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https://www.readbyqxmd.com/read/29471111/mortality-prediction-in-intensive-care-units-icus-using-a-deep-rule-based-fuzzy-classifier
#1
Raheleh Davoodi, Mohammad Hassan Moradi
Electronic health records (EHRs) contain critical information useful for clinical studies. Early assessment of patients' mortality in intensive care units is of great importance. In this paper, a Deep Rule-Based Fuzzy System (DRBFS) was proposed to develop an accurate in-hospital mortality prediction in the intensive care unit (ICU) patients employing a large number of input variables. Our main contribution is proposing a system, which is capable of dealing with big data with heterogeneous mixed categorical and numeric attributes...
February 19, 2018: Journal of Biomedical Informatics
https://www.readbyqxmd.com/read/29469712/future-growth-of-physicians-and-non-physician-providers-within-the-u-s-dermatology-workforce
#2
Michael R Sargen, Lucy Shi, Roderick S Hooker, Suephy C Chen
Trends in the training, supply, availability, career decisions, and retirement of US dermatology physicians are not well delineated. The current study evaluates whether growth in the dermatology workforce will keep pace with population expansion in the United States. A dermatologist supply model was projected to 2030 drawing on data from the American Academy of Dermatology, American Medical Association, Bureau of Labor Statistics, American Association of Medical Colleges, and other associations. The clinically active dermatologist workforce in 2015 was 36 per capita (1,000,000); entry following postgraduate training was age 30 with career separation at age 65 on average...
September 15, 2017: Dermatology Online Journal
https://www.readbyqxmd.com/read/29467045/systematic-review-with-network-meta-analysis-of-randomized-controlled-trials-of-rotator-cuff-tear-treatment
#3
Seihee Kim, Jinseub Hwang, Min Jee Kim, Jae-Young Lim, Woo Hyung Lee, Ji Eun Choi
OBJECTIVES: Rotator cuff tear is the leading cause of the decline in quality of life for older adults, but comparative evidence on treatment effectiveness is lacking. This study systematically reviewed the effects of various rotator cuff tear treatments through a Bayesian meta-analysis of the related randomized clinical trials (RCTs). METHODS: We searched nine electronic databases for RCTs evaluating rotator cuff tear treatments from their inception through June 2017...
February 22, 2018: International Journal of Technology Assessment in Health Care
https://www.readbyqxmd.com/read/29465461/resident-autonomy-in-the-operating-room-how-faculty-assess-real-time-entrustability
#4
Xiaodong Phoenix Chen, Amy M Sullivan, Douglas S Smink, Adnan Alseidi, Joan M Bengtson, Gifty Kwakye, John L Dalrymple
OBJECTIVE: This study aimed to identify the empirical processes and evidence that expert surgical teachers use to determine whether to take over certain steps or entrust the resident with autonomy to proceed during an operation. BACKGROUND: Assessing real-time entrustability is inherent in attending surgeons' determinations of residents' intraoperative autonomy in the operating room. To promote residents' autonomy, it is necessary to understand how attending surgeons evaluate residents' performance and support opportunities for independent practice based on the assessment of their entrustability...
February 20, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29465295/predicting-complicated-outcomes-in-spinal-cord-injury-patients-with-urinary-tract-infection-development-and-internal-validation-of-a-risk-model
#5
Sheng Si, Yan Yan, Brian M Fuller, Stephen Y Liang
CONTEXT/OBJECTIVE: Patients with chronic SCI hospitalized for UTI can have significant morbidity. It is unclear whether SIRS criteria, SOFA score, or quick SOFA score can be used to predict complicated outcome. DESIGN: Retrospective cohort study. A risk prediction model was developed and internally validated using bootstrapping methodology. SETTING: Urban, academic hospital in St. Louis, Missouri. PARTICIPANTS: 402 hospitalizations for UTI between October 1, 2010 and September 30, 2015, arising from 164 patients with chronic SCI, were included in the final analysis...
