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Appropriateness criterion

Muhammad Bilal, Abdul Haseeb, Mohammad H Arshad, Altamash A Jaliawala, Iman Farooqui, Amna Minhas, Ahmedullah Hussaini, Arsalan A Khan, Sharjeel Ahmad, Zainab Saleem, Ozair Awan, Noor Us Sabahat, Araib Ayaz, Haania Rizwan
Background In developing countries like Pakistan, treatment is mediated by private and public healthcare setups with a limited budget for health facilities. Moreover, the inappropriate use of treadmill tests imposes a burden on healthcare resources and leads to unwarranted interventions. Our aim is to assess the prevalence and predictors of inappropriate referrals for the exercise tolerance test (ETT) to diagnose coronary artery disease (CAD) while taking public and private healthcare settings into consideration...
January 23, 2018: Curēus
Tayyib T A Hayat, Matthew A Myers, John Hell, Matthew Cordingly, Diederik O Bulters, Nicolas Weir, George Pengas
BACKGROUND: The Wessex Modified Richmond Sedation Scale (WMRSS) has been developed with the aim of improving the early identification of patients requiring decompressive hemicraniectomy for malignant middle cerebral artery syndrome (MMS). The objective of this study was to evaluate the WMRSS against the Glasgow Coma Scale (GCS). METHODS: A retrospective study was conducted of patients admitted to our unit for observation of MMS. Data were obtained on WMRSS and GCS recordings from admission up to 120-h post-ictus...
April 11, 2018: Acta Neurochirurgica
Ling Chen, Xiongze Zhang, Feng Wen
PURPOSE: To determine whether venous beading (VB) in two or more quadrants is an appropriate grading criterion for severe nonproliferative diabetic retinopathy (NPDR). METHODS: A hospital-based, retrospective, cross-sectional study. A total of 806 patients admitted with diabetic retinopathy (DR) from January 2014 to April 2017 were included in this study. DR severity was graded by the international grading criterion. The status of VB, intraretinal microvascular abnormalities (IRMA), capillary nonperfusion, arteriovenous nicking, and diabetic macular edema was evaluated based on fundus fluorescein angiography...
April 6, 2018: Graefe's Archive for Clinical and Experimental Ophthalmology
Milan Grkovski, Karem Gharzeddine, Peter Sawan, Heiko Schoder, Laure Michaud, Wolfgang Andreas Weber, John Laurence Humm
The aim of this study was to investigate the value of pharmacokinetic modeling for quantifying11 C-choline uptake in patients with recurrent prostate cancer. Methods: 194 patients with clinical suspicion of recurrent prostate cancer underwent11 C-choline dynamic PET over the pelvic region (0-8-min), followed by 6 min static acquisition at ~25 min post-injection. Regions of interest (ROIs) were drawn over sites of disease identified by a radiologist with experience in nuclear medicine.11 C-choline uptake and pharmacokinetics were evaluated by standardized uptake value (SUV), graphical analysis (Patlak plot; KiP) and 1- and 2-compartment pharmacokinetic models (K1, K1/k2, k3, k4 and macro-parameter KiC)...
April 6, 2018: Journal of Nuclear Medicine: Official Publication, Society of Nuclear Medicine
R K Tannus, S R Almeida-Carvalho, C A Loureiro-Matos, A Miziara-Gonzalez, A A Salzedas-Netto, D Szejnfeld, G D'Ippolito, V Pereira-Lanzoni, I Souza-Silva
BACKGROUND AND AIM: There are several prognostic systems that address different aspects of the patient and the tumour and can guide the management of patients with hepatocellular carcinoma (HCC). This study aimed to evaluate and compare the eight staging systems for a group of patients in a public service in Brazil. METHODS: Patients with HCC were retrospectively analysed between 2000 and 2012. The prognostic systems Okuda, The Cancer of the Liver Italian Program (CLIP), the Chinese University Prognostic Index (CUPI), Groupe d'Etude et de Traitément du Carcinome Hepatocellulaire (GRETCH), the modified TNM-based Japan Integrated Score (JIS) combined with alpha-fetoprotein and Child-Turcotte-Pugh (CTP), the TNM system, and the Barcelona Clinic Liver Cancer Classification (BCLC) were applied to these patients and compared through model fit measurements, likelihood scores, and the Akaike Information Criterion (AIC)...
2018: PloS One
Joana I F Pereira, Raquel S A Pires, Anabela F Araújo-Pedrosa, Maria Cristina C S P Canavarro
OBJECTIVES: The literature has been conceptualizing pregnancy occurrence as a multiphase event. However, the different combinations of decisions and behaviors leading to pregnancy that end in abortion remain unexplored in the literature. The aims of the study were to describe the reproductive and relational trajectories leading to pregnancy in women who decide to abort and to explore the differences in this process according to women's age [adolescents (<20 years old) vs. adults]. STUDY DESIGN: In this cross-sectional study, 426 women [246 adolescents (58...
