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Clinical decision and prediction rules

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https://www.readbyqxmd.com/read/28208193/approach-to-suspected-acute-pulmonary-embolism-should-we-use-scoring-systems
#1
Marc Righini, Grégoire Le Gal, Henri Bounameaux
Modern diagnostic strategies for pulmonary embolism diagnosis almost all rely on an initial assessment of the pretest probability. Clinical prediction rules are decision-making tools using combinations of easily available clinical predictors to define the probability of a disease. The assessment of the clinical probability of pulmonary embolism has an important impact on the diagnostic strategy and on therapeutic management. Clinical prediction rules provide accurate and reproducible estimates of clinical probability...
February 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28187294/comprehensible-knowledge-model-creation-for-cancer-treatment-decision-making
#2
Muhammad Afzal, Maqbool Hussain, Wajahat Ali Khan, Taqdir Ali, Sungyoung Lee, Eui-Nam Huh, Hafiz Farooq Ahmad, Arif Jamshed, Hassan Iqbal, Muhammad Irfan, Manzar Abbas Hydari
BACKGROUND: A wealth of clinical data exists in clinical documents in the form of electronic health records (EHRs). This data can be used for developing knowledge-based recommendation systems that can assist clinicians in clinical decision making and education. One of the big hurdles in developing such systems is the lack of automated mechanisms for knowledge acquisition to enable and educate clinicians in informed decision making. MATERIALS AND METHODS: An automated knowledge acquisition methodology with a comprehensible knowledge model for cancer treatment (CKM-CT) is proposed...
January 29, 2017: Computers in Biology and Medicine
https://www.readbyqxmd.com/read/28179372/graphics-and-statistics-for-cardiology-clinical-prediction-rules
#3
REVIEW
Mark Woodward, Hugh Tunstall-Pedoe, Sanne Ae Peters
Graphs and tables are indispensable aids to quantitative research. When developing a clinical prediction rule that is based on a cardiovascular risk score, there are many visual displays that can assist in developing the underlying statistical model, testing the assumptions made in this model, evaluating and presenting the resultant score. All too often, researchers in this field follow formulaic recipes without exploring the issues of model selection and data presentation in a meaningful and thoughtful way...
February 8, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28177169/emergency-department-triage-of-traumatic-head-injury-using-brain-electrical-activity-biomarkers-a-multisite-prospective-observational-validation-trial
#4
Daniel Hanley, Leslie S Prichep, Jeffrey Bazarian, J Stephen Huff, Rosanne Naunheim, John Garrett, Elizabeth Jones, David Wright, John O'Neill, Neeraj Badjatia, Dheeraj Gandhi, Kenneth C Curley, Richard Chiacchierini, Brian O'Neil, Dallas C Hack
OBJECTIVES: A brain electrical activity biomarker for identifying traumatic brain injury (TBI) in Emergency Department (ED) patients presenting with high GCS after sustaining a head injury has shown promise for objective, rapid, triage. The main objective of this study was to prospectively evaluate the efficacy of an automated classification algorithm to determine the likelihood of being CT positive, in high functioning TBI patients in the acute state. METHODS: Adult patients admitted to the ED for evaluation within 72 hours of sustaining a closed head injury with GCS 12-15were candidates for study...
February 8, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28137453/ovarian-preservation-from-tumors-and-torsions-in-girls-prospective-diagnostic-study
#5
Z B Stanković, K Sedlecky, D Savić, B J Lukač, I Mažibrada, S Perovic
STUDY OBJECTIVE: To develop a new decision tree system (DTS) for the management of adnexal masses in prepubertal and adolescent girls, aimed to improve the distinction between benign and malignant masses, help preserve affected ovaries during surgery and reduce the rate of surgical management of uncomplicated functional ovarian cysts. DESIGN: A prospective diagnostic study using clinical and ultrasound data collected for all patients under 19 years of age with adnexal masses managed between 2006 and 2015...
January 27, 2017: Journal of Pediatric and Adolescent Gynecology
https://www.readbyqxmd.com/read/28099325/intraoperative-clinical-decision-support-for-anesthesia-a-narrative-review-of-available-systems
#6
Bala G Nair, Eilon Gabel, Ira Hofer, Howard A Schwid, Maxime Cannesson
With increasing adoption of anesthesia information management systems (AIMS), there is growing interest in utilizing AIMS data for intraoperative clinical decision support (CDS). CDS for anesthesia has the potential for improving quality of care, patient safety, billing, and compliance. Intraoperative CDS can range from passive and post hoc systems to active real-time systems that can detect ongoing clinical issues and deviations from best practice care. Real-time CDS holds the most promise because real-time alerts and guidance can drive provider behavior toward evidence-based standardized care during the ongoing case...
