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Clinical decision-making

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https://www.readbyqxmd.com/read/28735363/routine-follow-up-radiographs-for-distal-radius-fractures-are-seldom-clinically-substantiated
#1
N L Weil, M El Moumni, S M Rubinstein, P Krijnen, M F Termaat, I B Schipper
INTRODUCTION: The value of routine radiographs during follow-up after distal radius fractures is unclear. The aim of this study was to evaluate whether routine radiographs performed during the follow-up period in patients with a distal radius fracture influenced clinical decision making. METHODS: This retrospective cohort study included patients aged ≥18 years who were treated for a distal radius fracture at four hospitals in The Netherlands in 2012. Demographic and clinical and radiographic characteristics were collected from medical records...
July 22, 2017: Archives of Orthopaedic and Trauma Surgery
https://www.readbyqxmd.com/read/28735282/a-systematic-review-of-criteria-used-to-define-recovery-from-sport-related-concussion-in-youth-athletes
#2
REVIEW
Mohammad Nadir Haider, John J Leddy, Sonja Pavlesen, Melissa Kluczynski, John G Baker, Jeffrey C Miecznikowski, Barry S Willer
OBJECTIVE: The Concussion in Sport Group guidelines recommend a multifaceted approach to help clinicians make return to sport decisions. The purpose of this study was to identify the most common multifaceted measures used to define clinical recovery from sport-related concussion in young athletes (high school and/or college level) and to summarise existing knowledge of criteria used to make return to sport decisions. DESIGN: Systematic review. DATA SOURCES: The PubMed (MEDLINE), SPORTDiscus and Embase electronic databases were searched from 1 January 2000 to 1 March 2017 by three independent reviewers...
July 22, 2017: British Journal of Sports Medicine
https://www.readbyqxmd.com/read/28734928/lv-mass-independently-predicts-mortality-and-need-for-future-revascularization-in%C3%A2-patients-undergoing-diagnostic-coronary-angiography
#3
Ahmed Abdi-Ali, Robert J H Miller, Danielle Southern, Mei Zhang, Yoko Mikami, Merril Knudtson, Bobak Heydari, Andrew G Howarth, Carmen P Lydell, Mathew T James, Stephen B Wilton, James A White
OBJECTIVES: The goal of this study was to assess associations between left ventricular (LV) mass, all-cause mortality, and need for revascularization in patients undergoing coronary angiography. BACKGROUND: LV hypertrophy is associated with adverse cardiovascular outcomes in healthy subjects. However, its influence in those with known or suspected coronary artery disease is poorly understood. METHODS: A total of 3,754 patients (mean age 59...
July 13, 2017: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/28734786/clinical-usefulness-of-tools-to-support-decision-making-for-palliative-treatment-of%C3%A2-metastatic-colorectal-cancer-a-systematic-review
#4
Ellen G Engelhardt, Dóra Révész, Hans J Tamminga, Cornelis J A Punt, Mirjam Koopman, Bregje D Onwuteaka-Philipsen, Ewout W Steyerberg, Ilse P Jansma, Henrica C W De Vet, Veerle M H Coupé
BACKGROUND: Decision-making regarding palliative treatment for patients with metastatic colorectal cancer (mCRC) is complex and comprises numerous decisions. Decision-making should be guided by the premise of maintaining and/or improving patients' quality of life, by patient preference, and by the trade-off between treatment benefits and harm. Decision support systems (DSSs) for clinicians (eg, nomograms) can assist in this process. The present systematic review aimed to provide a comprehensive overview of the available DSSs for incurable mCRC and to assess their clinical usefulness...
June 24, 2017: Clinical Colorectal Cancer
https://www.readbyqxmd.com/read/28734560/deciding-on-breast-cancer-risk-reduction-the-role-of-counseling-in-individual-decision-making-a-qualitative-study
#5
Sarah B Blakeslee, Worta McCaskill-Stevens, Patricia A Parker, Christine M Gunn, Hanna Bandos, Therese B Bevers, Tracy A Battaglia, Angela Fagerlin, Jacqueline Müller-Nordhorn, Christine Holmberg
OBJECTIVES: The presentation of risks and benefits in clinical practice is common particularly in situations in which treatment recommendations involve trade-offs. The treatment of breast cancer risk with selective estrogen receptor modulators (SERMs) is such a decision. We investigated the influence of health care provider (HCP) counseling on women's decision-making. METHODS: Thirty breast cancer risk counseling sessions were recorded from April 2012-August 2013 at a comprehensive cancer center and at a safety-net, community hospital in the US...
