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Clinical decision rules

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https://www.readbyqxmd.com/read/28934822/stent-placement-for-benign-esophageal-leaks-perforations-and-fistulae-a-clinical-prediction-rule-for-successful-leakage-control
#1
Emo E van Halsema, Wouter F W Kappelle, Bas L A M Weusten, Robert Lindeboom, Mark I van Berge Henegouwen, Paul Fockens, Frank P Vleggaar, Manon C W Spaander, Jeanin E van Hooft
Background and study aims Sealing esophageal leaks by stent placement allows healing in 44 % - 94 % of patients. We aimed to develop a prediction rule to predict the chance of successful stent therapy. Patients and methods In this multicenter retrospective cohort study, patients with benign upper gastrointestinal leakage treated with stent placement were included. We used logistic regression analysis including four known clinical predictors of stent therapy outcome. The model performance to predict successful stent therapy was evaluated in an independent validation sample...
September 21, 2017: Endoscopy
https://www.readbyqxmd.com/read/28933327/concussion-in-sports-what-trauma-orthopedic-surgeons-need-to-know
#2
A Gänsslen, T Neubauer, W Krutsch
Concussion in sport is often underdiagnosed with the potential risk of long-term sequelae. This article presents the mechanisms, the underlying pathophysiology and typical primary signs and symptoms. The recognition and resulting medical measures including the present recommendations and decisions on return to play are described. The majority of patients with concussion present with clinical and cognitive symptoms only for short time intervals. As a rule a complete subjective recovery is observed within a few hours or days...
2017: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
https://www.readbyqxmd.com/read/28925655/pleuritic-chest-pain-sorting-through-the-differential-diagnosis
#3
Brian V Reamy, Pamela M Williams, Michael Ryan Odom
Pleuritic chest pain is characterized by sudden and intense sharp, stabbing, or burning pain in the chest when inhaling and exhaling. Pulmonary embolism is the most common serious cause, found in 5% to 21% of patients who present to an emergency department with pleuritic chest pain. A validated clinical decision rule for pulmonary embolism should be employed to guide the use of additional tests such as d-dimer assays, ventilation-perfusion scans, or computed tomography angiography. Myocardial infarction, pericarditis, aortic dissection, pneumonia, and pneumothorax are other serious causes that should be ruled out using history and physical examination, electrocardiography, troponin assays, and chest radiography before another diagnosis is made...
September 1, 2017: American Family Physician
https://www.readbyqxmd.com/read/28914640/machine-learning-novel-bioinformatics-approaches-for-combating-antimicrobial-resistance
#4
Nenad Macesic, Fernanda Polubriaginof, Nicholas P Tatonetti
PURPOSE OF REVIEW: Antimicrobial resistance (AMR) is a threat to global health and new approaches to combating AMR are needed. Use of machine learning in addressing AMR is in its infancy but has made promising steps. We reviewed the current literature on the use of machine learning for studying bacterial AMR. RECENT FINDINGS: The advent of large-scale data sets provided by next-generation sequencing and electronic health records make applying machine learning to the study and treatment of AMR possible...
September 12, 2017: Current Opinion in Infectious Diseases
https://www.readbyqxmd.com/read/28895526/molecular-testing-for-lynch-syndrome-in-people-with-colorectal-cancer-systematic-reviews-and-economic-evaluation
#5
Tristan Snowsill, Helen Coelho, Nicola Huxley, Tracey Jones-Hughes, Simon Briscoe, Ian M Frayling, Chris Hyde
BACKGROUND: Inherited mutations in deoxyribonucleic acid (DNA) mismatch repair (MMR) genes lead to an increased risk of colorectal cancer (CRC), gynaecological cancers and other cancers, known as Lynch syndrome (LS). Risk-reducing interventions can be offered to individuals with known LS-causing mutations. The mutations can be identified by comprehensive testing of the MMR genes, but this would be prohibitively expensive in the general population. Tumour-based tests - microsatellite instability (MSI) and MMR immunohistochemistry (IHC) - are used in CRC patients to identify individuals at high risk of LS for genetic testing...
September 2017: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/28891177/cognitive-challenges-to-minimising-low-value-care
#6
Ian A Scott
Clinical decisions often rely on pattern recognition, simple rules of thumb, tacit knowledge and habit. In many instances, such intuitive decisions are fast and accurate, but they can be subject to cognitive biases leading to delivery of care of low value at odds with scientific evidence of best practice. If programmes, such as EVOLVE (Evaluating Evidence, Enhancing Efficiencies) and Choosing Wisely are to have maximal impact in minimising low value care, such biases, and the factors that hide and accentuate them, need to be exposed and addressed in a collegiate and non-judgemental manner...
