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Clinical decision-making

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https://www.readbyqxmd.com/read/28320053/management-of-colorectal-trauma-a-review
#1
REVIEW
Ju Yong Cheong, Anil Keshava
Traumatic colorectal injuries are common during times of military conflict, and major improvements in their care have arisen in such periods. Since World War II, many classification systems for colorectal trauma have been proposed, including (i) Flint Grading System; (ii) Penetrating Abdominal Trauma Index; (iii) Colonic/Rectal Injury Scale; and (iv) destructive/non-destructive colonic injuries. The primary goal of these classifications was to aid surgical management and, more particularly, to determine whether a primary repair or faecal diversion should be performed...
March 20, 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/28319477/emerging-techniques-in-truly-minimal-invasive-treatment-options-of-benign-prostatic-obstruction
#2
Karl-Dietrich Sievert, Thomas Kunit
PURPOSE OF REVIEW: Benign prostatic enlargement is a common age-related condition, affecting over 50% of men aged more than 60 years. Side effects of medical therapy and significant morbidity of transurethral resection of the prostate and open surgery led to the development of so-called minimally invasive procedures, with the aim to be efficient but with less morbidity and shorter or no hospitalization. For this review, a systematic literature was performed. We report recent results in different treatment options for benign prostate hypoplasia (BPH) and recommend the best minimal-invasive treatment for BPH...
March 17, 2017: Current Opinion in Urology
https://www.readbyqxmd.com/read/28319316/barriers-to-the-management-of-obstructed-defecation-according-to-colorectal-surgeons
#3
Nagham Al-Mozany, Caroline Wright, Greg O'Grady, Christopher J Young, Michael J Solomon
INTRODUCTION: Obstructive defecation (OD) has a high prevalence and disease impact, however patients often experience suboptimal management. This problem reflects the complex pathophysiology of OD, as well as health service delivery factors. This study aimed to identify factors acting as a barrier to effective OD management as perceived by specialist colorectal surgeons treating this disorder. METHOD: A postal questionnaire was administered to a bi-national sampling of colorectal specialists in Australia and New Zealand who were registered with their specialty society...
March 20, 2017: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
https://www.readbyqxmd.com/read/28318971/maternal-decision-making-during-pregnancy-parental-obligations-and-cultural-differences
#4
REVIEW
Janet Malek
Decision-making during pregnancy can be ethically complex. This paper offers a framework for maternal decision-making and clinical counseling that can be used to approach such decisions in a systematic way. Three fundamental questions are addressed: (1) Who should make decisions? (2) How should decisions be made? and (3) What is the role of the clinician? The proposed framework emphasizes the decisional authority of the pregnant woman. It draws ethical support from the concept of a good parent and the requirements of parental obligations...
February 10, 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/28318954/computed-tomography-perfusion-based-decision-making-for-acute-ischemic-stroke-missing-the-mismatch
#5
J A Molad, M Findler, E Auriel
The emerging use of mechanical thrombectomy for acute ischemic stroke treatment focuses on the importance of patient selection. Computed tomography perfusion (CTP) is one of widely used techniques. However, the accuracy and reliability of this modality is in debate among vascular neurologists. We present a case of an 80-year-old man admitted because of acute ischemic stroke. CT angiography demonstrated left proximal M2 occlusion. As CTP demonstrated signs of large ischemic core with no significant penumbra, mechanical thrombectomy was not performed following tPA administration...
March 15, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28318605/achilles-tendon-moment-arm-length-is-smaller-in-children-with-cerebral-palsy-than-in-typically-developing-children
#6
Barbara M Kalkman, Lynn Bar-On, Francesco Cenni, Constantinos N Maganaris, Alfie Bass, Gill Holmes, Kaat Desloovere, Gabor J Barton, Thomas D O'Brien
When studying muscle and whole-body function in children with cerebral palsy (CP), knowledge about both internal and external moment arms is essential since they determine the mechanical advantage of a muscle over an external force. Here we asked if Achilles tendon moment arm (MAAT) length is different in children with CP and age-matched typically developing (TD) children, and if MAAT can be predicted from anthropometric measurements. Sixteen children with CP (age: 10y 7m±3y, 7 hemiplegia, 12 diplegia, GMFCS level: I (11) and II (8)) and twenty TD children (age: 10y 6m±3y) participated in this case-control study...