June 27, 2017: Patient Education and Counseling
https://www.readbyqxmd.com/read/28734529/ultrasound-based-differentiation-of-malignant-and-benign-thyroid-nodules-an-extreme-learning-machine-approach
#6
Jianfu Xia, Huiling Chen, Qiang Li, Minda Zhou, Limin Chen, Zhennao Cai, Yang Fang, Hong Zhou
BACKGROUND AND OBJECTIVES: It is important to be able to accurately distinguish between benign and malignant thyroid nodules in order to make appropriate clinical decisions. The purpose of this study was to improve the effectiveness and efficiency for discriminating the malignant from benign thyroid cancers based on the Ultrasonography (US) features. METHODS: There were 114 benign nodules in 106 patients (82 women and 24 men) and 89 malignant nodules in 81 patients (69 women and 12 men) included in this study...
August 2017: Computer Methods and Programs in Biomedicine
https://www.readbyqxmd.com/read/28734488/clinical-fellowship-for-an-innovative-integrated-bsn-phd-program-an-academic-and-practice-partnership
#7
Madelyne Z Greene, Mary Kate FitzPatrick, Jean Romano, Linda H Aiken, Therese S Richmond
Opportunities for research-focused doctoral education must be available to nurses early in their careers in order to ensure the further development of nursing science. Early entry into the research doctorate through an integrated BSN-PhD program is one innovative approach. This approach highlights the value of integrating post-licensure clinical training into the doctoral curriculum. To better prepare innovative nurse scientists early in their careers we developed a clinical nurse fellowship within an integrated BSN-PhD program in partnership with an affiliated health system...
July 2017: Journal of Professional Nursing: Official Journal of the American Association of Colleges of Nursing
https://www.readbyqxmd.com/read/28733500/clinical-decision-making
#8
(no author information available yet)
No abstract text is available yet for this article.
July 22, 2017: Veterinary Record
https://www.readbyqxmd.com/read/28733473/do-depression-and-anxiety-reduce-the-likelihood-of-remission-in-rheumatoid-arthritis-and-psoriatic-arthritis-data-from-the-prospective-multicentre-nor-dmard-study
#9
Brigitte Michelsen, Eirik Klami Kristianslund, Joseph Sexton, Hilde Berner Hammer, Karen Minde Fagerli, Elisabeth Lie, Ada Wierød, Synøve Kalstad, Erik Rødevand, Frode Krøll, Glenn Haugeberg, Tore K Kvien
OBJECTIVE: To investigate the predictive value of baseline depression/anxiety on the likelihood of achieving joint remission in rheumatoid arthritis (RA) and psoriatic arthritis (PsA) as well as the associations between baseline depression/anxiety and the components of the remission criteria at follow-up. METHODS: We included 1326 patients with RA and 728 patients with PsA from the prospective observational NOR-DMARD study starting first-time tumour necrosis factor inhibitors or methotrexate...
July 21, 2017: Annals of the Rheumatic Diseases
https://www.readbyqxmd.com/read/28733440/dose-transition-pathways-the-missing-link-between-complex-dose-finding-designs-and-simple-decision-making
#10
Christina Yap, Lucinda J Billingham, Ying Kuen Cheung, Charlie Craddock, John O'Quigley
The ever increasing pace of development of novel therapies mandates efficient methodologies for assessment of their tolerability and activity. Evidence increasingly support the merits of model-based dose-finding designs in identifying the recommended Phase II dose compared to conventional rule-based designs such as the 3+3 but despite this, their use remains limited. Here, we propose a useful tool, Dose Transition Pathways (DTP), which helps overcome several commonly-faced practical and methodological challenges in the implementation of model-based designs...