September 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28888541/frequency-of-mutations-in-a-large-series-of-clinically-ascertained-ovarian-cancer-cases-tested-on-multi-gene-panels-compared-to-reference-controls
#7
Jenna Lilyquist, Holly LaDuca, Eric Polley, Brigette Tippin Davis, Hermela Shimelis, Chunling Hu, Steven N Hart, Jill S Dolinsky, Fergus J Couch, David E Goldgar
OBJECTIVES: Given the lack of adequate screening modalities, knowledge of ovarian cancer risks for carriers of pathogenic alterations in predisposition genes is important for decisions about risk-reduction by salpingo-oophorectomy. We sought to determine which genes assayed on multi-gene panels are associated with ovarian cancer, the magnitude of the associations, and for which clinically meaningful associations could be ruled out. METHODS: 7768 adult ovarian cancer cases of European ancestry referred to a single clinical testing laboratory underwent multi-gene panel testing for detection of pathogenic alterations in known or suspected ovarian cancer susceptibility genes...
September 7, 2017: Gynecologic Oncology
https://www.readbyqxmd.com/read/28882447/improving-the-informed-consent-process-in-hematopoietic-cell-transplantation-patient-caregiver-and-provider-perspectives
#8
Minakshi Raj, Sung Won Choi, Tuba Suzer Gurtekin, Jodyn Platt
One of the significant modifications to the Common Rule is the requirement that prospective participants are given information sufficient for a "reasonable person". However, there is limited research on what types of information patients, caregivers, and providers consider "key information". Although certain aspects of informed consent (IC) may be considered standard, considering individualized needs and preferences of patients is necessary for patient-centered consent. In the current study, we qualitatively examined the specific types of information that patients and caregivers involved in hematopoietic cell transplantation (HCT), as well as their providers, believe are important and necessary as part of the IC process in order to make a decision about participating in clinical research; and further, how these perspectives are aligned...
September 4, 2017: Biology of Blood and Marrow Transplantation
https://www.readbyqxmd.com/read/28880046/clinical-decisions-support-malfunctions-in-a-commercial-electronic-health-record
#9
Steven Z Kassakian, Thomas R Yackel, Paul N Gorman, David A Dorr
OBJECTIVES: Determine if clinical decision support (CDS) malfunctions occur in a commercial electronic health record (EHR) system, characterize their pathways and describe methods of detection. METHODS: We retrospectively examined the firing rate for 226 alert type CDS rules for detection of anomalies using both expert visualization and statistical process control (SPC) methods over a five year period. Candidate anomalies were investigated and validated. RESULTS: Twenty-one candidate CDS anomalies were identified from 8,300 alert-months...
September 6, 2017: Applied Clinical Informatics
https://www.readbyqxmd.com/read/28877157/external-validation-of-six-pediatric-fever-and-neutropenia-clinical-decision-rules
#10
Gabrielle M Haeusler, Karin A Thursky, Monica A Slavin, Francoise Mechinaud, Franz E Babl, Penelope Bryant, Richard De Abreu Lourenco, Robert Phillips
BACKGROUND: Fever and neutropenia (FN) clinical decision rules (CDRs) are recommended to help distinguish children with cancer at high and low risk of severe infection. The aim of this study was to validate existing pediatric FN CDRs, designed to stratify children with cancer at high or low risk of serious infection or medical complication. METHODS: Pediatric CDRs suitable for validation were identified from a literature search. Relevant data were extracted from an existing dataset of 650 retrospective FN episodes in children with cancer...
September 5, 2017: Pediatric Infectious Disease Journal
https://www.readbyqxmd.com/read/28877008/definitions-and-statistical-properties-of-master-protocols-for-personalized-medicine-in-oncology
#11
Lindsay A Renfro, Sumithra J Mandrekar
Within the field of cancer research, discovery of biomarkers and genetic mutations that are potentially predictive of treatment benefit are motivating a paradigm shift in how cancer clinical trials are conducted. In this review, we provide an overview of the class of trials known as "master protocols", including basket trials, umbrella trials, and platform trials. For each, we describe standardized terminology, provide a motivating example with modeling details and decision rules, and discuss statistical advantages and limitations...
