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Clinical decision rules

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https://www.readbyqxmd.com/read/28630238/impact-of-sex-on-cardiac-troponin-concentrations-a-critical-appraisal
#1
REVIEW
Kai M Eggers, Bertil Lindahl
BACKGROUND: The use of sex-specific cutoffs for cardiac troponin (cTn) is currently debated. Although endorsed by scientific working groups, concerns have been raised that sex-specific cutoffs may have only a small clinical effect at the cost of increased complexity in decision-making. METHODS: We reviewed studies investigating the interrelations between high-sensitivity (hs) cTn results and sex, diagnoses, and outcome. Investigated populations included community-dwelling subjects and patients with stable angina, congestive heart failure, or acute chest pain including those with acute coronary syndromes...
June 19, 2017: Clinical Chemistry
https://www.readbyqxmd.com/read/28629781/position-paper-for-the-evaluation-and-management-of-oral-status-in-patients-with-valvular-disease-groupe-de-travail-valvulopathies-de-la-soci%C3%A3-t%C3%A3-fran%C3%A3-aise-de-cardiologie-soci%C3%A3-t%C3%A3-fran%C3%A3-aise-de-chirurgie-orale-soci%C3%A3-t%C3%A3-fran%C3%A3-aise-de-parodontologie-et-d-implantologie
#2
REVIEW
Sarah Millot, Philippe Lesclous, Marie-Laure Colombier, Loredana Radoi, Clément Messeca, Mathieu Ballanger, Jean-Luc Charrier, Philippe Tramba, Stéphane Simon, Alain Berrebi, Fabien Doguet, Emmanuel Lansac, Christophe Tribouilloy, Gilbert Habib, Xavier Duval, Bernard Iung
Oral health is of particular importance in patients with heart valve diseases because of the risk of infective endocarditis. Recommendations for antibiotic prophylaxis before dental procedures have been restricted, but the modalities of oral evaluation and dental care are not detailed in guidelines. Therefore, a multidisciplinary working group reviewed the literature to propose detailed approaches for the evaluation and management of buccodental status in patients with valvular disease. Simple questions asked by a non-dental specialist may draw attention to buccodental diseases...
June 16, 2017: Archives of Cardiovascular Diseases
https://www.readbyqxmd.com/read/28622763/treatment-decisions-and-mortality-in-hiv-positive-presumptive-smear-negative-tb-in-the-xpert%C3%A2-mtb-rif-era-a-cohort-study
#3
Sabine M Hermans, Juliet A Babirye, Olive Mbabazi, Francis Kakooza, Robert Colebunders, Barbara Castelnuovo, Christine Sekaggya-Wiltshire, Rosalind Parkes-Ratanshi, Yukari C Manabe
BACKGROUND: The Xpert™ MTB/RIF (XP) has a higher sensitivity than sputum smear microscopy (70% versus 35%) for TB diagnosis and has been endorsed by the WHO for TB high burden countries to increase case finding among HIV co-infected presumptive TB patients. Its impact on the diagnosis of smear-negative TB in a routine care setting is unclear. We determined the change in diagnosis, treatment and mortality of smear-negative presumptive TB with routine use of Xpert MTB/RIF (XP). METHODS: Prospective cohort study of HIV-positive smear-negative presumptive TB patients during a 12-month period after XP implementation in a well-staffed and trained integrated TB/HIV clinic in Kampala, Uganda...
June 16, 2017: BMC Infectious Diseases
https://www.readbyqxmd.com/read/28621297/endoscopic-ultrasound-with-or-without-fine-needle-aspiration-has-a-meaningful-impact-on-clinical-care-in-the-pediatric-population
#4
Amit Raina, Maire A Conrad, Benjamin Sahn, Alireza Sedarat, Gregory G Ginsberg, Nuzhat A Ahmad, Vinay Chandrasekhara, Petar Mamula, Michael L Kochman
BACKGROUND AND OBJECTIVES: The safety and utility of endoscopic ultrasound (EUS) for the evaluation and management of gastrointestinal (GI) tract disorders among adults has been established. The literature on safety and efficacy in a pediatric referral population (under 21 years of age) is limited. We hypothesized that EUS is safe and useful in the pediatric population. We reviewed the pediatric EUS experience at a single tertiary-care system. We describe the indications, findings, safety, technical success rate, and impact on clinical outcomes...
