logan, Christina Baxter
Accidental or intentional releases of toxic gases or vapors are the most common occurrence in hazardous material (HAZMAT) incidents that result in human injuries. The most serious hazard from exposure to gases or vapors is via the respiratory system. Dermal uptake, as a secondary route, is still a concern, most acutely for the unprotected public. There is a limited evidence base describing skin absorption of toxic gases and vapors in HAZMAT exposure scenarios, which are relatively brief compared with traditional test periods for skin absorption studies...
January 1, 2017: Toxicology and Industrial Health
https://www.readbyqxmd.com/read/28195840/decision-support-for-the-capacity-management-of-bronchoscopy-devices-optimizing-the-cost-efficient-mix-of-reusable-and-single-use-devices-through-mathematical-modeling
#10
Günther M Edenharter, Daniel Gartner, Dominik Pförringer
BACKGROUND: Increasing costs of material resources challenge hospitals to stay profitable. Particularly in anesthesia departments and intensive care units, bronchoscopes are used for various indications. Inefficient management of single- and multiple-use systems can influence the hospitals' material costs substantially. Using mathematical modeling, we developed a strategic decision support tool to determine the optimum mix of disposable and reusable bronchoscopy devices in the setting of an intensive care unit...
February 10, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28195244/health-technology-assessment-introducing-a-vacuum-based-preservation-system-for-biological-materials-in-the-anatomic-pathology-workflow
#11
R Saliceti, E Nicodemo, A Giannini, A Cortese
INTRODUCTION: The objective of this work is to assess the implementation of a newly introduced medical equipment technology for the vacuum-based preservation of biological materials within an Anatomic Pathology service. METHODS: The approach selected for the analysis is the Health Technology Assessment (HTA ), a comprehensive evaluation method based on relevant scientific evidence and designed to support healthcare decision makers in purchasing, replacing or disposing of technologies...
March 2016: Pathologica
https://www.readbyqxmd.com/read/28193619/improving-specialist-drug-prescribing-in-primary-care-using-task-and-error-analysis-an-observational-study
#12
Narinder Chana, Talya Porat, Cate Whittlesea, Brendan Delaney
BACKGROUND: Electronic prescribing has benefited from computerised clinical decision support systems (CDSSs); however, no published studies have evaluated the potential for a CDSS to support GPs in prescribing specialist drugs. AIM: To identify potential weaknesses and errors in the existing process of prescribing specialist drugs that could be addressed in the development of a CDSS. DESIGN AND SETTING: Semi-structured interviews with key informants followed by an observational study involving GPs in the UK...
February 13, 2017: British Journal of General Practice: the Journal of the Royal College of General Practitioners
https://www.readbyqxmd.com/read/28193230/analysis-of-the-policymaking-process-in-burkina-faso-s-health-sector-case-studies-of-the-creation-of-two-health-system-support-units
#13
Andre Zida, John N Lavis, Nelson K Sewankambo, Bocar Kouyate, Kaelan Moat, Jessica Shearer
BACKGROUND: Burkina Faso has made a number of health system policy decisions to improve performance on health indicators and strengthen responsiveness to health-related challenges. These included the creation of a General Directorate of Health Information and Statistics (DGISS) and a technical unit to coordinate performance-based financing (CT-FBR). We analysed the policymaking processes associated with the establishment of these units, and documented the factors that influenced this process...
February 13, 2017: Health Research Policy and Systems
https://www.readbyqxmd.com/read/28192551/effectiveness-of-computer-automation-for-the-diagnosis-and-management-of-childhood-type-2-diabetes-a-randomized-clinical-trial
#14
Tamara S Hannon, Tamara M Dugan, Chandan K Saha, Steven J McKee, Stephen M Downs, Aaron E Carroll
Importance: Type 2 diabetes (T2D) is increasingly common in young individuals. Primary prevention and screening among children and adolescents who are at substantial risk for T2D are recommended, but implementation of T2D screening practices in the pediatric primary care setting is uncommon. Objective: To determine the feasibility and effectiveness of a computerized clinical decision support system to identify pediatric patients at high risk for T2D and to coordinate screening for and diagnosis of prediabetes and T2D...
