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Clinical decision and prediction rules

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https://www.readbyqxmd.com/read/29161680/prediction-of-violent-crime-on-discharge-from-secure-psychiatric-hospitals-a-clinical-prediction-rule-fovox
#1
A Wolf, T R Fanshawe, A Sariaslan, R Cornish, H Larsson, S Fazel
BACKGROUND: Current approaches to assess violence risk in secure hospitals are resource intensive, limited by accuracy and authorship bias and may have reached a performance ceiling. This study seeks to develop scalable predictive models for violent offending following discharge from secure psychiatric hospitals. METHODS: We identified all patients discharged from secure hospitals in Sweden between January 1, 1992 and December 31, 2013. Using multiple Cox regression, pre-specified criminal, sociodemographic, and clinical risk factors were included in a model that was tested for discrimination and calibration in the prediction of violent crime at 12 and 24 months post-discharge...
August 4, 2017: European Psychiatry: the Journal of the Association of European Psychiatrists
https://www.readbyqxmd.com/read/29154810/multiple-performance-measures-are-needed-to-evaluate-triage-systems-in-the-emergency-department
#2
Joany M Zachariasse, Daan Nieboer, Rianne Oostenbrink, Henriëtte A Moll, Ewout W Steyerberg
OBJECTIVE: Emergency department triage systems can be considered prediction rules with an ordinal outcome, where different directions of misclassification have different clinical consequences. We evaluated strategies to compare the performance of triage systems and aim to propose a set of performance measures that should be used in future studies. STUDY DESIGN AND SETTING: We identified performance measures based on literature review and expert knowledge. Their properties are illustrated in a case study evaluating two triage modifications in a cohort of 14,485 pediatric emergency department visits...
November 14, 2017: Journal of Clinical Epidemiology
https://www.readbyqxmd.com/read/29133377/information-provided-by-diagnostic-and-screening-tests-improving-probabilities
#3
REVIEW
Mark Weatherall
Uncertainty in clinical encounters is inevitable and despite this uncertainty clinicians must still work with patients to make diagnostic and treatment decisions. Explicit diagnostic reasoning based on probabilities will optimise information in relation to uncertainty. In clinical diagnostic encounters, there is often pre-existing information that reflects the probability any particular patient has a disease. Diagnostic testing provides extra information that refines diagnostic probabilities. However, in general diagnostic tests will be positive in most, but not all cases of disease (sensitivity) and may not be negative in all cases of disease absence (specificity)...
November 13, 2017: Postgraduate Medical Journal
https://www.readbyqxmd.com/read/29122932/diagnostic-performance-of-an-acoustic-based-system-for-coronary-artery-disease-risk-stratification
#4
Simon Winther, Louise Nissen, Samuel Emil Schmidt, Jelmer Sybren Westra, Laust Dupont Rasmussen, Lars Lyhne Knudsen, Lene Helleskov Madsen, Jane Kirk Johansen, Bjarke Skogstad Larsen, Johannes Jan Struijk, Lars Frost, Niels Ramsing Holm, Evald Høj Christiansen, Hans Erik Botker, Morten Bøttcher
OBJECTIVE: Diagnosing coronary artery disease (CAD) continues to require substantial healthcare resources. Acoustic analysis of transcutaneous heart sounds of cardiac movement and intracoronary turbulence due to obstructive coronary disease could potentially change this. The aim of this study was thus to test the diagnostic accuracy of a new portable acoustic device for detection of CAD. METHODS: We included 1675 patients consecutively with low to intermediate likelihood of CAD who had been referred for cardiac CT angiography...
November 9, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/29117964/clinical-characteristics-of-children-evaluated-for-suspected-pulmonary-embolism-with-d-dimer-testing
#5
Jessica Kanis, Jonathan Pike, Cassandra L Hall, Jeffrey A Kline
BACKGROUND: We sought to determine clinical variables in children tested for suspected pulmonary embolism (PE) that predict PE+ outcome for the development of paediatric PE prediction rule. METHODS: Data were collected by query of a laboratory database for D-dimer from January 2004 to December 2014 for a large multicentre hospital system and the radiology database for pulmonary vascular imaging in children aged 5-17. Using explicit, predefined methods, trained abstractors, determined if D-dimer was sent in the evaluation of PE and then recorded predictor data which was tested for association with PE+ outcome using univariate techniques...