September 6, 2017: Journal of Biopharmaceutical Statistics
https://www.readbyqxmd.com/read/28874933/head-ct-for-minor-head-injury-presenting-to-the-emergency-department-in-the-era-of-choosing-wisely
#12
John DeAngelis, Valerie Lou, Timmy Li, Henry Tran, Praneeta Bremjit, Molly McCann, Peter Crane, Courtney M C Jones
INTRODUCTION: The Choosing Wisely campaign currently recommends avoiding computed tomography (CT) of the head in low-risk emergency department (ED) patients with minor head injury, based on validated decision rules. However, the degree of adherence to this guideline in clinical practice is unknown. The objective of this study was to evaluate adherence to the Choosing Wisely campaign's recommendations regarding head CT imaging of patients with minor head injury in the ED. METHODS: We conducted a retrospective cohort study of adult ED patients at a Level I trauma center...
August 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28873162/mutation-detection-in-patients-with-advanced-cancer-by-universal-sequencing-of-cancer-related-genes-in-tumor-and-normal-dna-vs-guideline-based-germline-testing
#13
Diana Mandelker, Liying Zhang, Yelena Kemel, Zsofia K Stadler, Vijai Joseph, Ahmet Zehir, Nisha Pradhan, Angela Arnold, Michael F Walsh, Yirong Li, Anoop R Balakrishnan, Aijazuddin Syed, Meera Prasad, Khedoudja Nafa, Maria I Carlo, Karen A Cadoo, Meg Sheehan, Megan H Fleischut, Erin Salo-Mullen, Magan Trottier, Steven M Lipkin, Anne Lincoln, Semanti Mukherjee, Vignesh Ravichandran, Roy Cambria, Jesse Galle, Wassim Abida, Marcia E Arcila, Ryma Benayed, Ronak Shah, Kenneth Yu, Dean F Bajorin, Jonathan A Coleman, Steven D Leach, Maeve A Lowery, Julio Garcia-Aguilar, Philip W Kantoff, Charles L Sawyers, Maura N Dickler, Leonard Saltz, Robert J Motzer, Eileen M O'Reilly, Howard I Scher, Jose Baselga, David S Klimstra, David B Solit, David M Hyman, Michael F Berger, Marc Ladanyi, Mark E Robson, Kenneth Offit
Importance: Guidelines for cancer genetic testing based on family history may miss clinically actionable genetic changes with established implications for cancer screening or prevention. Objective: To determine the proportion and potential clinical implications of inherited variants detected using simultaneous sequencing of the tumor and normal tissue ("tumor-normal sequencing") compared with genetic test results based on current guidelines. Design, Setting, and Participants: From January 2014 until May 2016 at Memorial Sloan Kettering Cancer Center, 10 336 patients consented to tumor DNA sequencing...
September 5, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28872354/video-and-clinical-screening-of-national-rugby-league-players-suspected-of-sustaining-concussion
#14
Andrew J Gardner, Magdalena Wojtowicz, Douglas P Terry, Christopher R Levi, Ross Zafonte DO, Grant L Iverson
PRIMARY OBJECTIVE: This study reviewed the available sideline Sport Concussion Assessment Tool-Third Edition (SCAT3) performance of players who were removed from play using the 'concussion interchange rule' (CIR), the available video footage of these incidences, and associated return to play and concussion diagnosis decisions. RESEARCH DESIGN: Descriptive, observational case series. METHODS AND PROCEDURES: Data were collected from all NRL players who used the CIR during the 2014 season...
September 5, 2017: Brain Injury: [BI]
https://www.readbyqxmd.com/read/28870378/-think-aloud-and-near-live-usability-testing-of-two-complex-clinical-decision-support-tools
#15
Safiya Richardson, Rebecca Mishuris, Alexander O'Connell, David Feldstein, Rachel Hess, Paul Smith, Lauren McCullagh, Thomas McGinn, Devin Mann
OBJECTIVES: Low provider adoption continues to be a significant barrier to realizing the potential of clinical decision support. "Think Aloud" and "Near Live" usability testing were conducted on two clinical decision support tools. Each was composed of an alert, a clinical prediction rule which estimated risk of either group A Streptococcus pharyngitis or pneumonia and an automatic order set based on risk. The objective of this study was to further understanding of the facilitators of usability and to evaluate the types of additional information gained from proceeding to "Near Live" testing after completing "Think Aloud"...
