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Clinical decision and prediction rules

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https://www.readbyqxmd.com/read/28808076/influence-of-the-duration-of-penicillin-prescriptions-on-outcomes-for-acute-sore-throat-in-adults-the-descarte-prospective-cohort-study-in-uk-general-practice
#1
Michael Moore, Beth Stuart, Fd Richard Hobbs, Chris C Butler, Alastair D Hay, John Campbell, Brendan C Delaney, Sue Broomfield, Paula Barratt, Kerenza Hood, Hazel Everitt, Mark Mullee, Ian Williamson, David Mant, Paul Little
BACKGROUND: Guidelines recommend 10-day treatment courses for acute sore throat, but shorter courses may be used in practice. AIM: To determine whether antibiotic duration predicts adverse outcome of acute sore throat in adults in routine care. DESIGN AND SETTING: A secondary analysis of the DESCARTE (Decision rule for the Symptoms and Complications of Acute Red Throat in Everyday practice) prospective cohort study of 12 829 adults presenting in UK general practice with acute sore throat...
August 14, 2017: British Journal of General Practice: the Journal of the Royal College of General Practitioners
https://www.readbyqxmd.com/read/28764221/maximal-aortic-valve-cusp-separation-and-severity-of-aortic-stenosis
#2
K Jayaprakash, V P Dilu, Raju George
INTRODUCTION: An integrated approach that incorporates two dimensional, M mode and Doppler echocardiographic evaluation has become the standard means for accurate quantification of severity of valvular aortic stenosis. Maximal separation of the aortic valve cusps during systole has been shown to correlate well with the severity of aortic stenosis measured by other echocardiographic parameters. AIM: To study the correlation between Maximal Aortic valve Cusp Separation (MACS) and severity of aortic valve stenosis and to find cut-off values of MACS for detecting severe and mild aortic stenosis...
June 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28731391/malpractice-litigation-following-spine-surgery
#3
Alan H Daniels, Roy Ruttiman, Adam E M Eltorai, J Mason DePasse, Bielinsky A Brea, Mark A Palumbo
OBJECTIVE Adverse events related to spine surgery sometimes lead to litigation. Few studies have evaluated the association between spine surgical complications and medical malpractice proceedings, outcomes, and awards. The aim of this study was to identify the most frequent causes of alleged malpractice in spine surgery and to gain insight into patient demographic and clinical characteristics associated with medical negligence litigation. METHODS A search for "spine surgery" spanning February 1988 to May 2015 was conducted utilizing the medicolegal research service VerdictSearch (ALM Media Properties, LLC)...
July 21, 2017: Journal of Neurosurgery. Spine
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
#4
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/28647160/a-clinical-decision-rule-to-predict-zygomatico-maxillary-fractures
#5
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/28611156/clinical-prediction-rule-for-delayed-hemothorax-after-minor-thoracic-injury-a-multicentre-derivation-and-validation-study
#6
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
#7
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
https://www.readbyqxmd.com/read/28589638/inter-observer-reliability-in-reading-amplitude-integrated-electroencephalogram-in-the-newborn-intensive-care-unit
#8
Bhavesh Mehta, Nadine Griffiths, Kaye Spence, Sharon Laing
AIM: Amplitude-integrated electroencephalogram (aEEG) is widely used in neonates to detect electrical seizure and predict outcome following hypoxic ischaemic encephalopathy and other encephalopathy. Because accurate interpretation is important for clinical decision-making and family counselling, inter-observer reliability is a major concern. We aimed to evaluate inter-observer reliability in the interpretation of aEEG tracings in a neonatal intensive care unit. METHODS: Three neonatal intensive care unit clinicians with different levels of experience in reading aEEG independently reviewed and scored aEEG traces using standardised criteria, categories and interpretation rules...
June 7, 2017: Journal of Paediatrics and Child Health
https://www.readbyqxmd.com/read/28585184/text-mining-of-the-electronic-health-record-an-information-extraction-approach-for-automated-identification-and-subphenotyping-of-hfpef-patients-for-clinical-trials
#9
Siddhartha R Jonnalagadda, Abhishek K Adupa, Ravi P Garg, Jessica Corona-Cox, Sanjiv J Shah
Precision medicine requires clinical trials that are able to efficiently enroll subtypes of patients in whom targeted therapies can be tested. To reduce the large amount of time spent screening, identifying, and recruiting patients with specific subtypes of heterogeneous clinical syndromes (such as heart failure with preserved ejection fraction [HFpEF]), we need prescreening systems that are able to automate data extraction and decision-making tasks. However, a major obstacle is the vast amount of unstructured free-form text in medical records...