November 8, 2017: Archives of Disease in Childhood
https://www.readbyqxmd.com/read/29107623/early-symptom-improvement-at-10-sessions-as-a-predictor-of-rtms-treatment-outcome-in-major-depression
#6
Kfir Feffer, Hyewon Helen Lee, Farrokh Mansouri, Peter Giacobbe, Fidel Vila-Rodriguez, Sidney H Kennedy, Zafiris J Daskalakis, Daniel M Blumberger, Jonathan Downar
BACKGROUND: Predicting rTMS nonresponse could be helpful in sparing patients from futile treatment, and in improving use of limited rTMS resources. While several predictive biomarkers have been proposed, few are accurate for individual-level prediction; none have entered routine use. An alternative approach in pharmacotherapy predicts outcome from early response; patients showing minimal (e.g., ≤20%) improvement at 2 weeks can be predicted as nonresponders with negative predictive values (NPV) > 80-90%...
October 19, 2017: Brain Stimulation
https://www.readbyqxmd.com/read/29103551/decision-support-tools-in-low-back-pain
#7
REVIEW
Veerle M H Coupé, Miranda L van Hooff, Marinus de Kleuver, Ewout W Steyerberg, Raymond W J G Ostelo
Information from individual classification systems or clinical prediction rules that aim to facilitate stratified care in low back pain is important but often not comprehensive enough to be used to support clinical decision-making. The development and implementation of a clinically useful decision support tool (DST) that considering all key features is a challenging enterprise, requiring a multidisciplinary approach. Key features are inclusion of all relevant treatment options, patient characteristics, and benefits and harms and presentation as an accessible and easy to use toolkit...
December 2016: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/29095182/reducing-unnecessary-head-computed-tomography-in-mild-traumatic-brain-injury
#8
Nathaniel John Webster, Nathan Moore, Felicia Stewart
There is growing concern about the frequency of computed tomographic (CT) scans performed for evaluation of adults with suspected mild traumatic brain injury. The Canadian CT Head Rule and the New Orleans Criteria are the most studied head CT decision tools that aid providers in determining which patients do not require a CT scan. This article examines recent research to determine which of these tools has proven to be the most effective at safely reducing the use of head CT scans. The reviewed studies concluded that both the Canadian CT Head Rule and the New Orleans Criteria had similar sensitivities, but the Canadian CT Head Rule showed superior specificity in predicting the presence of a clinically significant brain injury...
October 2017: Advanced Emergency Nursing Journal
https://www.readbyqxmd.com/read/29080550/frequency-of-use-and-acceptability-of-clinical-prediction-rules-for-pulmonary-embolism-among-swiss-general-internal-medicine-residents
#9
N Faller, O Stalder, A Limacher, S Bassetti, J H Beer, D Genné, E Battegay, D Hayoz, J Leuppi, B Mueller, A Perrier, G Waeber, N Rodondi, D Aujesky
INTRODUCTION: Whether clinical prediction rules for pulmonary embolism are accepted and used among general internal medicine residents remains uncertain. We therefore evaluated the frequency of use and acceptability of the Revised Geneva Score (RGS) and the Pulmonary Embolism Severity Index (PESI), and explored which factors were associated with rule use. MATERIALS/METHODS: In an online survey among general internal medicine residents from 10 Swiss hospitals, we assessed rule acceptability using the Ottawa Acceptability of Decision Rules Instrument (OADRI) and explored the association between physician and training-related factors and rule use using mixed logistic regression models...
October 18, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/29078878/machine-learning-to-identify-multigland-disease-in-primary-hyperparathyroidism
#10
Joseph R Imbus, Reese W Randle, Susan C Pitt, Rebecca S Sippel, David F Schneider
BACKGROUND: 20%-25% of patients with primary hyperparathyroidism will have multigland disease (MGD). Preoperatative imaging can be inaccurate or unnecessary in MGD. Identification of MGD could direct the need for imaging and inform operative approach. The purpose of this study is to use machine learning (ML) methods to predict MGD. METHODS: Retrospective review of a prospective database. The ML platform, Waikato Environment for Knowledge Analysis, was used, and we selected models for (1) overall accuracy and (2) preferential identification of MGD...