May 2017: Endoscopic Ultrasound
https://www.readbyqxmd.com/read/28620564/moyamoya-syndrome-in-a-child-with-neurofibromatosis-type-1-magnetic-resonance-imaging-as-a-tool-for-clinical-decision-making
#5
Jonathan Mayl, Hanisha Patel, Tushar Chandra
Moyamoya syndrome is a rare cerebrovasculopathy of unknown etiology which is associated with multiple risk factors. Moyamoya was first discovered in Japan and is reported to have an increased prevalence in the Japanese population. The term "Moyamoya" translates into "puff of smoke" and is named after the finding of the collateral cerebral vasculature that develops secondary to occlusion of an internal carotid artery at the entrance into the circle of Willis. This collateral vasculature characterizes the disease...
May 9, 2017: Curēus
https://www.readbyqxmd.com/read/28611156/clinical-prediction-rule-for-delayed-hemothorax-after-minor-thoracic-injury-a-multicentre-derivation-and-validation-study
#6
Marcel Émond, Chantal Guimont, Jean-Marc Chauny, Raoul Daoust, Éric Bergeron, Laurent Vanier, Lynne Moore, Miville Plourde, Batomen Kuimi, Valérie Boucher, Nadine Allain-Boulé, Natalie Le Sage
BACKGROUND: About 75% of patients with minor thoracic injury are discharged after an emergency department visit. However, complications such as delayed hemothorax can occur. We sought to derive and validate a clinical decision rule to predict hemothorax in patients discharged from the emergency department. METHODS: We conducted a 6-year prospective cohort study in 4 university-affiliated emergency departments. Patients aged 16 years or older presenting with a minor thoracic injury were assessed at 5 time points (initial visit and 7, 14, 30 and 90 d after the injury)...
June 12, 2017: CMAJ Open
https://www.readbyqxmd.com/read/28609435/predicting-infectious-complications-in-children-with-cancer-an-external-validation-study
#7
Gabrielle M Haeusler, Karin A Thursky, Francoise Mechinaud, Franz E Babl, Richard De Abreu Lourenco, Monica A Slavin, Robert Phillips
BACKGROUND: The aim of this study was to validate the 'Predicting Infectious ComplicatioNs in Children with Cancer' (PICNICC) clinical decision rule (CDR) that predicts microbiologically documented infection (MDI) in children with cancer and fever and neutropenia (FN). We also investigated costs associated with current FN management strategies in Australia. METHODS: Demographic, episode, outcome and cost data were retrospectively collected on 650 episodes of FN...
June 13, 2017: British Journal of Cancer
https://www.readbyqxmd.com/read/28594220/field-reliability-influences-field-validity-risk-assessments-of-individuals-found-not-guilty-by-reason-of-insanity
#8
W Neil Gowensmith, Daniel C Murrie, Marcus T Boccaccini, Brandon J McNichols
Individuals acquitted as not guilty by reason of insanity (NGRI) are usually committed to psychiatric hospitals for treatment until they are considered suitable for conditional release back to the community. The clinical evaluations that inform conditional release decisions have rarely been studied but provide an ideal opportunity to examine the reliability and validity of complex evaluations in the field. For example, to what extent do forensic evaluators agree about an acquittee's readiness for conditional release? And how accurate are their opinions? We reviewed 175 evaluation reports across 62 cases from Hawaii, which requires 3 separate evaluations from independent clinicians for each felony NGRI acquittee referred for conditional release evaluation...
June 2017: Psychological Assessment
https://www.readbyqxmd.com/read/28589638/inter-observer-reliability-in-reading-amplitude-integrated-electroencephalogram-in-the-newborn-intensive-care-unit
#9
Bhavesh Mehta, Nadine Griffiths, Kaye Spence, Sharon Laing
AIM: Amplitude-integrated electroencephalogram (aEEG) is widely used in neonates to detect electrical seizure and predict outcome following hypoxic ischaemic encephalopathy and other encephalopathy. Because accurate interpretation is important for clinical decision-making and family counselling, inter-observer reliability is a major concern. We aimed to evaluate inter-observer reliability in the interpretation of aEEG tracings in a neonatal intensive care unit. METHODS: Three neonatal intensive care unit clinicians with different levels of experience in reading aEEG independently reviewed and scored aEEG traces using standardised criteria, categories and interpretation rules...
