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Clinical decision and prediction rules

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https://www.readbyqxmd.com/read/28323801/predicting-acute-compartment-syndrome-pacs-the-role-of-continuous-monitoring
#1
Andrew H Schmidt, Michael J Bosse, Katherine P Frey, Robert V OʼToole, Daniel J Stinner, Daniel O Scharfstein, Vadim Zipunnikov, Ellen J MacKenzie
The diagnosis of acute compartment syndrome (ACS) is a common clinical challenge among patients who sustain high-energy orthopaedic trauma, largely because no validated criteria exist to reliably define the presence of the condition. In the absence of validated diagnostic standards, concern for the potential clinical and medicolegal impact of a missed compartment syndrome may result in the potential overuse of fasciotomy in "at-risk" patients. The goal of the Predicting Acute Compartment Syndrome Study was to develop a decision rule for predicting the likelihood of ACS that would reduce unnecessary fasciotomies while guarding against potentially missed ACS...
April 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28320917/predictors-of-massive-blood-transfusion-a-delphi-study-to-examine-the-views-of-experts
#2
Jacqueline V Mclennan, K C Mackway-Jones, S T Horne, R Body
BACKGROUND: Trauma patients requiring massive blood transfusion (MBT) have high morbidity and mortality: early and aggressive use of blood products during immediate resuscitation may improve survival. There is currently a lack of evidence to guide initial identification of these patients which is especially important in areas where plasma may need to be thawed. In the absence of this evidence, this study aimed to robustly evaluate expert opinion by using a Delphi process to identify predictors of massive transfusion...
March 20, 2017: Journal of the Royal Army Medical Corps
https://www.readbyqxmd.com/read/28292304/design-and-implementation-of-electronic-health-record-integrated-clinical-prediction-rules-icpr-a-randomized-trial-in-diverse-primary-care-settings
#3
David A Feldstein, Rachel Hess, Thomas McGinn, Rebecca G Mishuris, Lauren McCullagh, Paul D Smith, Michael Flynn, Joseph Palmisano, Gheorghe Doros, Devin Mann
BACKGROUND: Clinical prediction rules (CPRs) represent a method of determining individual patient risk to help providers make more accurate decisions at the point of care. Well-validated CPRs are underutilized but may decrease antibiotic overuse for acute respiratory infections. The integrated clinical prediction rules (iCPR) study builds on a previous single clinic study to integrate two CPRs into the electronic health record and assess their impact on practice. This article discusses study design and implementation of a multicenter cluster randomized control trial of the iCPR clinical decision support system, including the tool adaptation, usability testing, staff training, and implementation study to disseminate iCPR at multiple clinical sites across two health care systems...
March 14, 2017: Implementation Science: IS
https://www.readbyqxmd.com/read/28286843/clinical-scoring-systems-in-predicting-the-outcome-of-acute-upper-gastrointestinal-bleeding-a-narrative-review
#4
REVIEW
Hanieh Ebrahimi Bakhtavar, Hamid Reza Morteza Bagi, Farzad Rahmani, Kavous Shahsavari Nia, Arezu Ettehadi
Prediction of the outcome and severity of acute upper gastrointestinal bleeding (UGIB) has significant importance in patient care, disposition, and determining the need for emergent endoscopy. Recent international recommendations endorse using scoring systems for management of non-variceal UGIB patients. To date, different scoring systems have been developed for predicting the risk of 30-day mortality and re-bleeding. We have discussed the screening performance characteristics of Baylor bleeding score, the Rockall risk scoring score, Cedars-Sinai Medical Center predictive index, Glasgow Blatchford score, T-score, and AIMS65 systems, in the present review...