July 21, 2017: Clinical Cancer Research: An Official Journal of the American Association for Cancer Research
https://www.readbyqxmd.com/read/28733071/long-term-stroke-and-bleeding-risk-in-patients-with-atrial-fibrillation-treated-with-oral-anticoagulants-in-contemporary-practice-providing-evidence-for-shared-decision-making
#11
Peter A Noseworthy, Xiaoxi Yao, Bernard J Gersh, Ian Hargraves, Nilay D Shah, Victor M Montori
BACKGROUND: Oral anticoagulation is recommended as a lifelong therapy for most patients with atrial fibrillation (AF). However, data on long-term outcomes in clinical practice on these drugs are scarce, particularly for the recently approved agents. We aimed to describe differences in characteristics between patients in everyday practice and those enrolled in the pivotal trials, and to report long-term outcomes on oral anticoagulation in practice. METHODS: We performed a retrospective cohort analysis using a large U...
July 14, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28732214/crispr-cas9-technology-based-xenograft-tumors-as-candidate-reference-materials-for-multiple-eml4-alk-rearrangements-testing
#12
Rongxue Peng, Rui Zhang, Guigao Lin, Xin Yang, Ziyang Li, Kuo Zhang, Jiawei Zhang, Jinming Li
The echinoderm microtubule-associated protein-like 4 and anaplastic lymphoma kinase (ALK) receptor tyrosine kinase (EML4-ALK) rearrangement is an important biomarker that plays a pivotal role in therapeutic decision making for non-small-cell lung cancer (NSCLC) patients. Ensuring accuracy and reproducibility of EML4-ALK testing by fluorescence in situ hybridization, immunohistochemistry, RT-PCR, and next-generation sequencing requires reliable reference materials for monitoring assay sensitivity and specificity...
July 18, 2017: Journal of Molecular Diagnostics: JMD
https://www.readbyqxmd.com/read/28731912/assessing-infant-and-maternal-readiness-for-newborn-discharge
#13
Ling Jing, Casidhe-Nicole Bethancourt, Thomas McDonagh
PURPOSE OF REVIEW: The review highlights the shift from prescribed length of stay (LOS) to mother-infant dyad readiness as the basis for making discharge decisions for healthy term newborns. We describe the components of readiness that should be considered in making the decision, focusing on infant clinical readiness, and maternal and familial readiness. RECENT FINDINGS: Although the Newborns' and Mothers' Health Protection Act of 1996 aimed to protect infants and mothers by establishing a minimum LOS, the American Academy of Pediatrics 2015 policy on newborn discharge acknowledges the shift from LOS-based to readiness-based discharge decision-making...
July 20, 2017: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/28731408/defining-the-biological-basis-of-radiomic-phenotypes-in-lung-cancer
#14
Patrick Grossmann, Olya Stringfield, Nehme El-Hachem, Marilyn M Bui, Emmanuel Rios Velazquez, Chintan Parmar, Ralph Th Leijenaar, Benjamin Haibe-Kains, Philippe Lambin, Robert Gillies, Hugo Jwl Aerts
Medical imaging can visualize characteristics of human cancer noninvasively. Radiomics is an emerging field that translates these medical images into quantitative data to enable phenotypic profiling of tumors. While radiomics has been associated with several clinical endpoints, the complex relationships of radiomics, clinical factors, and tumor biology are largely unknown. To this end, we analyzed two independent cohorts of respectively 262 North American and 89 European patients with lung cancer, and consistently identified previously undescribed associations between radiomic imaging features, molecular pathways, and clinical factors...
July 21, 2017: ELife
https://www.readbyqxmd.com/read/28731291/critical-questions-advancing-the-health-of-female-veterans
#15
Lisa Muirhead, Priscilla Hall, Cedrella Jones-Taylor, Gari D Clifford, Tasha Felton-Williams, Kathy Williams
PURPOSE: Women are the fastest growing Veteran population in the United States and many receive all or part of their health care outside of the Department of Veterans Affairs (VA). The purpose of this article is to review the healthcare issues of women Veterans and discuss implications for care. DATA SOURCES: Review of selected literature, VA resources and guidelines, and expert opinion. CONCLUSIONS: Few providers are aware of the impact military service has on the health of women and fail to ask the all-important question, "Have you served in the military?" Recognizing women's military service can reveal important information that can answer perplexing clinical questions, aid in designing comprehensive plans of care, and enable women to receive the assistance needed to address complex physical and psychosocial issues to improve the quality of their lives...