March 27, 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Jacqueline Huvanandana, Angela E Carberry, Robin M Turner, Emily J Bek, Camille H Raynes-Greenow, Alistair L McEwan, Heather E Jeffery
BACKGROUND: With the greatest burden of infant undernutrition and morbidity in low and middle income countries (LMICs), there is a need for suitable approaches to monitor infants in a simple, low-cost and effective manner. Anthropometry continues to play a major role in characterising growth and nutritional status. METHODS: We developed a range of models to aid in identifying neonates at risk of malnutrition. We first adopted a logistic regression approach to screen for a composite neonatal morbidity, low and high body fat (BF%) infants...
2018: PloS One
Ingo Bulla, Benoît Aliaga, Virginia Lacal, Jan Bulla, Christoph Grunau, Cristian Chaparro
BACKGROUND: DNA methylation patterns store epigenetic information in the vast majority of eukaryotic species. The relatively high costs and technical challenges associated with the detection of DNA methylation however have created a bias in the number of methylation studies towards model organisms. Consequently, it remains challenging to infer kingdom-wide general rules about the functions and evolutionary conservation of DNA methylation. Methylated cytosine is often found in specific CpN dinucleotides, and the frequency distributions of, for instance, CpG observed/expected (CpG o/e) ratios have been used to infer DNA methylation types based on higher mutability of methylated CpG...
March 27, 2018: BMC Bioinformatics
Adrian Quintero, Emmanuel Lesaffre
Hierarchical models are extensively used in pharmacokinetics and longitudinal studies. When the estimation is performed from a Bayesian approach, model comparison is often based on the deviance information criterion (DIC). In hierarchical models with latent variables, there are several versions of this statistic: the conditional DIC (cDIC) that incorporates the latent variables in the focus of the analysis and the marginalized DIC (mDIC) that integrates them out. Regardless of the asymptotic and coherency difficulties of cDIC, this alternative is usually used in Markov chain Monte Carlo (MCMC) methods for hierarchical models because of practical convenience...
March 26, 2018: Statistics in Medicine
Lauren Power, Deirdre Mullally, Eileen R Gibney, Michelle Clarke, Marjolein Visser, Dorothee Volkert, Laura Bardon, Marian A E de van der Schueren, Clare A Corish
BACKGROUND: Older adults are at increased risk of malnutrition compared to their younger counterparts. Malnutrition screening should be conducted using a valid malnutrition screening tool. An aim of the Healthy Diet for a Healthy Life (HDHL) Joint Programming Initiative (JPI) 'Malnutrition in the Elderly Knowledge Hub' (MaNuEL) was to review the reported validity of existing malnutrition screening tools used in older adults. METHODS: A literature search was conducted to identify validation studies of malnutrition screening tools in older populations in community, rehabilitation, residential care and hospital settings...
April 2018: Clinical Nutrition ESPEN
Kyung T Han
Computerized adaptive testing (CAT) greatly improves measurement efficiency in high-stakes testing operations through the selection and administration of test items whose difficulty level is most relevant to each individual test taker. This paper explains the three components of a conventional CAT item selection algorithm-test content balancing, item selection criterion, and item exposure control. There were several noteworthy methodologies underlying each component. Test script method and constrained CAT method were for test content balancing...
March 24, 2018: Journal of Educational Evaluation for Health Professions
Tiffany K Pon, Anjlee Mahajan, Aaron Rosenberg, Alpesh Amin, Digish Shah, Ian Jenkins, Vineet Gupta, Heather Hofmann, Anthony Bejjani, Richard White
Making a definitive diagnosis of heparin-induced thrombocytopenia (HIT) can be problematic. A prompt platelet rise following treatment has been proposed as a "post-test" criterion for diagnosis. However, the platelet response following discontinuation of heparin and initiation of a recommended alternative anticoagulant remains largely undefined and unstudied. This study aimed to characterize platelet response to initial treatment in patients with a low, intermediate, or high likelihood of having HIT...
March 24, 2018: Journal of Thrombosis and Thrombolysis
Anup Pant, Syril Dorairaj, Rouzbeh Amini
Quantifying the mechanical properties of the iris is important, as it provides insight into the pathophysiology of glaucoma. Recent ex-vivo studies have shown that the mechanical properties of the iris are different in glaucomatous eyes as compared to normal ones. Notwithstanding the importance of the ex-vivo studies, such measurements are severely limited for diagnosis and preclude development of treatment strategies. With the advent of detailed imaging modalities, it is possible to determine the in-vivo mechanical properties using inverse finite element modeling...
