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Net clinical benefit

Zhongyi Han, Benzheng Wei, Stephanie Leung, Ilanit Ben Nachum, David Laidley, Shuo Li
Pathogenesis-based diagnosis is a key step to prevent and control lumbar neural foraminal stenosis (LNFS). It conducts both early diagnosis and comprehensive assessment by drawing crucial pathological links between pathogenic factors and LNFS. Automated pathogenesis-based diagnosis would simultaneously localize and grade multiple spinal organs (neural foramina, vertebrae, intervertebral discs) to diagnose LNFS and discover pathogenic factors. The automated way facilitates planning optimal therapeutic schedules and relieving clinicians from laborious workloads...
February 15, 2018: Neuroinformatics
José Miguel Rivera-Caravaca, Vanessa Roldán, María Asunción Esteve-Pastor, Mariano Valdés, Vicente Vicente, Francisco Marín, Gregory Y H Lip
The TIMI-AF score was described to predict net clinical outcomes (NCOs) in atrial fibrillation (AF) patients receiving warfarin. However, this score derived from the ENGAGE AF-TIMI 48 trial, and no external validation exists in real world clinical practice. We tested the long-term predictive performance of the TIMI-AF score in comparison with CHA 2 DS 2 -VASc and HAS-BLED in a 'real-world' cohort of anticoagulated AF patients. METHODS: We included 1156 consecutive AF patients stable on vitamin K antagonist (INR 2...
March 2018: American Heart Journal
Muammer Altok, Kara Babaian, Mary F Achim, Grace C Achim, Patricia Troncoso, Surena F Matin, Brian F Chapin, John W Davis
OBJECTIVES: To evaluate the peri-operative, pathologic, and oncologic outcomes from surgeon led pathologic staging of pelvic lymph node metastases at the time of robot-assisted radical prostatectomy (RARP). PATIENTS AND METHODS: Over the 6-year period of 2006-2012, three distinct pelvic lymph node dissection strategies were utilized in chronologic order at a single cancer referral hospital. Strategies were characterized by both a 1) omission of PLND versus inclusion decision threshold, and 2) standard versus extended templates for patients selected for PLND...
February 15, 2018: BJU International
Maridi Aerts, Hendrik Reynaert
Gastrinomas are functionally active pancreatic neuroendocrine tumors (NETs) secreting gastrin and are associated with local or regional metastases in 60% of the cases. Somatostatin analogs (SSAs) are currently recommended as a first-line treatment for the symptomatic treatment of NETs. Although antiproliferative activity of SSAs has been demonstrated in various cancer types in several in vivo and in vitro studies, clinical benefits with SSAs have been only achieved in a small proportion of patients. We report a disease control on a long-acting SSA lanreotide in a patient with metastatic gastrinoma...
September 2017: Case Reports in Gastroenterology
Donna P Ankerst, Martin Goros, Scott A Tomlins, Dattatraya Patil, Ziding Feng, John T Wei, Martin G Sanda, Jonathan Gelfond, Ian M Thompson, Robin J Leach, Michael A Liss
BACKGROUND: The Prostate Cancer Prevention Trial Risk Calculator (PCPTRC) is a commonly used risk tool for predicting the outcome on biopsy based on the established risk factors. OBJECTIVE: To determine whether incorporation of the novel urinary markers prostate cancer antigen 3 (PCA3) and TMPRSS2:ERG (T2:ERG) into the PCPTRC improves its discrimination, accuracy, and clinical net benefit. DESIGN, SETTING, AND PARTICIPANTS: Since PCA3 and T2:ERG were not measured as part of the PCPTRC, a Bayesian modeling approach was used to combine data where the markers were measured in a Michigan cohort with the PCPTRC as prior probabilities to form an updated PCPTRC...
February 5, 2018: European Urology Focus
Birgit Prodinger, Paul Taylor
BACKGROUND: Patient reported outcome measures (PROMs) have been integrated in national quality registries or specific national monitoring initiatives to inform the improvement of quality of care on a national scale. However there are many unanswered questions, such as: how these systems are set up, whether they lead to improved quality of care, which stakeholders use the information once it is available. The aim of this study was to examine supporting and hindering factors relevant to integrating patient-reported outcome measures (PROMs) in selected health information systems (HIS) tailored toward improving quality of care across the entire health system...
February 7, 2018: BMC Health Services Research
Sharon Eve Sonenblum, Stephen H Sprigle
OBJECTIVE/BACKGROUND: Despite the fact that most people with a spinal cord injury who use a wheelchair for mobility are considered at-risk for pressure ulcer (PrU) development, there still exists a spectrum of risk amongst this group. Efforts to differentiate risk level would benefit from clinical tools that can measure or predict the buttocks response to loading. Therefore, the goal of this study was to identify how tissue compliance and blood flow were impacted by clinically-measurable risk factors in young men with SCI...