February 21, 2018: Journal of Spinal Cord Medicine
https://www.readbyqxmd.com/read/29464984/the-challenges-of-implementing-advanced-access-for-residents-in-family-medicine-in-quebec-do-promising-strategies-exist
#6
Sabina Abou Malham, Nassera Touati, Lara Maillet, Mylaine Breton
BACKGROUND: The advanced access (AA) model is a highly recommended innovation to improve timely access to primary healthcare. Despite that many studies have shown positive impacts for healthcare professionals, and for patients, implementing this model in clinics with a teaching mission for family medicine residents poses specific challenges. OBJECTIVE: To identify these challenges within these clinics, as well as potential strategies to address them. DESIGN: The authors adopted a qualitative multiple case study design, collected data in 2016 using semi-structured interviews (N = 40) with healthcare professionals and clerical staff in four family medicine units in Quebec, and performed a thematic analysis...
December 2018: Medical Education Online
https://www.readbyqxmd.com/read/29463140/premature-ventricular-beats-in-the-athlete-management-considerations
#7
Tamanna K Singh, Aaron L Baggish
Premature ventricular beats (PVBs) in competitive athletes are incidentally found during pre-participation ECG screening. Their clinical significance remains debatable with several studies suggesting they are a benign reflection of athlete's heart, and others proposing they may indicate underlying structural heart disease and heightened risk for sudden cardiac death (SCD). Areas covered: Effective management of athletes with PVBs may best be accomplished using an algorithmic approach for risk stratification with a goal of differentiating benign PVBs from those reflective of underlying cardiomyopathies...
February 21, 2018: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/29462227/prevalence-of-psoriasis-in-children-and-adolescents-in-the-united-states-a-claims-based-analysis
#8
Amy S Paller, Rakesh Singh, Martin Cloutier, Marjolaine Gauthier-Loiselle, Bruno Emond, Annie Guérin, Arijit Ganguli
IMPORTANCE: While psoriasis (Ps) is mainly characterized as an adult disease, it can also develop during childhood. However, prevalence estimates of pediatric psoriasis in the United States (US) are lacking. OBJECTIVE: To assess the 2015 annual prevalence of Ps and moderate-to-severe Ps in pediatric individuals in the US. DESIGN: This is a retrospective study based on a large administrative insurance claims database in the US. SETTING: Data were extracted from the Truven Health Analytics MarketScan® Commercial Claims and Encounters database, which covers over 60 million individuals with employer-provided health insurance across the US...
February 1, 2018: Journal of Drugs in Dermatology: JDD
https://www.readbyqxmd.com/read/29461353/realigning-shared-governance-with-magnet%C3%A2-and-the-organization-s-operating-system-to-achieve-clinical-excellence
#9
Janette V Moreno, Anita S Girard, Wendy Foad
In 2012, an academic medical center successfully overhauled a 15-year-old shared governance to align 6 house-wide and 30 unit-based councils with the new Magnet Recognition Program® and the organization's operating system, using the processes of LEAN methodology. The redesign improved cross-council communication structures, facilitated effective shared decision-making processes, increased staff engagement, and improved clinical outcomes. The innovative structural and process elements of the new model are replicable in other health institutions...
March 2018: Journal of Nursing Administration
https://www.readbyqxmd.com/read/29460065/the-impact-of-intraoperative-magnetic-resonance-in-routine-pediatric-neurosurgical-practice-a-6-year-appraisal
#10
Sonia Tejada, Shivaram Avula, Benedetta Pettorini, Dawn Henningan, Laurence Abernethy, Conor Mallucci
BACKGROUND: The intraoperative magnetic resonance scanner (ioMR) was introduced in our unit in 2009, and has been used routinely since then. OBJECTIVE: This study aims to describe indications, radiological features, and clinical outcomes of the patients operated on with ioMRI and analyze our experience. METHODS: A retrospective analysis of a prospective surgical database has been performed, including surgical procedure, intent, radiological reports, need for second-look surgery, and complications, supplemented by further review of the clinical notes and the scans...