February 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28081211/development-and-validation-of-a-clinical-prediction-rule-for-bacteremia-among-maintenance-hemodialysis-patients-in-outpatient-settings
#7
Sho Sasaki, Takeshi Hasegawa, Hiroo Kawarazaki, Atsushi Nomura, Daisuke Uchida, Takahiro Imaizumi, Masahide Furusho, Hiroki Nishiwaki, Shingo Fukuma, Yugo Shibagaki, Shunichi Fukuhara
BACKGROUND: To our knowledge, no reliable clinical prediction rule (CPR) for identifying bacteremia in hemodialysis (HD) patients has been established. The aim of this study was to develop a CPR for bacteremia in maintenance HD patients visiting the outpatient department. METHODS: This multicenter cohort study involved consecutive maintenance HD patients who visited the outpatient clinic or emergency room of seven Japanese institutions between August 2011 and July 2013...
2017: PloS One
https://www.readbyqxmd.com/read/28049389/external-validation-of-two-classification-and-regression-tree-models-to-predict-the-outcome-of-inpatient-cardiopulmonary-resuscitation
#8
Ryan W R Guilbault, Marcus Andreas Ohlsson, Anna M Afonso, Mark H Ebell
OBJECTIVE: To prospectively validate a previously developed classification and regression tree (CART) model that predicts the likelihood of a good outcome among patients undergoing inpatient cardiopulmonary resuscitation. DESIGN: Prospective validation of a clinical decision rule. SETTING: Skåne University Hospital in Malmo, Sweden. PATIENTS: All adult patients (N = 287) experiencing in-hospital cardiopulmonary arrest and undergoing cardiopulmonary resuscitation between 2007 and 2010...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28045960/modelling-predictors-of-molecular-response-to-frontline-imatinib-for-patients-with-chronic-myeloid-leukaemia
#9
Haneen Banjar, Damith Ranasinghe, Fred Brown, David Adelson, Trent Kroger, Tamara Leclercq, Deborah White, Timothy Hughes, Naeem Chaudhri
BACKGROUND: Treatment of patients with chronic myeloid leukaemia (CML) has become increasingly difficult in recent years due to the variety of treatment options available and challenge deciding on the most appropriate treatment strategy for an individual patient. To facilitate the treatment strategy decision, disease assessment should involve molecular response to initial treatment for an individual patient. Patients predicted not to achieve major molecular response (MMR) at 24 months to frontline imatinib may be better treated with alternative frontline therapies, such as nilotinib or dasatinib...
2017: PloS One
https://www.readbyqxmd.com/read/28002683/a-prediction-model-to-help-with-the-assessment-of-adenopathy-in-lung-cancer-hal
#10
Oisin J O'Connell, Francisco A Almeida, Michael J Simoff, Lonny Yarmus, Ray Lazarus, Benjamin Young, Yu Chen, Roy Semaan, Timothy M Saettele, Joseph Cicenia, Harmeet Bedi, Corrine Kliment, Liang Li, Sonali Sethi, Javier Diaz-Mendoza, David Feller-Kopman, Juhee Song, Thomas Gildea, Hans Lee, Horiana B Grosu, Michael Machuzak, Macarena Rodriguez-Vial, George A Eapen, Carlos A Jimenez, Roberto F Casal, David E Ost
RATIONALE: Estimating the probability of finding N2 or N3 (prN2/3) malignant nodal disease on EBUS-TBNA in patients with non-small cell lung cancer (NSCLC) can facilitate the selection of subsequent management strategies. OBJECTIVE: The goal of this study was to develop a clinical prediction model for estimating the prN2/3. METHODS: We used the AQuIRE registry to identify patients with NSCLC with clinical radiographic stage T1-3, N0-3, M0 disease that had EBUS-TBNA for staging...