2018: PloS One
Sabrina Trippoli, Erminia Caccese, Claudio Marinai, Andrea Messori
OBJECTIVES: In the acute ischemic stroke, endovascular devices have shown promising clinical results and are also likely to represent value for money, as several modeling studies have shown. Pharmacoeconomic evaluations in this field, however, have little impact on the procurement of these devices. The present study explored how complex pharmacoeconomic models that evaluate effectiveness and cost can be incorporated into the in-hospital procurement of thrombectomy devices. PATIENTS AND METHODS: As regards clinical modeling, we extracted outcomes at three months from randomized trials conducted for four thrombectomy devices, and we projected long-term results using standard Markov modeling...
January 29, 2018: Clinical Neurology and Neurosurgery
Caitlyn T Solem, Youngmin Kwon, Ruchit M Shah, Abdalla Aly, Marc F Botteman
The Quality-Adjusted Time Without Symptoms or Toxicity (Q-TWiST) has been used to evaluate the clinical benefits and risks of oncology treatments. However, limited information is available to interpret and contextualize Q-TWiST results. Areas covered: A systematic review of Q-TWiST literature was conducted to provide contextualizing benchmarks for future studies. 51 articles with 81 unique Q-TWiST comparisons were identified. The mean (95% CI) and median absolute Q-TWiST gains for treatment versus control arms were 2...
February 5, 2018: Expert Review of Pharmacoeconomics & Outcomes Research
Felix J S van Soest, Elke Abbeloos, Scott McDougall, Henk Hogeveen
Recently, it has been shown that the addition of meloxicam to standard antimicrobial therapy for clinical mastitis (CM) improves the conception rate of dairy cows contracting CM in the first 120 d in milk. The objective of our study was to assess whether this improved reproduction through additional treatment with meloxicam would result in a positive net economic benefit for the farmer. We developed a stochastic bio-economic simulation model, in which a dairy cow with CM in the first 120 d in milk was simulated...
February 2, 2018: Journal of Dairy Science
Y J He, X T Li, Z Q Fan, Y L Li, K Cao, Y S Sun, T Ouyang
Objective: To construct a dynamic enhanced MR based predictive model for early assessing pathological complete response (pCR) to neoadjuvant therapy in breast cancer, and to evaluate the clinical benefit of the model by using decision curve. Methods: From December 2005 to December 2007, 170 patients with breast cancer treated with neoadjuvant therapy were identified and their MR images before neoadjuvant therapy and at the end of the first cycle of neoadjuvant therapy were collected. Logistic regression model was used to detect independent factors for predicting pCR and construct the predictive model accordingly, then receiver operating characteristic (ROC) curve and decision curve were used to evaluate the predictive model...
January 23, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Max Rockstroh, Stefan Franke, Raluca Dees, Angela Merzweiler, Gerd Schneider, Max Dingler, Christian Dietz, Jonas Pfeifer, Franziska Kühn, Malte Schmitz, Alexander Mildner, Armin Janß, Jasmin Dell'Anna Pudlik, Marcus Köny, Björn Andersen, Björn Bergh, Thomas Neumuth
The effective development and dissemination of the open integration for the next generation of operating rooms require a comprehensive testing environment. In this paper, we present the various challenges to be addressed in demonstration applications, and we discuss the implementation approach, the foci of the demonstration sites and the evaluation efforts. Overall, the demonstrator setups have proven the feasibility of the service-oriented medical device architecture (SOMDA) and real-time approaches with a large variety of example applications...
February 3, 2018: Biomedizinische Technik. Biomedical Engineering
Kook-Hwan Oh, Seon Ha Baek, Kwon-Wook Joo, Dong Ki Kim, Yon-Su Kim, Sejoong Kim, Yun Kyu Oh, Byoung Geun Han, Jae Hyun Chang, Wookyung Chung, Ki Young Na
INTRODUCTION: In peritoneal dialysis (PD) patients, volume overload is related to cardiac dysfunction and mortality, while intravascular volume depletion is associated with a rapid decline in the residual renal function (RRF). This study sought to determine the clinical usefulness of bioimpedance spectroscopy (BIS)-guided fluid management for preserving RRF and cardiac function in PD patients. SUBJECTS AND METHODS: This is a multicenter, prospective, open-label study that was conducted over a 1-year period (NCT01887262)...