February 19, 2018: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/29457445/model-for-end-stage-liver-disease-and-seven-derivations-to-prioritize-liver-transplant-candidates-which-is-the-winner
#11
Fariba Tohidinezhad, Saeid Eslami, Ameen Abu-Hanna, Mohsen Aliakbarian
OBJECTIVES: Under the present liver transplant policy, patients with the highest risk of death receive preference for organ placement. The aim of this study was to evaluate the Model for End-stage Liver Disease (MELD) and seven prognostic derivatives of this test for outcome prediction in cirrhotic patients on liver transplant wait lists. MATERIAL AND METHODS: The study included 416 patients (65.9% male; age 49 ± 13.9 years) who were entered to liver transplant wait lists from January 2013 to October 2016...
February 16, 2018: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/29457273/clinical-risk-factors-for-early-seizure-recurrence-in-dogs-hospitalized-for-seizure-evaluation
#12
M Kwiatkowska, A Tipold, E Huenerfauth, A Pomianowski
BACKGROUND: Epileptic seizures are a common cause for neurological evaluations in dogs. HYPOTHESIS/OBJECTIVES: To determine the timing, frequency, and risk factors for early seizure recurrence (ESR) among dogs admitted to the hospital for seizure evaluation and to facilitate rapid decision making about whether dogs should be placed in the intensive care unit (ICU) or day ward. ANIMALS: Nine-hundred twenty-two dogs referred for seizure investigation; 214 patients were included...
February 18, 2018: Journal of Veterinary Internal Medicine
https://www.readbyqxmd.com/read/29454848/a-multi-center-derivation-and-validation-of-a-simple-predictive-index-for-healthcare-associated-clostridium-difficile-infection
#13
Meghann L Davis, Harlan G Sparrow, Judy O Ikwuagwu, William L Musick, Kevin W Garey, Katherine K Perez
OBJECTIVES: Clostridium difficile infection (CDI) is the most common cause of healthcare-associated infections in the United States. Despite well-established risk factors, very little research has focused on use of these variables to identify a patient population at high-risk for CDI to target with primary prevention strategies. A predictive index for healthcare-associated CDI could improve clinical care and guide research for primary prevention trials. Our objective was to develop a predictive index to identify patients at high-risk for healthcare-associated CDI...
February 15, 2018: Clinical Microbiology and Infection
https://www.readbyqxmd.com/read/29454592/effective-antimicrobial-stewardship-strategies-for-cost-effective-utilization-of-telavancin-for-the-treatment-of-patients-with-hospital-acquired-bacterial-pneumonia-caused-by-staphylococcus-aureus
#14
James A McKinnell, Shelby Corman, Dipen Patel, Grace H Leung, Lynne M Gordon, Thomas P Lodise
PURPOSE: Clinicians and stewardship programs are challenged with positioning of novel, higher priced antibiotic agents for the treatment of clinical infections. We developed a decision-analytic model to describe costs, including drug, total treatment costs, and health care outcomes, associated with telavancin (TLV) compared with vancomycin (VAN) for patients with Staphylococcus aureus (SA) hospital-acquired bacterial pneumonia (HABP). METHODS: This decision-analytic model assessed the treatment of SA-HABP with TLV versus VAN...
February 14, 2018: Clinical Therapeutics
https://www.readbyqxmd.com/read/29452730/external-validation-of-a-decision-tree-early-warning-score-using-only-laboratory-data-a-retrospective-review-of-prospectively-collected-data
#15
Tara E Holm Atkins, Malin C Öhman, Mikkel Brabrand
INTRODUCTION: Early warning scores (EWS) have been developed to identify the degree of illness severity among acutely ill patients. One system, The Laboratory Decision Tree Early Warning Score (LDT-EWS) is wholly laboratory data based. Laboratory data was used in the development of a rare computerized method, developing a decision tree analysis. This article externally validates LDT-EWS, which is obligatory for an EWS before clinical use. METHOD: We conducted a retrospective review of prospectively collected data based on a time limited sample of all patients admitted through the medical admission unit (MAU) on a Danish secondary hospital...