2017: Emergency (Tehran, Iran)
https://www.readbyqxmd.com/read/28278448/screening-for-anxiety-depression-and-anxious-depression-in-primary-care-a-field-study-for-icd-11-phc
#5
David P Goldberg, Geoffrey M Reed, Rebeca Robles, Fareed Minhas, Bushra Razzaque, Sandra Fortes, Jair de Jesus Mari, Tai Pong Lam, José Ángel Garcia, Linda Gask, Anthony C Dowell, Marianne Rosendal, Joseph K Mbatia, Shekhar Saxena
BACKGROUND: In this field study of WHO's revised classification of mental disorders for primary care settings, the ICD-11 PHC, we tested the usefulness of two five-item screening scales for anxiety and depression to be administered in primary care settings. METHODS: The study was conducted in primary care settings in four large middle-income countries. Primary care physicians (PCPs) referred individuals who they suspected might be psychologically distressed to the study...
February 20, 2017: Journal of Affective Disorders
https://www.readbyqxmd.com/read/28268786/improving-clinical-models-based-on-knowledge-extracted-from-current-datasets-a-new-approach
#6
D Mendes, S Paredes, T Rocha, P Carvalho, J Henriques, J Morais
The Cardiovascular Diseases (CVD) are the leading cause of death in the world, being prevention recognized to be a key intervention able to contradict this reality. In this context, although there are several models and scores currently used in clinical practice to assess the risk of a new cardiovascular event, they present some limitations. The goal of this paper is to improve the CVD risk prediction taking into account the current models as well as information extracted from real and recent datasets. This approach is based on a decision tree scheme in order to assure the clinical interpretability of the model...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/28267709/predicting-serious-complications-in-patients-with-cancer-and-pulmonary-embolism-using-decision-tree-modelling-the-epiphany-index
#7
A Carmona-Bayonas, P Jiménez-Fonseca, C Font, F Fenoy, R Otero, C Beato, J M Plasencia, M Biosca, M Sánchez, M Benegas, D Calvo-Temprano, D Varona, L Faez, I de la Haba, M Antonio, O Madridano, M P Solis, A Ramchandani, E Castañón, P J Marchena, M Martín, F Ayala de la Peña, V Vicente
BACKGROUND: Our objective was to develop a prognostic stratification tool that enables patients with cancer and pulmonary embolism (PE), whether incidental or symptomatic, to be classified according to the risk of serious complications within 15 days. METHODS: The sample comprised cases from a national registry of pulmonary thromboembolism in patients with cancer (1075 patients from 14 Spanish centres). Diagnosis was incidental in 53.5% of the events in this registry...
March 7, 2017: British Journal of Cancer
https://www.readbyqxmd.com/read/28256042/the-allomap%C3%A2-genomic-biomarker-story-10-years-after
#8
Mario C Deng
Over the last >20 years, we have co-developed the rationale for the first diagnostic and prognostic leukocyte gene expression profiling (GEP) biomarker test in transplantation medicine that gained US-FDA-regulatory clearance and international evidence-based medicine guideline acceptance to rule out moderate/severe acute cellular cardiac allograft rejection without invasive endomyocardial biopsies (EMB). Based on this test, a non-invasive clinical algorithm was implemented since 2005. After clinical implementation, this GEP-based monitoring in direct comparison with an EMB-based strategy was non-inferior with respect to detection of clinical rejection, defined as new onset allograft dysfunction with/without histology of ACR, re-transplantation or death, and at the same time improved patient satisfaction...
March 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28255067/reducing-head-ct-use-for-children-with-head-injuries-in-a-community-emergency-department
#9
Rebecca M Jennings, Jennifer J Burtner, Joseph F Pellicer, Deepthi K Nair, Miranda C Bradford, Michele Shaffer, Neil G Uspal, Joel S Tieder
BACKGROUND AND OBJECTIVE: Clinical decision rules have reduced use of computed tomography (CT) to evaluate minor pediatric head injury in pediatric emergency departments (EDs). CT use remains high in community EDs, where the majority of children seek medical care. We sought to reduce the rate of CT scans used to evaluate pediatric head injury from 29% to 20% in a community ED. METHODS: We evaluated a quality improvement (QI) project in a community ED aimed at decreasing the use of head CT scans in children by implementing a validated head trauma prediction rule for traumatic brain injury...
