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Clinical decision and prediction rules

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https://www.readbyqxmd.com/read/27931012/impact-of-thrombophilia-screening-on-venous-thromboembolism-management-practices
#1
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...
December 1, 2016: 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
#2
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
#3
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...
December 2, 2016: AIDS Care
https://www.readbyqxmd.com/read/27904602/comparison-of-different-risk-stratification-systems-in-predicting-short-term-serious-outcome-of-syncope-patients
#4
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
#5
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
#6
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
#7
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
#8
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
#9
Mark Emmanuel 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 (CDR) 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 aged 3-15 years presenting to primary care clinics with a complaint of sore throat, and whose parents provided consent...
November 18, 2016: Pediatric Infectious Disease Journal
https://www.readbyqxmd.com/read/27862642/external-validation-of-the-pecarn-head-trauma-prediction-rules-in-japan
#10
Kentaro Ide, Satoko Uematsu, Kenichi Tetsuhara, Satoshi Yoshimura, Takahiro Kato, Tohru Kobayashi
OBJECTIVES: The Pediatric Emergency Care Applied Research Network (PECARN) head trauma prediction rules are used to assist computed tomography (CT) decision-making for children with minor head trauma. Although the PECARN rules have been validated in North America and Europe, they have not yet been validated in Asia. In Japan, there are no clinical decision rules for children with minor head trauma. The rate of head CT for children with minor head trauma in Japan is high since CT is widely accessible across the country...
November 12, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27860223/validation-of-risk-stratification-for-children-with-febrile-neutropenia-in-a-pediatric-oncology-unit-in-india
#11
Anirban Das, Amita Trehan, Sapna Oberoi, Deepak Bansal
PURPOSE: The study aims to validate a score predicting risk of complications in pediatric patients with chemotherapy-related febrile neutropenia (FN) and evaluate the performance of previously published models for risk stratification. PATIENTS AND METHODS: Children diagnosed with cancer and presenting with FN were evaluated in a prospective single-center study. A score predicting the risk of complications, previously derived in the unit, was validated on a prospective cohort...
November 15, 2016: Pediatric Blood & Cancer
https://www.readbyqxmd.com/read/27853033/performance-of-waist-circumference-and-proposed-cutoff-levels-for-defining-overweight-and-obesity-in-nigerians
#12
Christian I Okafor, Taiwo H Raimi, Ibrahim D Gezawa, Anas A Sabir, Ofem Enang, Fabian Puepet, Olufemi A Fasanmade, Esther N Ofoegbu, Olatunde Odusan
BACKGROUND: Waist circumference (WC) is a simple tool for measuring central obesity in routine clinic settings. Gender- and ethnic-specific optimal cutoff points for WC are encouraged for populations lacking such data. OBJECTIVES: To derive WC cutoff values, predictive of overweight and obesity in Nigerians and to evaluate the performance of currently recommended values. SUBJECTS AND METHODS: Apparently, healthy urban dwellers from six cities spread across Nigeria were selected for this cross-sectional study...
October 2016: Annals of African Medicine
https://www.readbyqxmd.com/read/27823754/utility-of-clinical-decision-rule-for-intensive-care-unit-admission-in-patients-with-traumatic-intracranial-hemorrhage
#13
Brandt D Whitehurst, Jared Reyes, Stephen D Helmer, James M Haan
BACKGROUND: Recent literature suggests the majority of traumatic intracranial hemorrhage does not require intervention. One recently described clinical decision rule was sensitive in identifying patients requiring critical care interventions in an urban setting. We sought to validate its effectiveness in our predominately rural setting. METHODS: A retrospective study was conducted of adult patients with traumatic intracranial hemorrhage. The rule, based on age, initial Glasgow coma scale score, and presence of a non-isolated head injury, was applied to externally validate the previously reported findings...
October 8, 2016: American Journal of Surgery
https://www.readbyqxmd.com/read/27810250/a-clinical-prediction-rule-to-determine-the-need-for-repeat-ercp-after-endoscopic-treatment-of-postsurgical-bile-leaks
#14
Apostolos V Tsolakis, Paul D James, Gilaad G Kaplan, Robert P Myers, James Hubbard, Todd Wilson, Scott Zimmer, Rachid Mohamed, Martin Cole, Sydney Bass, Mark G Swain, Steven J Heitman
BACKGROUND AND AIMS: In patients who have undergone ERCP with biliary stenting for post-surgical bile leaks, the optimal method (ERCP or gastroscopy) and timing of stent removal is controversial. We developed a clinical prediction rule to identify cases in which a repeat ERCP is unnecessary. METHODS: Population-based study of all patients who underwent ERCP for management of surgically induced bile leaks between 2000 and 2012. Multivariate and binary recursive partitioning analyses were performed to generate a rule predicting the absence of biliary pathology on repeat endoscopic evaluation...