January 31, 2018: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
Jason M Glanz, Komal J Narwaney, Shane R Mueller, Edward M Gardner, Susan L Calcaterra, Stanley Xu, Kristin Breslin, Ingrid A Binswanger
BACKGROUND: Naloxone is a life-saving opioid antagonist. Chronic pain guidelines recommend that physicians co-prescribe naloxone to patients at high risk for opioid overdose. However, clinical tools to efficiently identify patients who could benefit from naloxone are lacking. OBJECTIVE: To develop and validate an overdose predictive model which could be used in primary care settings to assess the need for naloxone. DESIGN: Retrospective cohort...
January 29, 2018: Journal of General Internal Medicine
Tina M Olsson, Mats Fridell
BACKGROUND: Women with comorbid substance use disorders are an extremely vulnerable group having an increased relative risk of negative outcomes such as incarceration, morbidity and mortality. In Sweden, women with comorbid substance use disorders may be placed in compulsory care for substance abuse treatment. Clinical intake assessment procedures are a distinct aspect of clinical practice and are a foundation upon which client motivation and continued treatment occurs. METHOD: The current study is a naturalistic quasi-experiment and aims to assess the five-year costs and benefits of a standard intake interview versus an extended psychological and psychiatric assessment for a group of chronic substance abusing women placed in compulsory care in Sweden between 1997 and 2000...
January 30, 2018: BMC Health Services Research
P McEwan, H Bennett, K Bolin, M Evans, K Bergenheim
AIMS: Insulin therapy is indicated for people with Type 1 diabetes mellitus; however, treatment-related weight gain and hypoglycaemia represent barriers to optimal glycaemic management. This study assessed the health economic value of maintained reductions in HbA1c , BMI and hypoglycaemia incidence among the UK Type 1 diabetes mellitus population. METHODS: The Cardiff Type 1 Diabetes Model was used to estimate lifetime costs, life-years and quality-adjusted life-years (QALYs) for individuals with Type 1 diabetes mellitus at different baseline HbA1c , BMI and hypoglycaemic event rates...
January 27, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
Evan Atlantis, Shima Ghassem Pour, Federico Girosi
OBJECTIVES: We sought to determine whether screening for anxiety and depression, an emerging risk factor for type 2 diabetes (T2D), adds clinically meaningful information beyond current T2D risk assessment tools. DESIGN: Prospective cohort. PARTICIPANTS AND SETTING: The 45 and Up Study is a large-scale prospective cohort of men and women aged 45 years and over, randomly sampled from the general population of New South Wales, Australia. 51 588 participants without self-reported diabetes at baseline (2006-2009) were followed up for approximately 3 years (2010)...
January 23, 2018: BMJ Open
Carmela Nappi, Valeria Gaudieri, Wanda Acampa, Parthiban Arumugam, Roberta Assante, Emilia Zampella, Teresa Mannarino, Ciro Gabriele Mainolfi, Massimo Imbriaco, Mario Petretta, Alberto Cuocolo
BACKGROUND: Coronary artery calcium (CAC) can be used to estimate vascular age in adults, providing a convenient transformation of CAC from Agatston units into a year's scale. We investigated the role of coronary vascular age in predicting stress-induced myocardial ischemia in subjects with suspected coronary artery disease (CAD). METHODS: A total of 717 subjects referred to CAC scoring and 82Rb PET/CT stress-rest myocardial perfusion imaging for suspected CAD were studied...
January 22, 2018: Journal of Nuclear Cardiology: Official Publication of the American Society of Nuclear Cardiology
Angeles Sanchis-Bonet, Marta Barrionuevo-González, Ana Bajo-Chueca, Nelson Morales-Palacios, Manuel Sanchez-Chapado
INTRODUCTION: To assess whether [-2]pro-prostate-specific antigen (p2PSA) meets the criteria to justify its inclusion in a predictive model of prostate cancer (PCa) diagnosis and in the clinical decision-making process. MATERIALS AND METHODS: A total 172 men with total prostate-specific antigen of 2-10 ng/mL underwent measurement of free PSA and p2PSA before prostate biopsy in an observational and prospective study. From these measurements, the Prostate Health Index (PHI) was calculated...
January 18, 2018: Urologia Internationalis
Jae Seok Bae, Jong-Hwa Ahn, Udaya Tantry, Paul A Gurbel, Young-Hoon Jeong
With over 1.5 billion people, East Asians are the most populous race in the world. Health status in this population is an important global issue. In the contemporary trials of antithrombotic treatment, East Asian patients have a lower risk for atherothrombotic diseases (especially, coronary artery disease [CAD]) and a higher risk for bleeding (especially, gastrointestinal bleeding and hemorrhagic stroke). Despite these observations, antithrombotic treatment strategies in East Asian patients are mainly based on the American or European guidelines that are derived from randomized, controlled trials including mostly Caucasians...
January 16, 2018: Current Vascular Pharmacology
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