March 3, 2017: Journal of Biomechanics
https://www.readbyqxmd.com/read/28318522/prognostic-stratification-and-healthcare-approach-in-patients-with-multiple-pathologies
#7
M Bernabeu-Wittel, B Barón-Franco, D Nieto-Martín, L Moreno-Gaviño, N Ramírez-Duque, M Ollero-Baturone
Polypathological patients constitute a prevalent, fairly homogeneous population, which is characterised by high clinical complexity, substantial vulnerability and significant resource consumption, in addition to high mortality and the need for comprehensive, coordinated care. It is particularly important to establish a reliable prognosis in these patients. It is also extremely useful for professionals involved in the decision-making process for patients and their families in vital planning and their preferences, for strategic health planning in management fields, and for clinical research, by facilitating their incorporation into clinical trials and other intervention studies...
March 16, 2017: Revista Clínica Española
https://www.readbyqxmd.com/read/28317578/honing-the-classification-of-high-risk-endometrial-cancer-with-inclusion-of-lymphovascular-space-invasion
#8
Sofiane Bendifallah, Morgane Perrin, Lobna Ouldamer, Vincent Lavoué, Geoffroy Canlorbe, Emilie Raimond, Delphine Hudry, Charles Coutant, Olivier Graesslin, Cyril Touboul, Pierre Collinet, Emile Daraï, Marcos Ballester
OBJECTIVES: The purpose of this study was to analyse the clinical impact of LVSI status in a large French multicentre cohort of women with high-risk ECs according to the ESMO classification. METHODS: Data of 258 women with high-risk EC who received primary surgical treatment between January 2001 and December 2012 were abstracted from prospective multicentre database. The end points were the recurrence and the lymph node metastasis (LNM) rates. Recurrence free survival (RFS) and overall survival (OS) were analyzed...
March 2017: Surgical Oncology
https://www.readbyqxmd.com/read/28316248/assessing-the-impact-of-post-traumatic-stress-symptoms-on-resting-state-function-networks-in-a-military-chronic-mild-traumatic-brain-injury-sample
#9
Dominic E Nathan, Julie F Bellgowan, Louis M French, Jonathan P Wolf, Terry Oakes, Jeannine B Mielke, Elyssa B Sham, Wei Liu, Gerard Riedy
The relationship between post traumatic stress disorder (PTSD) and chronic symptoms of mild traumatic brain injury (mTBI) is difficult to discern and poorly understood. An accurate differential diagnosis, assessment and treatment of mTBI and PTSD is challenging due to significant symptom overlap and the absence of clearly established biomarkers. The objective of this work is to examine how post traumatic stress influences task-free brain networks in chronic mTBI subjects. Control subjects (N=44) were compared with chronic mTBI subjects with low (N=58, PCLC total<30), medium (N=124, PCLC total = 31-49) and high (N=105, PCLC total ≥ 60) post traumatic stress symptoms (PTSS)...
March 19, 2017: Brain Connectivity
https://www.readbyqxmd.com/read/28315947/impact-of-18-f-fdg-pet-ct-on-surgical-management-in-patients-with-advanced-melanoma-an-outcome-based-analysis
#10
Andrea Forschner, Susann-Cathrin Olthof, Brigitte Gückel, Peter Martus, Werner Vach, Christian la Fougère, Konstantin Nikolaou, Ulrike Keim, Thomas Kurt Eigentler, Claus Garbe, Christina Pfannenberg
PURPOSE: To evaluate the influence of (18)F-FDG-PET/CT on clinical decision making and outcome in advanced melanoma patients planned for radical metastasectomy. METHODS AND MATERIALS: A cohort of 333 patients with mainly stage III/IV melanoma having a PET/CT for clinical reasons was prospectively enrolled in our oncologic PET/CT registry between 2013 and 2015. Referring physicians completed questionnaires regarding their intended management for each patient before and after PET/CT...