February 13, 2018: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/29449200/mhealth-technology-and-nurse-health-coaching-to-improve-health-in-diabetes-protocol-for-a-randomized-controlled-trial
#16
Sheridan Miyamoto, Madan Dharmar, Sarina Fazio, Yajarayma Tang-Feldman, Heather M Young
BACKGROUND: Chronic diseases, including diabetes mellitus, are the leading cause of mortality and disability in the United States. Current solutions focus primarily on diagnosis and pharmacological treatment, yet there is increasing evidence that patient-centered models of care are more successful in improving and addressing chronic disease outcomes. OBJECTIVE: The objective of this clinical trial is to evaluate the impact of a mobile health (mHealth) enabled nurse health coaching intervention on self-efficacy among adults with type-2 diabetes mellitus...
February 15, 2018: JMIR Research Protocols
https://www.readbyqxmd.com/read/29448963/academic-medical-centers-as-innovation-ecosystems-to-address-population-omics-challenges-in-precision-medicine
#17
REVIEW
Patrick J Silva, Valerie M Schaibley, Kenneth S Ramos
While the promise of the Human Genome Project provided significant insights into the structure of the human genome, the complexities of disease at the individual level have made it difficult to utilize -omic information in clinical decision making. Some of the existing constraints have been minimized by technological advancements that have reduced the cost of sequencing to a rate far in excess of Moore's Law (a halving in cost per unit output every 18 months). The reduction in sequencing costs has made it economically feasible to create large data commons capturing the diversity of disease across populations...
February 15, 2018: Journal of Translational Medicine
https://www.readbyqxmd.com/read/29444696/bedside-analysis-of-the-sublingual-microvascular-glycocalyx-in-the-emergency-room-and-intensive-care-unit-the-glyconurse-study
#18
Alexandros Rovas, Alexander-Henrik Lukasz, Hans Vink, Marc Urban, Jan Sackarnd, Hermann Pavenstädt, Philipp Kümpers
BACKGROUND: Deterioration of the endothelial glycocalyx (eGC), a protective carbohydrate-rich layer lining the luminal surface of the endothelium, plays a key role in vascular barrier dysfunction and eventually organ-failure in systemic inflammatory response syndrome and sepsis. Early detection of glycocalyx damage could thus become an important goal in critical care. This study was designed to determine the feasibility and reproducibility of quantitative, real-time glycocalyx measurements performed at bedside in the emergency room (ER) and intensive care unit (ICU)...
February 14, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29442335/early-assessment-of-the-likely-cost-effectiveness-of-single-use-flexible-video-bronchoscopes
#19
Christoffer Lilja Terjesen, Julia Kovaleva, Lars Ehlers
BACKGROUND: Bronchoscopic procedures are common in the clinical setting, with estimates indicating 500,000 are undertaken per year in the USA alone. These procedures are generally regarded as safe. Unfortunately, a risk of cross-contamination between patients, with possible subsequent infection, is associated with the re-usable technology typically used in these procedures. OBJECTIVE: Our objective was to conduct an early cost-effectiveness analysis (CEA) of single-use flexible video bronchoscope technology compared with the current reusable technology in a US hospital intensive care setting...
June 2017: PharmacoEconomics Open
https://www.readbyqxmd.com/read/29441837/nurses-as-change-agents-for-a-better-future-in-health-care-the-politics-of-drift-and-dilution
#20
Anne M Rafferty
This paper takes the 70th Anniversary of the National Health Service (NHS) in the United Kingdom as an opportunity to reflect upon the strategic direction of nursing policy and the extent to which nurses can realise their potential as change agents in building a better future for health care. It argues that the policy trajectory set for nursing at the outset of the NHS continues to influence its strategic direction, and that the trajectory needs to be reset with the voices of nurses being more engaged in the design, as much as the delivery of health policy...
February 14, 2018: Health Economics, Policy, and Law
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