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Clinical decision-making

Kunal N Karmali, Donald M Lloyd-Jones, Joep van der Leeuw, David C Goff, Salim Yusuf, Alberto Zanchetti, Paul Glasziou, Rodney Jackson, Mark Woodward, Anthony Rodgers, Bruce C Neal, Eivind Berge, Koon Teo, Barry R Davis, John Chalmers, Carl Pepine, Kazem Rahimi, Johan Sundström
BACKGROUND: Clinical practice guidelines have traditionally recommended blood pressure treatment based primarily on blood pressure thresholds. In contrast, using predicted cardiovascular risk has been advocated as a more effective strategy to guide treatment decisions for cardiovascular disease (CVD) prevention. We aimed to compare outcomes from a blood pressure-lowering treatment strategy based on predicted cardiovascular risk with one based on systolic blood pressure (SBP) level. METHODS AND FINDINGS: We used individual participant data from the Blood Pressure Lowering Treatment Trialists' Collaboration (BPLTTC) from 1995 to 2013...
March 2018: PLoS Medicine
Megan Z Roberts, G Eric Gaskill, Julie Kanter-Washko, T Rogers Kyle, Brittany C Jones, Nicole M Bohm
Patients with sickle cell disease (SCD) experience initial and recurrent venous thromboembolism (VTE) more commonly and at a younger age than the general population, and it confers a higher mortality for patients with SCD. However, limited evidence is available to guide anticoagulant use for VTE treatment in this population. The primary objective of this study is to characterize the effectiveness and safety of direct oral anticoagulants (DOAC) and warfarin for VTE treatment among patients with SCD. This single-center retrospective study includes adult patients with SCD who were diagnosed with VTE...
March 19, 2018: Journal of Thrombosis and Thrombolysis
Timothy J Wood, Debra Pugh, Claire Touchie, James Chan, Susan Humphrey-Murto
There is an increasing focus on factors that influence the variability of rater-based judgments. First impressions are one such factor. First impressions are judgments about people that are made quickly and are based on little information. Under some circumstances, these judgments can be predictive of subsequent decisions. A concern for both examinees and test administrators is whether the relationship remains stable when the performance of the examinee changes. That is, once a first impression is formed, to what degree will an examiner be willing to modify it? The purpose of this study is to determine the degree that first impressions influence final ratings when the performance of examinees changes within the context of an objective structured clinical examination (OSCE)...
March 20, 2018: Advances in Health Sciences Education: Theory and Practice
Hiroki Nishiwaki, Takeshi Hasegawa, Megumi Shinji, Fujio Matsuo, Tsuyoshi Watanabe, Hirofumi Makino, Fumihiko Koiwa, Akira Hishida
BACKGROUND: The practice patterns of exercise restrictions for patients with chronic kidney disease have not been adequately evaluated yet; thus, we examined them using a cross-sectional design and explored the factors related with those restrictions. METHODS: The Chronic Kidney Disease Japan Cohort study was a multicentre cohort study of Japanese patients (age 20-75 years) living in Japan. We used the information in the questionnaire on the restriction of physical activities offered by physicians to the patients during enrolment...
March 19, 2018: Clinical and Experimental Nephrology
Juan Pablo Sade, Carlos Alberto Vargas Báez, Martin Greco, Carlos Humberto Martínez, Miguel Ángel Álvarez Avitia, Carlos Palazzo, Narciso Hernández Toriz, Patricia Isabel Bernal Trujillo, Diogo Assed Bastos, Fabio Augusto Schutz, Santiago Bella, Lucas Nogueira, Neal D Shore
Prostate cancer is a significant burden and cause of mortality in Latin America. This article reviews the treatment options for patients with metastatic castration-resistant prostate cancer (mCRPC) and provides consensus recommendations to assist Latin American prostate cancer specialists with clinical decision making. A multidisciplinary expert panel from Latin America reviewed the available data and their individual experience to develop clinical consensus opinions for the use of life-prolonging agents in mCRPC, with consideration given to factors influencing patient selection and treatment monitoring...