December 21, 2016: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27998283/a-genotypic-method-for-determining-hiv-2-coreceptor-usage-enables-epidemiological-studies-and-clinical-decision-support
#11
Matthias Döring, Pedro Borrego, Joachim Büch, Andreia Martins, Georg Friedrich, Ricardo Jorge Camacho, Josef Eberle, Rolf Kaiser, Thomas Lengauer, Nuno Taveira, Nico Pfeifer
BACKGROUND: CCR5-coreceptor antagonists can be used for treating HIV-2 infected individuals. Before initiating treatment with coreceptor antagonists, viral coreceptor usage should be determined to ensure that the virus can use only the CCR5 coreceptor (R5) and cannot evade the drug by using the CXCR4 coreceptor (X4-capable). However, until now, no online tool for the genotypic identification of HIV-2 coreceptor usage had been available. Furthermore, there is a lack of knowledge on the determinants of HIV-2 coreceptor usage...
December 20, 2016: Retrovirology
https://www.readbyqxmd.com/read/27931012/impact-of-thrombophilia-screening-on-venous-thromboembolism-management-practices
#12
Alejandro Garcia-Horton, Michael J Kovacs, Jameel Abdulrehman, Jay E Taylor, Shobha Sharma, Alejandro Lazo-Langner
BACKGROUND: It is unclear whether thrombophilia testing provides any further information on risk of recurrence or guidance in management of patients with a first episode of idiopathic venous thromboembolism (VTE). Furthermore, after the introduction to clinical practice of clinical prediction rules, thrombophilia screening could be less relevant in anticoagulation decision making. We assessed the potential impact of thrombophilia screening on the decision of maintaining anticoagulation beyond the initially planned anticoagulation period in patients with an unprovoked VTE, before and after the introduction of a clinical prediction rule into practice...
January 2017: Thrombosis Research
https://www.readbyqxmd.com/read/27918253/placental-growth-factor-alone-or-in-combination-with-soluble-fms-like-tyrosine-kinase-1-as-an-aid-to-the-assessment-of-women-with-suspected-pre-eclampsia-systematic-review-and-economic-analysis
#13
Geoff K Frampton, Jeremy Jones, Micah Rose, Liz Payne
BACKGROUND: Pre-eclampsia (PE) prediction based on blood pressure, presence of protein in the urine, symptoms and laboratory test abnormalities can result in false-positive diagnoses. This may lead to unnecessary antenatal admissions and preterm delivery. Blood tests that measure placental growth factor (PlGF) or the ratio of soluble fms-like tyrosine kinase 1 (sFlt-1) to PlGF could aid prediction of PE if either were added to routine clinical assessment or used as a replacement for proteinuria testing...
November 2016: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/27910703/co-calibration-of-two-self-reported-measures-of-adherence-to-antiretroviral-therapy
#14
Robin M Nance, J A Chris Delaney, Carol E Golin, Wendee M Wechsberg, Chinazo Cunningham, Frederick Altice, Katerina Christopoulos, Kevin Knight, Vu Quan, Michael S Gordon, Sandra Springer, Jeremy Young, Paul K Crane, Kenneth H Mayer, Michael J Mugavero, Carlos Del Rio, Richard A Kronmal, Heidi M Crane
Adherence to antiretroviral therapy (ART) is an important determinant of clinical success assessed in many HIV studies. Harmonizing adherence data from studies that use different measures is difficult without a co-calibration equation to convert between validated instruments. Our purpose was to co-calibrate two commonly used adherence measures: the AIDS Clinical Trials Group (ACTG) questionnaire and the Visual Analog Scale (VAS). We used robust linear regression to develop a co-calibration equation in a clinical care cohort...
April 2017: AIDS Care
https://www.readbyqxmd.com/read/27904602/comparison-of-different-risk-stratification-systems-in-predicting-short-term-serious-outcome-of-syncope-patients
#15
Saeed Safari, Alireza Baratloo, Behrooz Hashemi, Farhad Rahmati, Mohammad Mehdi Forouzanfar, Maryam Motamedi, Ladan Mirmohseni
BACKGROUND: Determining etiologic causes and prognosis can significantly improve management of syncope patients. The present study aimed to compare the values of San Francisco, Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL), Boston, and Risk Stratification of Syncope in the Emergency Department (ROSE) score clinical decision rules in predicting the short-term serious outcome of syncope patients. MATERIALS AND METHODS: The present diagnostic accuracy study with 1-week follow-up was designed to evaluate the predictive values of the four mentioned clinical decision rules...