October 31, 2016: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/27806680/is-it-safe-to-discharge-blunt-abdominal-trauma-patients-with-normal-initial-findings
#15
Mojtaba Chardoli, Samina Rezvani, Pejman Mansouri, Kaveh Naderi, Ali Vafaei, MirHojjat Khorasanizadeh, Vafa Rahimi-Movaghar
BACKGROUND: Trauma is the leading health concern among young adults. Blunt abdominal trauma (BAT) is the most common type of blunt traumas. BAT patients may prove normal in the initial clinical assessments, but since the time required for an intra-abdominal injury to be clinically apparent is not predictable, deciding when to safely discharge these patients could be a dilemma. The purpose of this study is to determine whether follow-up of the early discharged or further diagnostic assessment of the later discharged BAT patients with normal initial findings reveals any abnormal findings...
November 3, 2016: Acta Chirurgica Belgica
https://www.readbyqxmd.com/read/27800494/prediction-of-early-recurrence-of-liver-cancer-by-a-novel-discrete-bayes-decision-rule-for-personalized-medicine
#16
Hiroyuki Ogihara, Norio Iizuka, Yoshihiko Hamamoto
We discuss a novel diagnostic method for predicting the early recurrence of liver cancer with high accuracy for personalized medicine. The difficulty with cancer treatment is that even if the types of cancer are the same, the cancers vary depending on the patient. Thus, remarkable attention has been paid to personalized medicine. Unfortunately, although the Tokyo Score, the Modified JIS, and the TNM classification have been proposed as liver scoring systems, none of these scoring systems have met the needs of clinical practice...
2016: BioMed Research International
https://www.readbyqxmd.com/read/27785402/embryo-quality-predictive-models-based-on-cumulus-cells-gene-expression
#17
R Devjak, T Burnik Papler, I Verdenik, K Fon Tacer, E Vrtačnik Bokal
Since the introduction of in vitro fertilization (IVF) in clinical practice of infertility treatment, the indicators for high quality embryos were investigated. Cumulus cells (CC) have a specific gene expression profile according to the developmental potential of the oocyte they are surrounding, and therefore, specific gene expression could be used as a biomarker. The aim of our study was to combine more than one biomarker to observe improvement in prediction value of embryo development. In this study, 58 CC samples from 17 IVF patients were analyzed...
July 1, 2016: Balkan Journal of Medical Genetics: BJMG
https://www.readbyqxmd.com/read/27773828/deriving-a-clinical-prediction-rule-for-coronary-artery-disease-in-primary-care-improving-internal-and-external-validity-by-pooling-individual-patient-data-from-five-international-sites
#18
Marc Aerts, Girma Minalu, Stefan Bösner, Frank Buntinx, Bernard Burnand, Jörg Haasenritter, Lilli Herzig, J André Knottnerus, Staffan Nilsson, Walter Renier, Carol Sox, Harold Sox, Norbert Donner-Banzhoff
OBJECTIVE: To construct a clinical prediction rule for coronary artery disease (CAD) presenting with chest pain in primary care. STUDY DESIGN: Meta-Analysis using 3099 patients from 5 studies. To identify candidate predictors, we used random forest trees, multiple imputation of missing values and logistic regression within individual studies. To generate a prediction rule on the pooled data, we applied a regression model that took account of the differing standard data sets collected by the 5 studies...
October 20, 2016: Journal of Clinical Epidemiology
https://www.readbyqxmd.com/read/27742603/weighting-primary-care-patient-panel-size-a-novel-electronic-health-record-derived-measure-using-machine-learning
#19
Alvin Rajkomar, Joanne Wing Lan Yim, Kevin Grumbach, Ami Parekh
BACKGROUND: Characterizing patient complexity using granular electronic health record (EHR) data regularly available to health systems is necessary to optimize primary care processes at scale. OBJECTIVE: To characterize the utilization patterns of primary care patients and create weighted panel sizes for providers based on work required to care for patients with different patterns. METHODS: We used EHR data over a 2-year period from patients empaneled to primary care clinicians in a single academic health system, including their in-person encounter history and virtual encounters such as telephonic visits, electronic messaging, and care coordination with specialists...
October 14, 2016: JMIR Medical Informatics
https://www.readbyqxmd.com/read/27740698/a-practical-decision-tree-model-to-predict-complexity-of-reconstructive-surgery-after-periocular-basal-cell-carcinoma-excision
#20
E Tan, F Lin, L Sheck, P Salmon, S Ng
PURPOSE: To derive a decision rule for predicting surgical complexity in periorbital basal cell carcinoma (pBCC). DESIGN: Prospective, cohort study. PARTICIPANTS: Patients referred to an oculoplastic service for excision of pBCC from September 2010 to November 2015 METHODS: This study was conducted at two centres in New Zealand from September 2010 to November 2015. Baseline demographic information, and an initial assessment of operative complexity (a four-point grading scale) were collected...
October 14, 2016: Journal of the European Academy of Dermatology and Venereology: JEADV
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