March 21, 2018: Journal of Biomechanical Engineering
Matthieu Texier, Federico Rotolo, Michel Ducreux, Olivier Bouché, Jean-Pierre Pignon, Stefan Michiels
In early phase clinical trials of cytotoxic drugs in oncology, the efficacy is typically evaluated based on the tumor shrinkage. However, this criterion is not always appropriate for more recent cytostatic agents, and alternative endpoints have been proposed. The growth modulation index (GMI), defined as the ratio between the times to progression in two successive treatment lines, has been proposed for a single-arm phase II trials. The treatment effect is evaluated by estimating the rate of patients having a GMI superior to a given threshold...
2018: Computational and Mathematical Methods in Medicine
Li Zhang, Elvis Genbo Xu, Yabing Li, Hongling Liu, Doris E Vidal-Dorsch, John P Giesy
Previous studies showed that continuous exposure to ammonia nitrogen (AN) contributed to regional losses of benthic invertebrate diversity in China. Yet, the overall ecological risk of AN to aquatic organisms in major riverine systems of China has not been appropriately studied. Our research then investigated temporal (seasonally/yearly) and spatial distributions of AN and un-ionized ammonia (NH3 ) in major Chinese river basins using historic data generated between 2007 and 2014, and developed risk assessment criteria...
March 15, 2018: Chemosphere
Lelia Barks, Cynthia Garvan, Barbara Crane, Matthew Peterson, Lisa M Brown, Gail Powell-Cope
PURPOSE: Earlier, we reported development and initial testing of a rapid, low burden measure of wheelchair seated posture (the Seated Posture Scale [SPS]) for research and clinical use. The purpose of this study was to test the intrarater reliability, interrater reliability, and criterion related validity of the SPS. DESIGN: We used a descriptive design to test and develop the instrument. METHODS: We used the method described by Walter, Donner, and Eliasziw to determine 46 participants were needed, from two Veterans Administration nursing homes or CLCs (community living centers)...
March 19, 2018: Rehabilitation Nursing: the Official Journal of the Association of Rehabilitation Nurses
C Kajetanek, O Benoît, B Granger, F Menegaux, N Chereau, H Pascal-Mousselard, F Khiami
BACKGROUND: Surgery for athletic pubalgia usually consists in abdominal wall repair combined with routine bilateral adductor tenotomy. We currently confine the surgical procedure to the injured structure(s) (abdominal wall only, adductor tendon only, or both) to limit morbidity and expedite recovery. Outcomes of this à la carte approach are unclear. The objectives of this retrospective study were to determine the return to play (RTP) time, evaluate the potential influence of injury location, and assess the frequency of recurrence or contralateral involvement...
March 13, 2018: Orthopaedics & Traumatology, Surgery & Research: OTSR
Xiaotian Lian, Jun Guo, Wei Zeng, Hai Qing, Rui Ju, Wei Tang
PURPOSE: The purpose of this study was to explore new landmark-independent methods suitable for determining the midsagittal plane (MSP) in patients with craniomaxillofacial trauma and its clinical application. MATERIALS AND METHODS: Preoperative computed tomography data of 25 patients with craniomaxillofacial trauma were imported into Mimics software (Materialise, Leuven, Belgium) to reconstruct 3-dimensional skull models. In the experimental group, the MSP was determined by different landmarks that were clear, were scattered, and did not have displacement according to the types of fractures...
February 20, 2018: Journal of Oral and Maxillofacial Surgery
Ann-Kristin Niewald, Carina Oedingen, Oliver Razum
BACKGROUND: In 2006, the first human papillomavirus (HPV) vaccine was licensed in Europe and in 2007 it was included in the service catalogue of the statutory health insurance. The HPV vaccine led to a controversy in public and print media even before it was licensed. We evaluated the quality of the newspaper coverage of the HPV vaccine during the controversy in Germany. METHODS: The LexisNexis print media database was scanned for health journalism articles on HPV in 4 high-circulation national newspapers and 4 magazines using pre-defined search terms for the period 2006-2009...
March 16, 2018: Das Gesundheitswesen
Zhongkui Wang, Masamitsu Kido, Kan Imai, Kazuya Ikoma, Shinichi Hirai
Clinically in medializing calcaneal osteotomy (MCO), foot and ankle surgeons are facing difficulties in choosing appropriate surgical parameters due to the individual differences in deformities among flatfoot patients. Traditional cadaveric studies have provided important information regarding the biomechanical effects of tendons, ligaments, and plantar fascia, but limitations have been reached when dealing with individual differences and tailoring patient-specific surgeries. Therefore, this study aimed at implementing the finite element (FE) method to investigate the effect of different MCO parameters to help foot and ankle surgeons performing patient-specific surgeries...
March 15, 2018: Computer Methods in Biomechanics and Biomedical Engineering
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