2016: Journal of Research in Medical Sciences: the Official Journal of Isfahan University of Medical Sciences
https://www.readbyqxmd.com/read/27902658/understanding-negative-predictive-value-of-diagnostic-tests-used-in-clinical-practice
#16
Reba A Umberger, Linda A Hatfield, Patricia M Speck
Nurses review, evaluate, and use diagnostic test results on a routine basis. However, the skills necessary to evaluate a particular test using statistical outcome measures is often lacking. The purpose of this article is to examine and interpret the underlying principles for use of the statistical outcomes of diagnostic screening tests (sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values, with a discussion about use of SpPIn [Specificity, Positive test = rule in], and SnNOut [Sensitivity, Negative test = rule out]) in advanced nursing clinical practice...
January 2017: Dimensions of Critical Care Nursing: DCCN
https://www.readbyqxmd.com/read/27900363/integration-of-genomics-and-histology-revises-diagnosis-and-enables-effective-therapy-of-refractory-cancer-of-unknown-primary-with-pdl1-amplification
#17
Stefan Gröschel, Martin Bommer, Barbara Hutter, Jan Budczies, David Bonekamp, Christoph Heining, Peter Horak, Martina Fröhlich, Sebastian Uhrig, Daniel Hübschmann, Christina Geörg, Daniela Richter, Nicole Pfarr, Katrin Pfütze, Stephan Wolf, Peter Schirmacher, Dirk Jäger, Christof von Kalle, Benedikt Brors, Hanno Glimm, Wilko Weichert, Albrecht Stenzinger, Stefan Fröhling
Identification of the tissue of origin in cancer of unknown primary (CUP) poses a diagnostic challenge and is critical for directing site-specific therapy. Currently, clinical decision-making in patients with CUP primarily relies on histopathology and clinical features. Comprehensive molecular profiling has the potential to contribute to diagnostic categorization and, most importantly, guide CUP therapy through identification of actionable lesions. We here report the case of an advanced-stage malignancy initially mimicking poorly differentiated soft-tissue sarcoma that did not respond to multiagent chemotherapy...
November 2016: Cold Spring Harbor Molecular Case Studies
https://www.readbyqxmd.com/read/27885107/a-systematic-review-of-clinical-prediction-scores-for-deep-vein-thrombosis
#18
REVIEW
Marina Kafeza, Joseph Shalhoub, Nina Salooja, Lucy Bingham, Konstantina Spagou, Alun H Davies
OBJECTIVE: Diagnosis of deep vein thrombosis remains a challenging problem. Various clinical prediction rules have been developed in order to improve diagnosis and decision making in relation to deep vein thrombosis. The purpose of this review is to summarise the available clinical scores and describe their applicability and limitations. METHODS: A systematic search of PubMed, MEDLINE and EMBASE databases was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance using the keywords: clinical score, clinical prediction rule, risk assessment, clinical probability, pretest probability, diagnostic score and medical Subject Heading terms: 'Venous Thromboembolism/diagnosis' OR 'Venous Thrombosis/diagnosis'...
November 24, 2016: Phlebology
https://www.readbyqxmd.com/read/27876174/artificial-neural-networks-predicting-head-ct-findings-in-elderly-patients-presenting-with-minor-head-injury-after-a-fall
#19
Michael W Dusenberry, Charles K Brown, Kori L Brewer
OBJECTIVES: To construct an artificial neural network (ANN) model that can predict the presence of acute CT findings with both high sensitivity and high specificity when applied to the population of patients≥age 65years who have incurred minor head injury after a fall. METHODS: An ANN was created in the Python programming language using a population of 514 patients ≥ age 65 years presenting to the ED with minor head injury after a fall. The patient dataset was divided into three parts: 60% for "training", 20% for "cross validation", and 20% for "testing"...
November 3, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27870815/the-cape-town-clinical-decision-rule-for-streptococcal-pharyngitis-in-children
#20
Mark E Engel, Karen Cohen, Ronald Gounden, Andre P Kengne, Dylan Dominic Barth, Andrew C Whitelaw, Veronica Francis, Motasim Badri, Annemie Stewart, James B Dale, Bongani M Mayosi, Gary Maartens
BACKGROUND: Existing clinical decision rules (CDRs) to diagnose group A streptococcal (GAS) pharyngitis have not been validated in sub-Saharan Africa. We developed a locally applicable CDR while evaluating existing CDRs for diagnosing GAS pharyngitis in South African children. METHODS: We conducted a prospective cohort study and enrolled 997 children 3-15 years of age presenting to primary care clinics with a complaint of sore throat, and whose parents provided consent...
March 2017: Pediatric Infectious Disease Journal
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