June 7, 2017: Journal of Paediatrics and Child Health
https://www.readbyqxmd.com/read/28589398/the-contemporary-role-of-multiparametric-magnetic-resonance-imaging-in-active-surveillance-for-prostate-cancer
#10
REVIEW
Ariel A Schulman, Christina Sze, Efrat Tsivian, Rajan T Gupta, Judd W Moul, Thomas J Polascik
PURPOSE OF REVIEW: Growing research supports the use of multiparametric magnetic resonance imaging (mpMRI) for the evaluation of localized prostate cancer (PCa). We highlight contemporary evidence supporting its use in active surveillance (AS). RECENT FINDINGS: The emerging approach to localized PCa favors risk-adapted screening, image-guided biopsies, and selective therapeutic interventions. mpMRI is increasingly critical to achieve each of these aims. Early evidence suggests a value of mpMRI before initial biopsy to guide fusion targeting and to rule out non-organ confined disease as well as in the initiation and serial monitoring of men on AS...
July 2017: Current Urology Reports
https://www.readbyqxmd.com/read/28585184/text-mining-of-the-electronic-health-record-an-information-extraction-approach-for-automated-identification-and-subphenotyping-of-hfpef-patients-for-clinical-trials
#11
Siddhartha R Jonnalagadda, Abhishek K Adupa, Ravi P Garg, Jessica Corona-Cox, Sanjiv J Shah
Precision medicine requires clinical trials that are able to efficiently enroll subtypes of patients in whom targeted therapies can be tested. To reduce the large amount of time spent screening, identifying, and recruiting patients with specific subtypes of heterogeneous clinical syndromes (such as heart failure with preserved ejection fraction [HFpEF]), we need prescreening systems that are able to automate data extraction and decision-making tasks. However, a major obstacle is the vast amount of unstructured free-form text in medical records...
June 5, 2017: Journal of Cardiovascular Translational Research
https://www.readbyqxmd.com/read/28577758/diagnosis-of-recurrent-venous-thromboembolism
#12
Stefano Barco, Stavros Konstantinides, Menno V Huisman, Frederikus A Klok
The diagnostic management of suspected recurrent venous thromboembolism (VTE) is challenging for four main reasons. First, clinical decision rules are less useful to identity patients with a low pre-test probability. Second, the diagnostic performance of D-dimer tests is decreased. Together, these two point lead to a clearly lower proportion of patients in whom recurrent VTE can be ruled out without performing imaging tests. Third, recurrent thrombi may be difficult to differentiate from residual thrombi, which may be often identified in patients with a history of VTE...
May 26, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28560191/application-of-fuzzy-logic-in-oral-cancer-risk-assessment
#13
Ioana Scrobotă, Grigore Băciuț, Adriana Gabriela Filip, Bianca Todor, Florin Blaga, Mihaela Felicia Băciuț
BACKGROUND: The mapping of the malignization mechanism is still incomplete, but oxidative stress is strongly correlated to carcinogenesis. In our research, using fuzzy logic, we aimed to estimate the oxidative stress related-cancerization risk of the oral potentially malignant disorders. METHODS: Serum from 16 patients diagnosed (clinical and histopathological) with oral potentially malignant disorders (Dept. of Cranio-Maxillofacial Surgery and Radiology, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj Napoca, Romania) was processed fluorometric for malondialdehyde and proton donors assays (Dept...
May 2017: Iranian Journal of Public Health
https://www.readbyqxmd.com/read/28554588/pathologic-c-spine-fracture-with-low-risk-mechanism-and-normal-physical-exam
#14
Andrew Hunter, Jolion McGreevy, Judith Linden
Cervical spinal fracture is a rare, but potentially disabling complication of trauma to the neck. Clinicians often rely on clinical decision rules and guidelines to decide whether or not imaging is necessary when a patient presents with neck pain. Validated clinical guidelines include the Canadian C-Spine Rule and the Nexus criteria. Studies suggest that the risks of a pathologic fracture from a simple rear end collision are negligible. We present a case of an individual who presented to an emergency department (ED) after a low speed motor vehicle collision complaining of lateral neck pain and had multiple subsequent visits for the same complaint with negative exam findings...
May 23, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28549662/simplified-diagnostic-management-of-suspected-pulmonary-embolism-the-years-study-a-prospective-multicentre-cohort-study
#15
Tom van der Hulle, Whitney Y Cheung, Stephanie Kooij, Ludo F M Beenen, Thomas van Bemmel, Josien van Es, Laura M Faber, Germa M Hazelaar, Christian Heringhaus, Herman Hofstee, Marcel M C Hovens, Karin A H Kaasjager, Rick C J van Klink, Marieke J H A Kruip, Rinske F Loeffen, Albert T A Mairuhu, Saskia Middeldorp, Mathilde Nijkeuter, Liselotte M van der Pol, Suzanne Schol-Gelok, Marije Ten Wolde, Frederikus A Klok, Menno V Huisman
BACKGROUND: Validated diagnostic algorithms in patients with suspected pulmonary embolism are often not used correctly or only benefit subgroups of patients, leading to overuse of computed tomography pulmonary angiography (CTPA). The YEARS clinical decision rule that incorporates differential D-dimer cutoff values at presentation, has been developed to be fast, to be compatible with clinical practice, and to reduce the number of CTPA investigations in all age groups. We aimed to prospectively evaluate this novel and simplified diagnostic algorithm for suspected acute pulmonary embolism...