June 2017: Journal of Cardiovascular Translational Research
https://www.readbyqxmd.com/read/28503347/wasting-of-extensor-digitorum-brevis-as-a-decisive-preoperative-clinical-indicator-of-lumbar-canal-stenosis-a-single-center-prospective-cohort-study
#10
S Munakomi, B M Kumar
BACKGROUND: The dilemma in managing patients with low back ache lies in differentiating radiculopathy from lumbar canal stenosis. This has a huge bearing in patients being planned for surgical intervention as underperforming leads to failed back syndrome whereas over-doing leads to instability. There still remains a loophole in clinically diagnosing lumbar canal stenosis. AIM: We opt to utilize a simple bedside clinical examination in routinely assessing patients presenting with low back ache in ruling out underlying canal stenosis...
September 2016: Annals of Medical and Health Sciences Research
https://www.readbyqxmd.com/read/28494618/machine-learning-methods-to-predict-diabetes-complications
#11
Arianna Dagliati, Simone Marini, Lucia Sacchi, Giulia Cogni, Marsida Teliti, Valentina Tibollo, Pasquale De Cata, Luca Chiovato, Riccardo Bellazzi
One of the areas where Artificial Intelligence is having more impact is machine learning, which develops algorithms able to learn patterns and decision rules from data. Machine learning algorithms have been embedded into data mining pipelines, which can combine them with classical statistical strategies, to extract knowledge from data. Within the EU-funded MOSAIC project, a data mining pipeline has been used to derive a set of predictive models of type 2 diabetes mellitus (T2DM) complications based on electronic health record data of nearly one thousand patients...
May 1, 2017: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/28490554/feasibility-cluster-randomised-controlled-trial-of-a-within-consultation-intervention-to-reduce-antibiotic-prescribing-for-children-presenting-to-primary-care-with-acute-respiratory-tract-infection-and-cough
#12
Peter S Blair, Sophie Turnbull, Jenny Ingram, Niamh Redmond, Patricia Jane Lucas, Christie Cabral, Sandra Hollinghurst, Padraig Dixon, Tim Peters, Jeremy Horwood, Paul Little, Nick A Francis, Anna Gilbertson, Catherine Jameson, Alastair D Hay
OBJECTIVE: To investigate recruitment and retention, data collection methods and the acceptability of a 'within-consultation' complex intervention designed to reduce antibiotic prescribing. DESIGN: Primary care feasibility cluster randomised controlled trial. SETTING: 32 general practices in South West England recruiting children from October 2014 to April 2015. PARTICIPANTS: Children (aged 3 months to <12 years) with acute cough and respiratory tract infection (RTI)...
May 9, 2017: BMJ Open
https://www.readbyqxmd.com/read/28490484/developing-a-decision-rule-to-optimise-clinical-pharmacist-resources-for-medication-reconciliation-in-the-emergency-department
#13
Sabrina De Winter, Peter Vanbrabant, Pieter Laeremans, Veerle Foulon, Ludo Willems, Sandra Verelst, Isabel Spriet
BACKGROUND: The process of obtaining a complete medication history for patients admitted to the hospital from the ED at hospital admission, without discrepancies, is error prone and time consuming. OBJECTIVES: The goal of this study was the development of a clinical decision rule (CDR) with a high positive predictive value in detecting ED patients admitted to hospital at risk of at least one discrepancy during regular medication history acquisition, along with favourable feasibility considering time and budget constraints...
May 10, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28471321/evaluation-of-probabilistic-disease-forecasts
#14
Gareth Hughes, Fiona Burnett
The statistical evaluation of probabilistic disease forecasts often involves calculation of metrics defined conditionally on disease status, such as sensitivity and specificity. However, for the purpose of disease management decision making, metrics defined conditionally on the result of the forecast - predictive values - are also important, although less frequently reported. In this context, the application of scoring rules in the evaluation of probabilistic disease forecasts is discussed. An index of separation with application in the evaluation of probabilistic disease forecasts, described in the clinical literature, is also considered and its relation to scoring rules illustrated...
May 4, 2017: Phytopathology
https://www.readbyqxmd.com/read/28446713/a-risk-prediction-model-for-post-stroke-depression-in-chinese-stroke-survivors-based-on-clinical-and-socio-psychological-features
#15
Rui Liu, Yingying Yue, Haitang Jiang, Jian Lu, Aiqin Wu, Deqin Geng, Jun Wang, Jianxin Lu, Shenghua Li, Hua Tang, Xuesong Lu, Kezhong Zhang, Tian Liu, Yonggui Yuan, Qiao Wang
BACKGROUND: Post-stroke depression (PSD) is a frequent complication that worsens rehabilitation outcomes and patient quality of life. This study developed a risk prediction model for PSD based on patient clinical and socio-psychology features for the early detection of high risk PSD patients. RESULTS: Risk predictors included a history of brain cerebral infarction (odds ratio [OR], 3.84; 95% confidence interval [CI], 2.22-6.70; P < 0.0001) and four socio-psychological factors including Eysenck Personality Questionnaire with Neuroticism/Stability (OR, 1...