March 19, 2018: Medical Oncology
Robert Roehle, Viktoria Wieske, Georg M Schuetz, Pascal Gueret, Daniele Andreini, Willem Bob Meijboom, Gianluca Pontone, Mario Garcia, Hatem Alkadhi, Lily Honoris, Jörg Hausleiter, Nuno Bettencourt, Elke Zimmermann, Sebastian Leschka, Bernhard Gerber, Carlos Rochitte, U Joseph Schoepf, Abbas Arjmand Shabestari, Bjarne Nørgaard, Akira Sato, Juhani Knuuti, Matthijs F L Meijs, Harald Brodoefel, Shona M M Jenkins, Kristian Altern Øvrehus, Axel Cosmus Pyndt Diederichsen, Ashraf Hamdan, Bjørn Arild Halvorsen, Vladimir Mendoza Rodriguez, Yung Liang Wan, Johannes Rixe, Mehraj Sheikh, Christoph Langer, Said Ghostine, Eugenio Martuscelli, Hiroyuki Niinuma, Arthur Scholte, Konstantin Nikolaou, Geir Ulimoen, Zhaoqi Zhang, Hans Mickley, Koen Nieman, Philipp Kaufmann, Ronny Ralf Büchel, Bernhard Herzog, Melvin Clouse, David A Halon, Jonathan Leipsic, David Bush, Reda Jakamy, Kai Sun, Lin Yang, Thorsten Johnson, Jean-Pierre Laissy, Roy Marcus, Simone Muraglia, Jean-Claude Tardif, Benjamin Chow, Narinder Paul, David Maintz, John Hoe, Albert de Roos, Robert Haase, Michael Laule, Peter Schlattmann, Marc Dewey
OBJECTIVES: To analyse the implementation, applicability and accuracy of the pretest probability calculation provided by NICE clinical guideline 95 for decision making about imaging in patients with chest pain of recent onset. METHODS: The definitions for pretest probability calculation in the original Duke clinical score and the NICE guideline were compared. We also calculated the agreement and disagreement in pretest probability and the resulting imaging and management groups based on individual patient data from the Collaborative Meta-Analysis of Cardiac CT (CoMe-CCT)...
March 19, 2018: European Radiology
Matthew A Morgan, Nicholas Papanicolaou
PURPOSE: This article reviews current prostatectomy techniques and then techniques for fluoroscopic voiding cystourethrography (VCUG) evaluation of the prostate and bladder after prostatectomy. Both normal post-prostatectomy appearances and complications will be reviewed. CONCLUSION: VCUG is a useful evaluation for both common and uncommon post-prostatectomy complications and appropriate interpretation of the VCUG complications is important to aid the urologist's clinical decision making...
March 19, 2018: Abdominal Radiology
Boju Pan, Junchao Guo, Quan Liao, Yupei Zhao
Integrins are transmembrane glycoproteins that consist of an α and a β subunit. Specific integrin heterodimers preferentially bind to distinct extracellular matrix (ECM) proteins to affect the characteristics of cells or the components of the ECM. Among the different integrins, β1 and β3 integrins serve essential roles in the progression of different cancer-associated processes, including the initiation, proliferation, survival, migration and invasion. Furthermore, previous studies have revealed a ratio between these two integrins in cancer cells, which also demonstrated that the functions of these two integrins are paradoxical...
April 2018: Oncology Letters
Valérie Zimmerlé, Emeline Laurent, Valérie Tauveron, Annabel Maruani, Emmanuelle Le Bidre, Mahtab Samimi, Laurent Machet
INTRODUCTION: Cutaneous cancers are very common, easily visible on skin. The general practitioner (GP) is in the front line to manage the lesions. He has to recognize malignancy and refer most often to the specialist for excision, or consider that the lesion is benign and in ambiguous cases, offer clinical monitoring. The current low medical density in the Centre Val de Loire area makes access to general practitioners (GP) and dermatologists harder. The aim of this study was to evaluate GPs' everyday practice in cutaneous cancers screening in general, and particularly in melanoma screening, in a rural region of France...
March 16, 2018: La Presse Médicale
Vivian Isaac, Sabrina Winona Pit, Craig S McLachlan
BACKGROUND: Social isolation in medical students is a subjective experience that may influence medical career decision making. Rural self-efficacy has been shown to influence rural career intentions following a rural clinical placement, however its impact on social isolation during a rural clinical placement has not been previously modeled. The objective of this study is to explore whether self-perception of social isolation is associated with rural career intent in rural medical students...
March 20, 2018: BMC Medical Education
Marten N Basta, John E Fiadjoe, Albert S Woo, Kenneth N Peeples, Oksana A Jackson
OBJECTIVE: This study aimed to identify risk factors for adverse perioperative events (APEs) after cleft palatoplasty to develop an individualized risk assessment tool. DESIGN: Retrospective cohort. SETTING: Tertiary institutional. PATIENTS: Patients younger than 2 years with cleft palate. INTERVENTIONS: Primary Furlow palatoplasty between 2008 and 2011. MAIN OUTCOME MEASURE(S): Adverse perioperative event, defined as laryngo- or bronchospasm, accidental extubation, reintubation, obstruction, hypoxia, or unplanned intensive care unit admission...