May 23, 2017: Lancet
https://www.readbyqxmd.com/read/28543102/low-flow-low-gradient-aortic-stenosis-still-a-diagnostic-and-therapeutic-challenge
#16
REVIEW
Anja Vogelgesang, Gerd Hasenfuss, Claudius Jacobshagen
Aortic stenosis (AS) is the most frequently observed valvular heart disease. During the symptomatic stage, the rate of death increases dramatically, so that a precise diagnostic approach is taken to guide therapeutic options. Of patients with severe AS, 30% to 50% present with low-flow/low-gradient AS (LF/LGAS) status. This review focuses on LF/LGAS and the best diagnostic and therapeutic management in either classic LF/LGAS with reduced left ventricular ejection fraction (LVEF) or paradoxical LF/LGAS with preserved LVEF...
May 23, 2017: Clinical Cardiology
https://www.readbyqxmd.com/read/28541237/treatment-decision-making-capacity-in-hospitalized-patients-with-schizophrenia
#17
N Bilanakis, V K Peritogiannis, Aik Vratsista
In contemporary medical ethics and clinical practice the autonomy of patients and their right to accept or refuse an offered treatment is acknowledged and respected. Prerequisite for the right of a patient to consent to any medical act is the capacity to make valid decisions regarding his/ her treatment. The objective of our study was to assess -for the first time in our country- treatment decision-making capacity of hospitalized patients with schizophrenia; to explore any possible association with demographic and clinical variables; and to compare treatment decision-making capacity of patients with schizophrenia with medical patients' capacity...
January 2017: Psychiatrikē, Psychiatriki
https://www.readbyqxmd.com/read/28540393/computed-tomography-scans-of-the-head-for-adult-patients-with-minor-head-injury-are-clinical-decision-rules-a-necessary-evil
#18
Desmond Wei Tan, Annabelle Mei En Lim, Daniel Yuxuan Ong, Li Lee Peng, Yiong Huak Chan, Irwani Ibrahim, Win Sen Kuan
INTRODUCTION: This study aimed to evaluate compliance with and performance of the Canadian Computed Tomography Head Rule (CCHR), and its applicability in the local adult population with minor head injury. METHODS: We conducted a retrospective study of consecutive patients who presented to the adult emergency department (ED) with minor head injury over six months. Data on predictor variables indicated in the CCHR was collected and compliance with the CCHR assessed by comparing the recommendations for head computed tomography (CT) scans to its actual usage...
May 25, 2017: Singapore Medical Journal
https://www.readbyqxmd.com/read/28531306/association-of-long-term-opioid-therapy-with-functional-status-adverse-outcomes-and-mortality-among-patients-with-polyneuropathy
#19
E Matthew Hoffman, James C Watson, Jennifer St Sauver, Nathan P Staff, Christopher J Klein
Importance: Polyneuropathy is one of the most common painful conditions managed within general and specialty clinics. Neuropathic pain frequently leads to decisions about using long-term opioid therapy. Understanding the association of long-term opioid use with functional status, adverse outcomes, and mortality among patients with polyneuropathy could influence disease-specific decisions about opioid treatment. Objectives: To quantify the prevalence of long-term opioid use among patients with polyneuropathy and to assess the association of long-term opioid use with functional status, adverse outcomes, and mortality...
May 22, 2017: JAMA Neurology
https://www.readbyqxmd.com/read/28527501/clinical-decision-support-and-the-electronic-health-record-applications-for-physiatry
#20
REVIEW
Joel S Shoolin
Clinical decision support (CDS) is a process that provides information to assist the user in decision making for evaluation and treatment. Although many think only of rules and alerts, CDS is much more than that. Order sets, clinical documents, information fields, and medication sentences are just a few other CDS tools to be considered. CDS has been shown to improve care. Forming the third point of the triangle, CDS, along with process redesign and workflow considerations, improves care and helps create successful outcomes...
May 2017: PM & R: the Journal of Injury, Function, and Rehabilitation
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