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Clinical decision rules

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https://www.readbyqxmd.com/read/28722083/-a-perception-of-the-development-trend-of-radiological-t-staging-in-gastric-cancer-through-uicc-ajcc-8-th-edition
#1
Lei Tang
More and more emphases were put on pre-therapy staging following the promotion of multidisciplinary team(MDT) collaboration and individualized medicine in gastric cancer. However, the accuracy of traditional radiology staging system which applies mechanically pathological staging is not satisfactory during clinical practice, therefore, the objectivity of treatment decisions is affected. Under such conditions, the newly introduced staging system from Union for International Cancer Control/American Joint Committee on Cancer(UICC/AJCC)(8(th) edition) divided out an independent cTNM system for the first time, and summarized the application range, operation specification and staging criteria...
July 25, 2017: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
https://www.readbyqxmd.com/read/28715289/survey-of-methods-used-to-determine-if-a-patient-has-a-deep-vein-thrombosis-an-exploratory-research-report
#2
John D Heick, James W Farris
BACKGROUND: The use of evidence-based practice (EBP) is encouraged in the physical therapy profession, but integrating evidence into practice can be difficult for clinicians because of lack of time and other constraints. OBJECTIVE: To survey physical therapy clinical instructors and determine the methods they use for screening for deep vein thrombosis (DVT), a type of venous thromboembolism (VTE) in the lower extremities. DESIGN: Exploratory survey...
July 17, 2017: Physiotherapy Theory and Practice
https://www.readbyqxmd.com/read/28711299/fracture-risk-assessment-in-clinical-practice-why-do-it-what-to-do-it-with
#3
Manju Chandran
Fracture is the outcome of concern in osteoporosis, and fracture reduction is the primary goal of osteoporosis treatment. Fracture risk assessment is a critical component in osteoporosis management. The earlier approach of deciding on whether to treat solely based on bone mineral density (BMD) T-scores has been supplanted by employing the concept of absolute risk over medium time periods and more encompassing integration of clinical risk factors with or without BMD into robust fracture risk assessment tools...
July 12, 2017: Journal of Clinical Densitometry
https://www.readbyqxmd.com/read/28705240/a-rule-based-electronic-phenotyping-algorithm-for-detecting-clinically-relevant-cardiovascular-disease-cases
#4
Santiago Esteban, Manuel Rodríguez Tablado, Ricardo Ignacio Ricci, Sergio Terrasa, Karin Kopitowski
BACKGROUND: The implementation of electronic medical records (EMR) is becoming increasingly common. Error and data loss reduction, patient-care efficiency increase, decision-making assistance and facilitation of event surveillance, are some of the many processes that EMRs help improve. In addition, they show a lot of promise in terms of data collection to facilitate observational epidemiological studies and their use for this purpose has increased significantly over the recent years...
July 14, 2017: BMC Research Notes
https://www.readbyqxmd.com/read/28701055/perspectives-of-dutch-health-professionals-regarding-auditory-processing-disorders-a-focus-group-study
#5
Karin Neijenhuis, Ellen de Wit, Margreet Luinge
OBJECTIVE: This study investigated the perspectives of professionals from the Dutch audiological centres on the definition and care pathways of children with suspected auditory processing disorders (susAPD). DESIGN: focus group interviews. STUDY SAMPLE: In total, 45 professionals from 6 disciplines, representing 22 different audiological centres and one ambulatory service, participated in five parallel focus group interviews. Participants had a variety of experience in diagnosing and advising children with suspected APD...
July 13, 2017: International Journal of Audiology
https://www.readbyqxmd.com/read/28700585/validation-of-the-sensitivity-of-the-national-emergency-x-radiography-utilization-study-nexus-head-computed-tomographic-ct-decision-instrument-for-selective-imaging-of-blunt-head-injury-patients-an-observational-study
#6
William R Mower, Malkeet Gupta, Robert Rodriguez, Gregory W Hendey
BACKGROUND: Clinicians, afraid of missing intracranial injuries, liberally obtain computed tomographic (CT) head imaging in blunt trauma patients. Prior work suggests that clinical criteria (National Emergency X-Radiography Utilization Study [NEXUS] Head CT decision instrument [DI]) can reliably identify patients with important injuries, while excluding injury, and the need for imaging in many patients. Validating this DI requires confirmation of the hypothesis that the lower 95% confidence limit for its sensitivity in detecting serious injury exceeds 99...
July 2017: PLoS Medicine
https://www.readbyqxmd.com/read/28694271/proposed-clinical-decision-rules-to-diagnose-acute-rhinosinusitis-among-adults-in-primary-care
#7
Mark H Ebell, Jens Georg Hansen
PURPOSE: To reduce inappropriate antibiotic prescribing, we sought to develop a clinical decision rule for the diagnosis of acute rhinosinusitis and acute bacterial rhinosinusitis. METHODS: Multivariate analysis and classification and regression tree (CART) analysis were used to develop clinical decision rules for the diagnosis of acute rhinosinusitis, defined using 3 different reference standards (purulent antral puncture fluid or abnormal finding on a computed tomographic (CT) scan; for acute bacterial rhinosinusitis, we used a positive bacterial culture of antral fluid)...