March 18, 2017: European Journal of Nuclear Medicine and Molecular Imaging
https://www.readbyqxmd.com/read/28315547/how-can-i-change-my-patients-treatment-decision-making-by-becoming-a-nurse-scientist-%C3%A2
#11
Tamryn F Gray
"What would you do?" I have heard this question numerous times throughout my nursing career by patients and families affected by cancer. As a pediatric blood and marrow transplantation nurse, I have often seen patients and their families wrestle with difficult treatment decisions. I have witnessed parents struggle between beginning end-of-life care for their child, or pursuing a risky but potentially life-saving clinical trial. With science driving advances in cancer treatments and patients playing more active roles in their care, uncertainty around cancer treatment decisions will only become more complicated...
April 1, 2017: Clinical Journal of Oncology Nursing
https://www.readbyqxmd.com/read/28315499/evaluation-of-the-decision-making-process-in-the-conservative-approach-to-small-testicular-masses
#12
Andrea Benelli, Virginia Varca, Lorenzo Derchi, Andrea Gregori, Giorgio Carmignani, Alchiede Simonato
INTRODUCTION: We evaluate the clinical outcome of patients treated with conservative approach for small testicular masses (STMs). We analyzed the steps who brought to the selection of the therapeutic approach: starting from clinical presentation, through imaging and lab studies. METHODS: We considered 18 patients who underwent an organ-sparing approach for STMs from 2005 until 2014. The selection criteria were dimension of the mass and absence of clinical, laboratory and/or radiological malignancy suspicion...
March 15, 2017: Urologia
https://www.readbyqxmd.com/read/28315120/prognostic-biomarkers-in-acute-coronary-syndromes-risk-stratification-beyond-cardiac-troponins
#13
REVIEW
K M Eggers, B Lindahl
PURPOSE OF REVIEW: Cardiac troponin (cTn) plays an essential role for assessment of outcome in acute coronary syndrome (ACS). However, the prognostic value of cTn is not absolute. In this mini-review, we summarize the evidence on the utility of established biomarkers of left-ventricular dysfunction, hemodynamic stress, inflammation, and renal dysfunction for risk prediction beyond cTn in ACS. RECENT FINDINGS: Only few biomarkers consistently demonstrate additive prognostic value to cTn levels...
April 2017: Current Cardiology Reports
https://www.readbyqxmd.com/read/28315113/-i-d-been-like-freaking-out-the-whole-night-exploring-emotion-regulation-based-on-junior-doctors-narratives
#14
Robert M Lundin, Kiran Bashir, Alison Bullock, Camille E Kostov, Karen L Mattick, Charlotte E Rees, Lynn V Monrouxe
The importance of emotions within medical practice is well documented. Research suggests that how clinicians deal with negative emotions can affect clinical decision-making, health service delivery, clinician well-being, attentiveness to patient care and patient satisfaction. Previous research has identified the transition from student to junior doctor (intern) as a particularly challenging time. While many studies have highlighted the presence of emotions during this transition, how junior doctors manage emotions has rarely been considered...
March 17, 2017: Advances in Health Sciences Education: Theory and Practice
https://www.readbyqxmd.com/read/28314191/robust-detection-and-segmentation-of-cell-nuclei-in-biomedical-images-based-on-a-computational-topology-framework
#15
Rodrigo Rojas-Moraleda, Wei Xiong, Niels Halama, Katja Breitkopf-Heinlein, Steven Dooley, Luis Salinas, Dieter W Heermann, Nektarios A Valous
The segmentation of cell nuclei is an important step towards the automated analysis of histological images. The presence of a large number of nuclei in whole-slide images necessitates methods that are computationally tractable in addition to being effective. In this work, a method is developed for the robust segmentation of cell nuclei in histological images based on the principles of persistent homology. More specifically, an abstract simplicial homology approach for image segmentation is established. Essentially, the approach deals with the persistence of disconnected sets in the image, thus identifying salient regions that express patterns of persistence...