November 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/29075029/radiographic-prediction-of-inferior-alveolar-nerve-injury-in-third-molar-surgery
#11
Sergio Uribe
Data sourcesMedline, Embase, relevant dental journals, reference lists of included studies and the World Health Organisation International Clinical Trials Registry.Study selectionStudies evaluating the predictive accuracy of panoramic radiography for postoperative inferior alveolar nerve (IAN) injury reporting on at least one of the seven signs of IAN injury and providing data to calculate false-positive (FP), true-positive (TP), false-negative (FN) and true-negative (TN) proportions were included.Data extraction and synthesisData were abstracted independently by two reviewers...
October 27, 2017: Evidence-based Dentistry
https://www.readbyqxmd.com/read/29071378/comparison-of-pecarn-and-catch-clinical-decision-rules-in-children-with-minor-blunt-head-trauma
#12
Ö Bozan, G Aksel, H A Kahraman, Ö Giritli, S E Eroğlu
INTRODUCTION AND PURPOSE: Computerized brain tomography (CBT) imaging plays a key role in the management of patients with head trauma, and there is an indication for CBT in moderate and severe injuries. However, it is difficult to determine an indication for CBT in patients with minor head trauma. The primary aim of this study is to compare the efficiency of the most commonly used clinical decision rules: the guidelines of the Pediatric Emergency Care Applied Research Network (PECARN), and those of the Canadian Assessment of Tomography for Childhood Head Injury (CATCH)...
October 25, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/29065633/the-research-of-clinical-decision-support-system-based-on-three-layer-knowledge-base-model
#13
Yicheng Jiang, Bensheng Qiu, Chunsheng Xu, Chuanfu Li
In many clinical decision support systems, a two-layer knowledge base model (disease-symptom) of rule reasoning is used. This model often does not express knowledge very well since it simply infers disease from the presence of certain symptoms. In this study, we propose a three-layer knowledge base model (disease-symptom-property) to utilize more useful information in inference. The system iteratively calculates the probability of patients who may suffer from diseases based on a multisymptom naive Bayes algorithm, in which the specificity of these disease symptoms is weighted by the estimation of the degree of contribution to diagnose the disease...
2017: Journal of Healthcare Engineering
https://www.readbyqxmd.com/read/29064366/spot-protein-creatinine-ratio-and-spot-albumin-creatinine-ratio-in-the-assessment-of-pre-eclampsia-a-diagnostic-accuracy-study-with-decision-analytic-model-based-economic-evaluation-and-acceptability-analysis
#14
Jason Waugh, Richard Hooper, Edmund Lamb, Stephen Robson, Andrew Shennan, Fiona Milne, Christopher Price, Shakila Thangaratinam, Vladislav Berdunov, Jenn Bingham
BACKGROUND: The National Institute for Health and Care Excellence (NICE) guidelines highlighted the need for 'large, high-quality prospective studies comparing the various methods of measuring proteinuria in women with new-onset hypertensive disorders during pregnancy'. OBJECTIVES: The primary objective was to evaluate quantitative assessments of spot protein-creatinine ratio (SPCR) and spot albumin-creatinine ratio (SACR) in predicting severe pre-eclampsia (PE) compared with 24-hour urine protein measurement...
October 2017: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/29060424/combination-of-static-and-temporal-data-analysis-to-predict-mortality-and-readmission-in-the-intensive-care
#15
Janani Venugopalan, Nikhil Chanani, Kevin Maher, May D Wang
There are approximately 4 million intensive care unit (ICU) admissions each year in the United States with costs accounting for 4.1% of national health expenditures. Unforeseen adverse events contribute disproportionately to these costs. Thus, there has been substantial research in developing clinical decision support systems to predict and improve ICU outcomes such as ICU mortality, prolonged length of stay, and ICU readmission. However, the data in the ICU is collected at diverse time intervals and includes both static and temporal data...
July 2017: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/29054440/external-validation-of-heart-type-fatty-acid-binding-protein-high-sensitivity-cardiac-troponin-and-electrocardiography-as-rule-out-for-acute-myocardial-infarction
#16
Christopher B Van Hise, Jaimi H Greenslade, William Parsonage, Martin Than, Joanna Young, Louise Cullen
OBJECTIVE: To externally validate a clinical decision rule incorporating heart fatty acid binding protein (h-FABP), high-sensitivity troponin (hs-cTn) and electrocardiogram (ECG) for the detection of acute myocardial infarction (AMI) on presentation to the Emergency Department. We also investigated whether this clinical decision rule improved identification of AMI over algorithms incorporating hs-cTn and ECG only. DESIGN AND METHODS: This study included data from 789 patients from the Brisbane ADAPT cohort and 441 patients from the Christchurch TIMI RCT cohort...