March 2, 2017: Pediatrics
https://www.readbyqxmd.com/read/28246898/external-validation-of-clinical-decision-rules-for-children-with-wrist-trauma
#10
Marjolein A M Mulders, Monique M J Walenkamp, Bente F H Dubois, Annelie Slaar, J Carel Goslings, Niels W L Schep
BACKGROUND: Clinical decision rules help to avoid potentially unnecessary radiographs of the wrist, reduce waiting times and save costs. OBJECTIVE: The primary aim of this study was to provide an overview of all existing non-validated clinical decision rules for wrist trauma in children and to externally validate these rules in a different cohort of patients. Secondarily, we aimed to compare the performance of these rules with the validated Amsterdam Pediatric Wrist Rules...
February 28, 2017: Pediatric Radiology
https://www.readbyqxmd.com/read/28246315/prospective-validation-of-a-clinical-decision-rule-to-identify-patients-presenting-to-the-emergency-department-with-chest-pain-who-can-safely-be-removed-from-cardiac-monitoring
#11
Shahbaz Syed, Mathieu Gatien, Jeffrey J Perry, Hina Chaudry, Soo-Min Kim, Kenneth Kwong, Muhammad Mukarram, Venkatesh Thiruganasambandamoorthy
BACKGROUND: Most patients with chest pain in the emergency department are assigned to cardiac monitoring for several hours, blocking access for patients in greater need. We sought to validate a previously derived decision rule for safe removal of patients from cardiac monitoring after initial evaluation in the emergency department. METHODS: We prospectively enrolled adults (age ≥ 18 yr) who presented with chest pain and were assigned to cardiac monitoring at 2 academic emergency departments over 18 months...
January 30, 2017: CMAJ: Canadian Medical Association Journal, Journal de L'Association Medicale Canadienne
https://www.readbyqxmd.com/read/28226978/improving-clinical-models-based-on-knowledge-extracted-from-current-datasets-a-new-approach
#12
D Mendes, S Paredes, T Rocha, P Carvalho, J Henriques, J Morais, D Mendes, S Paredes, T Rocha, P Carvalho, J Henriques, J Morais, D Mendes, T Rocha, P Carvalho, J Morais, S Paredes, J Henriques
The Cardiovascular Diseases (CVD) are the leading cause of death in the world, being prevention recognized to be a key intervention able to contradict this reality. In this context, although there are several models and scores currently used in clinical practice to assess the risk of a new cardiovascular event, they present some limitations. The goal of this paper is to improve the CVD risk prediction taking into account the current models as well as information extracted from real and recent datasets. This approach is based on a decision tree scheme in order to assure the clinical interpretability of the model...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/28225772/symptomatic-spinal-metastasis-a-systematic-literature-review-of-the-preoperative-prognostic-factors-for-survival-neurological-functional-and-quality-of-life-in-surgically-treated-patients-and-methodological-recommendations-for-prognostic-studies
#13
Anick Nater, Allan R Martin, Arjun Sahgal, David Choi, Michael G Fehlings
PURPOSE: While several clinical prediction rules (CPRs) of survival exist for patients with symptomatic spinal metastasis (SSM), these have variable prognostic ability and there is no recognized CPR for health related quality of life (HRQoL). We undertook a critical appraisal of the literature to identify key preoperative prognostic factors of clinical outcomes in patients with SSM who were treated surgically. The results of this study could be used to modify existing or develop new CPRs...
2017: PloS One
https://www.readbyqxmd.com/read/28208193/approach-to-suspected-acute-pulmonary-embolism-should-we-use-scoring-systems
#14
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
#15
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...
March 1, 2017: Computers in Biology and Medicine
https://www.readbyqxmd.com/read/28179372/graphics-and-statistics-for-cardiology-clinical-prediction-rules
#16
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...
April 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
#17
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
#18
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
#19
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
#20
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
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