October 2017: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/28867331/reference-ranges-for-serum-s100b-neuroprotein-specific-to-infants-under-four-months-of-age
#16
Jeanne Simon-Pimmel, Fleur Lorton, Damien Masson, Damien Bouvier, Matthieu Hanf, Christèle Gras-Le Guen
BACKGROUND: Minor head traumatisms are a common reason for consultation in paediatric emergency departments. The diagnosis of traumatic brain injuries involves performing a cranial computed tomography (CCT), associated with a risk of cancer due to the radiation. The serum S100B is an effective biomarker used to reduce reliance on CCT. While reference ranges have been determined, the limited number of cases regarding infants less than 4months of age has not allowed this biomarker to be used with this age group...
September 1, 2017: Clinical Biochemistry
https://www.readbyqxmd.com/read/28859829/multi-model-based-interactive-authoring-environment-for-creating-shareable-medical-knowledge
#17
Taqdir Ali, Maqbool Hussain, Wajahat Ali Khan, Muhammad Afzal, Jamil Hussain, Rahman Ali, Waseem Hassan, Arif Jamshed, Byeong Ho Kang, Sungyoung Lee
OBJECTIVE: Technologically integrated healthcare environments can be realized if physicians are encouraged to use smart systems for the creation and sharing of knowledge used in clinical decision support systems (CDSS). While CDSSs are heading toward smart environments, they lack support for abstraction of technology-oriented knowledge from physicians. Therefore, abstraction in the form of a user-friendly and flexible authoring environment is required in order for physicians to create shareable and interoperable knowledge for CDSS workflows...
October 2017: Computer Methods and Programs in Biomedicine
https://www.readbyqxmd.com/read/28856560/ensemble-classifiers-for-predicting-hiv-1-resistance-from-three-rule-based-genotypic-resistance-interpretation-systems
#18
Letícia M Raposo, Flavio F Nobre
Resistance to antiretrovirals (ARVs) is a major problem faced by HIV-infected individuals. Different rule-based algorithms were developed to infer HIV-1 susceptibility to antiretrovirals from genotypic data. However, there is discordance between them, resulting in difficulties for clinical decisions about which treatment to use. Here, we developed ensemble classifiers integrating three interpretation algorithms: Agence Nationale de Recherche sur le SIDA (ANRS), Rega, and the genotypic resistance interpretation system from Stanford HIV Drug Resistance Database (HIVdb)...
August 30, 2017: Journal of Medical Systems
https://www.readbyqxmd.com/read/28856440/the-impact-of-the-introduction-of-pecarn-head-ct-rules-on-the-utilisation-of-head-ct-scans-in-a-private-tertiary-hospital-in-sub-saharan-africa
#19
Isaac O Kobe, Mahmoud M Qureshi, Saidi Hassan, David L Oluoch-Olunya
BACKGROUND: The decision to order head CT scans to rule out clinically significant traumatic brain injury in mild head injury in children is made on the basis of clinical decision rules of which the Paediatric Emergency Care Applied Research Network (PECARN) CT head rules have been found to be most sensitive. PURPOSES: The purpose of this study is to determine the proportion of head CT scans done for children with mild head injury and to determine disposition of patients from casualty after the introduction of PECARN head CT rules compared to the period before...
August 30, 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/28844507/accuracy-of-fnac-and-ct-in-the-differentiation-of-benign-and-malignant-parotid-tumours-in-a-case-series
#20
Marina A Gavín-Clavero, Tomás Usón-Bouthelier, Úrsula M Jariod-Ferrer, Arancha Fernández-Larrañaga, Bianca Pantilie, Fernando Lobera-Molina, M Victoria Simón-Sanz, Bartolomé Nadal Cristóbal
INTRODUCTION: Parotid tumours, in addition to the wide variety of types, are histologically complex. Differentiating between benign and malignant tumours in preoperative diagnosis is important in deciding the type of surgery required. Fine needle aspiration cytology (FNAC) is a simple, quick, low-cost, low-invasive and well-tolerated tool used in the preoperative diagnosis of these tumours. MATERIAL AND METHODS: we calculated the sensitivity, specificity, predictive positive value (PPV) and negative predictive value (NPV) of FNAC and computed tomography (CT) in the differentiation of benign and malignant parotid tumours operated between 2010 to 2014 in the oral and maxillofacial surgery department of the University Hospital Miguel Servet...
August 24, 2017: Acta Otorrinolaringológica Española
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