July 2017: Annals of Family Medicine
https://www.readbyqxmd.com/read/28678042/consensus-derived-clinical-decision-rules-to-guide-advanced-imaging-decisions-for-pulmonary-embolism-in-pregnancy-and-the-postpartum-period
#8
Gordon W Fuller, Catherine Nelson-Piercy, Beverley J Hunt, Fiona E Lecky, Steve Thomas, Kimberley Horspool, Steve Goodacre
No abstract text is available yet for this article.
July 3, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/28666562/emergency-medicine-myths-computed-tomography-of-the-head-prior%C3%A2-to-lumbar-puncture-in-adults-with-suspected-bacterial-meningitis-due-diligence-or-antiquated-practice
#9
Michael D April, Brit Long, Alex Koyfman
BACKGROUND: Various sources purport an association between lumbar puncture and brainstem herniation in patients with intracranial mass effect lesions. Several organizations and texts recommend head computed tomography (CT) prior to lumbar puncture in selected patients. OBJECTIVE: To review the evidence regarding the utility of obtaining head CT prior to lumbar puncture in adults with suspected bacterial meningitis. DISCUSSION: Observational studies report a risk of post-lumbar puncture brainstem herniation in the presence of intracranial mass effect (1...
June 27, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28657261/rare-case-of-non-tuberculous-mycobacterium-a-diagnostic-dilemma
#10
N Marathe, B Canavan
Non-Tuberculous Mycobacterial (NTM) infections occur in HIV-negative patients with or without underlying lung disease. It is generally felt that these organisms are acquired from the environment. Unlike tuberculosis, there are no convincing data demonstrating human-to-human OR animal-to-human transmission of NTM. We report a case of NTM infection in a 38 year old patient with underlying emphysematous lung disease. The case highlights the diagnostic dilemma which occurs when persistent sputum Acid- Fast Bacilli (AFB) smears are positive, but Nucleic acid amplification test is negative...
February 10, 2017: Irish Medical Journal
https://www.readbyqxmd.com/read/28647160/a-clinical-decision-rule-to-predict-zygomatico-maxillary-fractures
#11
Simon Haworth, Anthony Bates, Andrea Beech, Greg Knepil
Patients presenting with periorbital trauma require clinical assessment to exclude zygomatico-maxillary fractures. A single-centre pilot investigation was undertaken at a general hospital in the United Kingdom. The sample was composed of 229 adult patients attending our emergency department with periorbital injuries. Findings from 17 signs or symptoms of facial injury were recorded on a validated tool. The relationship between clinical presentation and displaced zygomatico-maxillary fracture was assessed using diagnostic test parameters and tests for correlation...
May 25, 2017: Journal of Cranio-maxillo-facial Surgery
https://www.readbyqxmd.com/read/28643629/faecal-immunochemical-tests-to-triage-patients-with-lower-abdominal-symptoms-for-suspected-colorectal-cancer-referrals-in-primary-care-a-systematic-review-and-cost-effectiveness-analysis
#12
Marie Westwood, Isaac Corro Ramos, Shona Lang, Marianne Luyendijk, Remziye Zaim, Lisa Stirk, Maiwenn Al, Nigel Armstrong, Jos Kleijnen
BACKGROUND: Colorectal cancer (CRC) is the third most common cancer in the UK. Presenting symptoms that can be associated with CRC usually have another explanation. Faecal immunochemical tests (FITs) detect blood that is not visible to the naked eye and may help to select patients who are likely to benefit from further investigation. OBJECTIVES: To assess the effectiveness of FITs [OC-Sensor (Eiken Chemical Co./MAST Diagnostics, Tokyo, Japan), HM-JACKarc (Kyowa Medex/Alpha Laboratories Ltd, Tokyo, Japan), FOB Gold (Sentinel/Sysmex, Sentinel Diagnostics, Milan, Italy), RIDASCREEN Hb or RIDASCREEN Hb/Hp complex (R-Biopharm, Darmstadt, Germany)] for primary care triage of people with low-risk symptoms...
May 2017: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/28639051/adjuvant-treatment-for-pancreatic-ductal-carcinoma
#13
REVIEW
T Macarulla, T Fernández, M E Gallardo, O Hernando, A M López, M Hidalgo
Pancreatic ductal adenocarcinoma (PDAC) is a tumor with a very poor prognosis. Most of the patients are diagnosed in advanced stages of the disease, and 5-year survival rates in these patients remains <10%. Surgery still remains the only radical treatment option, although only 15-20% of patients are candidates for surgical resection at the time of the diagnosis. Patients who undergo radical surgery still have a limited survival rate, being the average of 23 months. Three clinical trials have shown that adjuvant chemotherapy therapy after surgery may improve survival: CONKO-1, ESPAC-3, and ESPAC-4...
June 21, 2017: Clinical & Translational Oncology
https://www.readbyqxmd.com/read/28630238/impact-of-sex-on-cardiac-troponin-concentrations-a-critical-appraisal
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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...
July 11, 2017: British Journal of Cancer
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