April 7, 2017: Oncotarget
https://www.readbyqxmd.com/read/28431109/performance-of-the-2015-acr-eular-classification-criteria-for-gout-in-a-primary-care-population-presenting-with-monoarthritis
#16
Hein J E M Janssens, Jaap Fransen, Matthijs Janssen, Tuhina Neogi, H Ralph Schumacher, Tim L Jansen, Nicola Dalbeth, William J Taylor
Objective.: To test the performance of the 2015 ACR-EULAR gout classification criteria against presence of SF MSU crystals in a primary healthcare population. Methods.: The criteria were applied to an existing dataset of consecutive patients with monoarthritis presenting to Dutch family physicians; all patients underwent microscopic SF analysis by design. The data had been prospectively collected to develop a diagnostic decision rule for gout in 2010. Diagnostic performance was assessed by calculating area under the receiver operating characteristic curve, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and constructing calibration plots for the full version of the criteria (including SF analysis results of all patients) and the clinical-only version (not including SF analysis results)...
April 20, 2017: Rheumatology
https://www.readbyqxmd.com/read/28410792/accuracy-of-pecarn-catch-and-chalice-head-injury-decision-rules-in-children-a-prospective-cohort-study
#17
Franz E Babl, Meredith L Borland, Natalie Phillips, Amit Kochar, Sarah Dalton, Mary McCaskill, John A Cheek, Yuri Gilhotra, Jeremy Furyk, Jocelyn Neutze, Mark D Lyttle, Silvia Bressan, Susan Donath, Charlotte Molesworth, Kim Jachno, Brenton Ward, Amanda Williams, Amy Baylis, Louise Crowe, Ed Oakley, Stuart R Dalziel
BACKGROUND: Clinical decision rules can help to determine the need for CT imaging in children with head injuries. We aimed to validate three clinical decision rules (PECARN, CATCH, and CHALICE) in a large sample of children. METHODS: In this prospective observational study, we included children and adolescents (aged <18 years) with head injuries of any severity who presented to the emergency departments of ten Australian and New Zealand hospitals. We assessed the diagnostic accuracy of PECARN (stratified into children aged <2 years and ≥2 years), CATCH, and CHALICE in predicting each rule-specific outcome measure (clinically important traumatic brain injury [TBI], need for neurological intervention, and clinically significant intracranial injury, respectively)...
June 17, 2017: Lancet
https://www.readbyqxmd.com/read/28410544/does-respiratory-variation-in-inferior-vena-cava-diameter-predict-fluid-responsiveness-a-systematic-review-and-meta-analysis
#18
REVIEW
Elliot Long, Ed Oakley, Trevor Duke, Franz E Babl
BACKGROUND: The aim of fluid resuscitation is to increase stroke volume, yet this effect is observed in only 50% of patients. Prediction of fluid responsiveness may allow fluid resuscitation to be administered to those most likely to benefit. The aim of this study was to systematically review the test characteristics of respiratory variation in inferior vena cava (IVC) diameter as a predictor of fluid responsiveness in patients with acute circulatory failure. METHODS: Electronic searches combined with reference review of identified studies...
May 2017: Shock
https://www.readbyqxmd.com/read/28407781/early-identification-of-patients-requiring-massive-transfusion-embolization-or-hemostatic-surgery-for-traumatic-hemorrhage-a-systematic-review-protocol
#19
Alexandre Tran, Maher Matar, Ewout W Steyerberg, Jacinthe Lampron, Monica Taljaard, Christian Vaillancourt
BACKGROUND: Hemorrhage is a major cause of early mortality following a traumatic injury. The progression and consequences of significant blood loss occur quickly as death from hemorrhagic shock or exsanguination often occurs within the first few hours. The mainstay of treatment therefore involves early identification of patients at risk for hemorrhagic shock in order to provide blood products and control of the bleeding source if necessary. The intended scope of this review is to identify and assess combinations of predictors informing therapeutic decision-making for clinicians during the initial trauma assessment...
April 13, 2017: Systematic Reviews
https://www.readbyqxmd.com/read/28393708/minor-head-trauma-in-the-pediatric-emergency-department-decision-making-nodes
#20
Mario Mastrangelo, Fabio Midulla
BACKGROUND: Minor head trauma is one of the leading cause of access to pediatric emergency departments with only a limited quote of patients resulting in clinically relevant brain injuries. OBJECTIVES: The aim of this review is to guide physicians involved in the management of pediatric head trauma towards a correct clinical approach. METHODS: A Pubmed/Medline search was realized through different entries including "minor head trauma" or "mild head trauma", "minor head injury" or "mild head injury", "acute head trauma"...
April 4, 2017: Current Pediatric Reviews
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