March 6, 2017: Medical Image Analysis
https://www.readbyqxmd.com/read/28306230/the-evidence-based-rationale-for-physical-therapy-treatment-of-children-adolescents-and-adults-diagnosed-with-joint-hypermobility-syndrome-hypermobile-ehlers-danlos-syndrome
#16
Raoul H H Engelbert, Birgit Juul-Kristensen, Verity Pacey, Inge de Wandele, Sandy Smeenk, Nicoleta Woinarosky, Stephanie Sabo, Mark C Scheper, Leslie Russek, Jane V Simmonds
New insights into the phenotype of Joint Hypermobility Syndrome (JHS) and Ehlers-Danlos Syndrome-hypermobile type (hEDS) have raised many issues in relation to classification, diagnosis, assessment, and treatment. Within the multidisciplinary team, physical therapy plays a central role in management of individuals with hypermobility related disorders. However, many physical therapists are not familiar with the diagnostic criteria, prevalence, common clinical presentation, and management. This guideline aims to provide practitioners with the state of the art regarding the assessment and management of children, adolescents, and adults with JHS/hEDS...
March 2017: American Journal of Medical Genetics. Part C, Seminars in Medical Genetics
https://www.readbyqxmd.com/read/28304215/use-of-statistical-and-pharmacokinetic-pharmacodynamic-modeling-and-simulation-to-improve-decision-making-a-section-summary-report-of-the-trends-and-innovations-in-clinical-trial-statistics-conference
#17
Holly Kimko, Seth Berry, Michael O'Kelly, Nitin Mehrotra, Matthew Hutmacher, Venkat Sethuraman
The application of modeling and simulation (M&S) methods to improve decision-making was discussed during the Trends & Innovations in Clinical Trial Statistics Conference held in Durham, North Carolina, USA on May 1-4, 2016. Uses of both pharmacometric and statistical M&S were presented during the conference, highlighting the diversity of the methods employed by pharmacometricians and statisticians to address a broad range of quantitative issues in drug development. Five presentations are summarized herein, which cover the development strategy of employing M&S to drive decision-making; European initiatives on best practice in M&S; case studies of pharmacokinetic/pharmacodynamics modeling in regulatory decisions; estimation of exposure-response relationships in the presence of confounding; and the utility of estimating the probability of a correct decision for dose selection when prior information is limited...
February 7, 2017: Journal of Biopharmaceutical Statistics
https://www.readbyqxmd.com/read/28304099/impact-of-shoulder-sonography-on-clinical-decision-making
#18
Michael V Friedman, Travis J Hillen, David V Holland, James M Essenberg, Jennifer L Demertzis
OBJECTIVES: To assess the impact of musculoskeletal shoulder sonography (US) on clinical decision making. METHODS: This Health Insurance Portability and Accountability Act-compliant retrospective study received Institutional Review Board approval with a waiver of informed consent. Consecutive musculoskeletal shoulder US examinations ordered over a 12-month period were retrospectively reviewed. The medical records of each patient were analyzed, recording immediate pre- and post-US treatment plans...
March 17, 2017: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
https://www.readbyqxmd.com/read/28303990/diagnostic-dilemma-of-granulomatous-inflammation-in-cancer-patients
#19
Azizullah Khan Dhiloo, Aun Raza, Naseem Akhtar, Waleed Zafar, Faisal Sultan
OBJECTIVE: To determine the frequency of granulomatous inflammation on histopathological findings amongst cancer patients and correlating them with tuberculosis. METHODS: The retrospective review was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised medical records of cancer patients with a histopathological finding of granulomatous inflammation between January 2010 and December 2015. Data was reviewed, including clinical history, availability of acid fast bacilli stain on tissue and mycobacterium tuberculosis culture results...
March 2017: JPMA. the Journal of the Pakistan Medical Association
https://www.readbyqxmd.com/read/28303438/using-health-technology-assessment-to-assess-the-value-of-new-medicines-results-of-a-systematic-review-and-expert-consultation-across-eight-european-countries
#20
Aris Angelis, Ansgar Lange, Panos Kanavos
BACKGROUND: Although health technology assessment (HTA) systems base their decision making process either on economic evaluations or comparative clinical benefit assessment, a central aim of recent approaches to value measurement, including value based assessment and pricing, points towards the incorporation of supplementary evidence and criteria that capture additional dimensions of value. OBJECTIVE: To study the practices, processes and policies of value-assessment for new medicines across eight European countries and the role of HTA beyond economic evaluation and clinical benefit assessment...
March 16, 2017: European Journal of Health Economics: HEPAC: Health Economics in Prevention and Care
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