February 13, 2017: JAMA Pediatrics
https://www.readbyqxmd.com/read/28190702/analysis-of-low-appropriateness-score-exam-trends-in-decision-support-based-radiology-order-entry-system
#15
Supriya Gupta, Kandace Klein, Anand H Singh, James H Thrall
PURPOSE: Awareness of imaging utilization increased after implementation of Radiology Order Entry with decision support systems (ROE-DS). Our hypothesis is few exams with low Clinical Appropriateness Score (CAS) on ROE-DS are performed. Clinical indications of exams with CAS less than 3 (9-point scale) were re-reviewed and reports analyzed. MATERIALS AND METHODS: Structured Query Language-based query retrieved exams with CAS less than 3 in ROE-DS from January 2007 to December 2011...
February 9, 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/28187896/hydra-a-web-based-system-for-cardiovascular-analysis-diagnosis-and-treatment
#16
J Novo, A Hermida, M Ortega, N Barreira, M G Penedo, J E López, C Calvo
BACKGROUND AND OBJECTIVE: Cardiovascular (CV) risk stratification is a highly complex process involving an extensive set of clinical trials to support the clinical decision-making process. There are many clinical conditions (e.g. diabetes, obesity, stress, etc.) that can lead to the early diagnosis or establishment of cardiovascular disease. In order to determine all these clinical conditions, a complete set of clinical patient analyses is typically performed, including a physical examination, blood analysis, electrocardiogram, blood pressure (BP) analysis, etc...
February 2017: Computer Methods and Programs in Biomedicine
https://www.readbyqxmd.com/read/28187885/automated-characterization-and-counting-of-ki-67-protein-for-breast-cancer-prognosis-a-quantitative-immunohistochemistry-approach
#17
Tushar Mungle, Suman Tewary, Indu Arun, Bijan Basak, Sanjit Agarwal, Rosina Ahmed, Sanjoy Chatterjee, Asok Kumar Maity, Chandan Chakraborty
Ki-67 protein expression plays an important role in predicting the proliferative status of tumour cells and deciding the future course of therapy in breast cancer. Immunohistochemical (IHC) determination of Ki-67 score or labelling index, by estimating the fraction of Ki67 positively stained tumour cells, is the most widely practiced method to assess tumour proliferation (Dowsett et al. 2011). Accurate manual counting of these cells (specifically nuclei) due to complex and dense distribution of cells, therefore, becomes critical and presents a major challenge to pathologists...
February 2017: Computer Methods and Programs in Biomedicine
https://www.readbyqxmd.com/read/28187881/a-clinical-decision-making-mechanism-for-context-aware-and-patient-specific-remote-monitoring-systems-using-the-correlations-of-multiple-vital-signs
#18
Abdur Rahim Mohammad Forkan, Ibrahim Khalil
BACKGROUND AND OBJECTIVES: In home-based context-aware monitoring patient's real-time data of multiple vital signs (e.g. heart rate, blood pressure) are continuously generated from wearable sensors. The changes in such vital parameters are highly correlated. They are also patient-centric and can be either recurrent or can fluctuate. The objective of this study is to develop an intelligent method for personalized monitoring and clinical decision support through early estimation of patient-specific vital sign values, and prediction of anomalies using the interrelation among multiple vital signs...
February 2017: Computer Methods and Programs in Biomedicine
https://www.readbyqxmd.com/read/28187811/determinants-of-prognosis-in-neurocatastrophes
#19
K Sharma, R D Stevens
A neurocatastrophe or severe brain injury (SBI) is a central nervous system insult associated with a high likelihood of death or severe disability. While many etiologic processes may lead to SBI, the most common and best-studied clinical paradigms are traumatic brain injury and anoxic-ischemic encephalopathy following cardiac arrest. Clinical phenotypes following SBI include acute and chronic disorders of consciousness as well as a range of cognitive and behavioral impairments. A fundamental task for medical teams working in the acute phase is to estimate SBI recovery probabilities with the highest degree of accuracy possible...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28187294/comprehensible-knowledge-model-creation-for-cancer-treatment-decision-making
#20
Muhammad Afzal, Maqbool Hussain, Wajahat Ali Khan, Taqdir Ali, Sungyoung Lee, Eui-Nam Huh, Hafiz Farooq Ahmad, Arif Jamshed, Hassan Iqbal, Muhammad Irfan, Manzar Abbas Hydari
BACKGROUND: A wealth of clinical data exists in clinical documents in the form of electronic health records (EHRs). This data can be used for developing knowledge-based recommendation systems that can assist clinicians in clinical decision making and education. One of the big hurdles in developing such systems is the lack of automated mechanisms for knowledge acquisition to enable and educate clinicians in informed decision making. MATERIALS AND METHODS: An automated knowledge acquisition methodology with a comprehensible knowledge model for cancer treatment (CKM-CT) is proposed...
January 29, 2017: Computers in Biology and Medicine
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