October 18, 2017: Clinical Biochemistry
https://www.readbyqxmd.com/read/29048993/personalized-risk-prediction-in-clinical-oncology-research-applications-and-practical-issues-using-survival-trees-and-random-forests
#17
Chen Hu, Jon Arni Steingrimsson
A crucial component of making individualized treatment decisions is to accurately predict each patient's disease risk. In clinical oncology, disease risks are often measured through time-to-event data, such as overall survival and progression/recurrence-free survival, and are often subject to censoring. Risk prediction models based on recursive partitioning methods are becoming increasingly popular largely due to their ability to handle nonlinear relationships, higher-order interactions, and/or high-dimensional covariates...
October 19, 2017: Journal of Biopharmaceutical Statistics
https://www.readbyqxmd.com/read/29029074/multimodality-imaging-evaluation-of-chagas-disease-an-expert-consensus-of-brazilian-cardiovascular-imaging-department-dic-and-the-european-association-of-cardiovascular-imaging-eacvi
#18
Maria Carmo P Nunes, Luigi Paolo Badano, J Antonio Marin-Neto, Thor Edvardsen, Covadonga Fernández-Golfín, Chiara Bucciarelli-Ducci, Bogdan A Popescu, Richard Underwood, Gilbert Habib, Jose Luis Zamorano, Roberto Magalhães Saraiva, Ester Cerdeira Sabino, Fernando A Botoni, Márcia Melo Barbosa, Marcio Vinicius L Barros, Eduardo Falqueto, Marcus Vinicius Simões, André Schmidt, Carlos Eduardo Rochitte, Manoel Otávio Costa Rocha, Antonio Luiz Pinho Ribeiro, Patrizio Lancellotti
Aims: To develop a document by Brazilian Cardiovascular Imaging Department (DIC) and the European Association of Cardiovascular Imaging (EACVI) to review and summarize the most recent evidences about the non-invasive assessment of patients with Chagas disease, with the intent to set up a framework for standardized cardiovascular imaging to assess cardiovascular morphologic and functional disturbances, as well as to guide the subsequent process of clinical decision-making. Methods and results: Chagas disease remains one of the most prevalent infectious diseases in Latin America, and has become a health problem in non-endemic countries...
September 25, 2017: European Heart Journal Cardiovascular Imaging
https://www.readbyqxmd.com/read/29020511/bayesian-additive-decision-trees-of-biomarker-by-treatment-interactions-for-predictive-biomarkers-detection-and-subgroup-identification
#19
Yang Zhao, Wei Zheng, Daisy Y Zhuo, Yuefeng Lu, Xiwen Ma, Hengchang Liu, Zhen Zeng, Glen Laird
Personalized medicine, or tailored therapy, has been an active and important topic in recent medical research. Many methods have been proposed in the literature for predictive biomarkers detection and subgroup identification. In this paper, we propose a novel decision tree based approach applicable in randomized clinical trials. We model the prognostic effects of the biomarkers using additive regression trees and the biomarker-by-treatment effect using a single regression tree. Bayesian approach is utilized to periodically revise the split variables and the split rules of the decision trees, which provides a better overall fitting...
October 11, 2017: Journal of Biopharmaceutical Statistics
https://www.readbyqxmd.com/read/29020294/predicting-resistance-to-piperacillin-tazobactam-cefepime-and-meropenem-in-septic-patients-with-bloodstream-infection-due-to-gram-negative-bacteria
#20
M Cristina Vazquez-Guillamet, Rodrigo Vazquez, Scott T Micek, Marin H Kollef
Background: Predicting antimicrobial resistance in gram-negative bacteria (GNB) could balance the need for administering appropriate empiric antibiotics while also minimizing the use of clinically unwarranted broad-spectrum agents. Our objective was to develop a practical prediction rule able to identify patients with GNB infection at low risk for resistance to piperacillin-tazobactam (PT), cefepime (CE), and meropenem (ME). Methods: The study included adult patients with sepsis or septic shock due to bloodstream infections caused by GNB admitted between 2008 and 2015 from Barnes-Jewish Hospital...
October 30, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
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