July 21, 2017: Journal of the American Association of Nurse Practitioners
https://www.readbyqxmd.com/read/28730951/penumbra-and-re-canalization-acute-computed-tomography-in-ischemic-stroke-evaluation-practise-study-protocol
#16
Salwa El-Tawil, Joanna Wardlaw, Ian Ford, Grant Mair, Tom Robinson, Lalit Kalra, Keith W Muir
Rationale Multimodal imaging, including computed tomography angiography and computed tomography perfusion imaging, yields additional information on intracranial vessels and brain perfusion and can differentiate between ischemic core and penumbra which may affect patient selection for intravenous thrombolysis. Hypothesis The use of multimodal imaging will increase the number of patients receiving intravenous thrombolysis and lead to better treatment outcomes. Sample size 400 patients. Methods and design PRACTISE is a prospective, multicenter, randomized, controlled trial in which patients presenting within 4...
August 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28730847/guidelines-for-the-assessment-and-diagnosis-of-patients-with-schizophrenia-spectrum-and-other-psychotic-disorders
#17
Donald Addington, Sabina Abidi, Iliana Garcia-Ortega, William G Honer, Zahinoor Ismail
OBJECTIVE: The objective of this article is to identify best practices in the diagnosis and assessment of patients with schizophrenia spectrum and other psychotic disorders. The diagnosis and assessment may occur in a range of situations from the emergency room to the outpatient clinic and at different stages of the disorder. The focus may be on acute exacerbations of illness, residual symptoms, levels of function, or changes in the response to treatment. METHODS: A systematic search was conducted for guidelines published in the last 5 years for schizophrenia and schizophrenia spectrum disorders...
January 1, 2017: Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie
https://www.readbyqxmd.com/read/28730697/impact-of-simultaneous-glutamate-dehydrogenase-gdh-and-toxin-a-b-rapid-immunoassay-on-clostridium-difficile-diagnosis-and-treatment-in-hospitalized-patients-with-antibiotic-associated-diarrhea-in-a-university-hospital-of-brazil
#18
Guilherme Grossi Lopes Cançado, Rodrigo Otávio Silveira Silva, Amanda Pontes Nader, Francisco Carlos Faria Lobato, Eduardo Garcia Vilela
BACKGROUND: Clostridium difficile is a major cause of health care-associated infection, but disagreement between diagnostic tests is an ongoing barrier to clinical decision making. Conventional enzyme immunoassay (EIA) for toxin detection is currently the most frequently used technique for CDI diagnosis, but its low sensitivity makes the development of an alternative strategy necessary for improving the diagnosis in developing countries. METHODS: Between years 2011 and 2015, 154 stool samples from patients with antibiotic-associated diarrhea were examined by toxigenic culture (TC) and EIA for the diagnosis of CDI...
July 20, 2017: Journal of Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28730671/many-faces-of-rationality-implications-of-the-great-rationality-debate-for-clinical-decision-making
#19
Benjamin Djulbegovic, Shira Elqayam
Given that more than 30% of healthcare costs are wasted on inappropriate care, suboptimal care is increasingly connected to the quality of medical decisions. It has been argued that personal decisions are the leading cause of death, and 80% of healthcare expenditures result from physicians' decisions. Therefore, improving healthcare necessitates improving medical decisions, ie, making decisions (more) rational. Drawing on writings from The Great Rationality Debate from the fields of philosophy, economics, and psychology, we identify core ingredients of rationality commonly encountered across various theoretical models...
July 20, 2017: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/28730455/does-professional-experience-save-teeth-a-survey-among-prosthodontists
#20
Shaza Bishti, Julia Lautensack, Jens C Türp, Stefan Wolfart
OBJECTIVES: The aim of this study is to investigate the effect of clinical experience and educational background on clinical decision-making of dentists presented with two prosthodontic cases. METHODS: A questionnaire-based survey was performed among 66 prosthodontists who were divided into two groups. The first group included clinicians from Belgium, Germany, and the Netherlands covering a wide spectrum of dental experience. The second (specialized) group consisted of German dentists performing their last module of a 3-year postgraduate master program in prosthodontics...
July 20, 2017: Clinical Oral Investigations
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