April 2018: Cleft Palate-craniofacial Journal
Lee A Zimmer, Norberto Andaluz
Endoscopic transsphenoidal surgery for pituitary tumors is an increasingly common practice. Little has been reported on the incidence and treatment of postoperative epistaxis in this population. The aim of this study was to analyze the incidence of postoperative epistaxis and formulate a treatment algorithm based on our experience. We performed a case series with chart review. A total of 434 consecutive patients who had endoscopic transsphenoidal pituitary surgery were identified between April 2006 and November 2013...
March 2018: Ear, Nose, & Throat Journal
Alvaro Sanabria, Daniel Sánchez, Andrés Chala, Andres Alvarez
The effect on quality of life (QOL) of laryngectomy and organ preservation protocols is important in decision making. The aim of this cross-sectional study was to evaluate QOL outcomes of patients with advanced laryngeal tumors who were treated with laryngectomy or organ preservation protocols in Latin America. A total of 35 patients from three oncology units were enrolled. Patients with stage III/IV laryngeal cancer who were treated using organ preservation protocols or laryngectomy were assessed with the University of Washington QOL Questionnaire...
March 2018: Ear, Nose, & Throat Journal
Xiaosong He, Danielle S Bassett, Ganne Chaitanya, Michael R Sperling, Lauren Kozlowski, Joseph I Tracy
Temporal lobe epilepsy tends to reshape the language system causing maladaptive reorganization that can be characterized by task-based functional MRI, and eventually can contribute to surgical decision making processes. However, the dynamic interacting nature of the brain as a complex system is often neglected, with many studies treating the language system as a static monolithic structure. Here, we demonstrate that as a specialized and integrated system, the language network is inherently dynamic, characterized by rich patterns of regional interactions, whose transient dynamics are disrupted in patients with temporal lobe epilepsy...
March 15, 2018: Brain: a Journal of Neurology
Vincent Auffret, Yves Cottin, Guillaume Leurent, Martine Gilard, Jean-Claude Beer, Amer Zabalawi, Frédéric Chagué, Emanuelle Filippi, Damien Brunet, Jean-Philippe Hacot, Philippe Brunel, Mourad Mejri, Luc Lorgis, Gilles Rouault, Philippes Druelles, Jean-Christophe Cornily, Romain Didier, Emilie Bot, Bertrand Boulanger, Isabelle Coudert, Aurélie Loirat, Marc Bedossa, Dominique Boulmier, Maud Maza, Marielle Le Guellec, Rishi Puri, Marianne Zeller, Hervé Le Breton
Aims: To derive and validate a readily useable risk score to identify patients at high-risk of in-hospital ST-segment elevation myocardial infarction (STEMI)-related cardiogenic shock (CS). Methods and results: In all, 6838 patients without CS on admission and treated by primary percutaneous coronary intervention (pPCI), included in the Observatoire Régional Breton sur l'Infarctus (ORBI), served as a derivation cohort, and 2208 patients included in the obseRvatoire des Infarctus de Côte-d'Or (RICO) constituted the external validation cohort...
March 15, 2018: European Heart Journal
Elliott Mark Weiss, Dawei Xie, Noah Cook, Katherine Coughlin, Steven Joffe
Importance: Little is known about how characteristics of particular clinical decisions influence decision-making preferences by patients or their surrogates. A better understanding of the factors underlying preferences is essential to improve the quality of shared decision making. Objective: To identify the characteristics of particular decisions that are associated with parents' preferences for family- vs medical team-centered decision making across the spectrum of clinical decisions that arise in the neonatal intensive care unit (NICU)...
March 19, 2018: JAMA Pediatrics
Jacqueline Cloos, Jeffrey R Harris, Jeroen J W M Janssen, Angele Kelder, F Huang, Gerrit Sijm, Maike Vonk, Alexander N Snel, Jennifer R Scheick, Willemijn J Scholten, Jannemieke Carbaat-Ham, Dennis Veldhuizen, Diana Hanekamp, Yvonne J M Oussoren-Brockhoff, Gertjan J L Kaspers, Gerrit J Schuurhuis, A Kate Sasser, Gert Ossenkoppele
Response criteria in acute myeloid leukemia (AML) has recently been re-established, with morphologic examination utilized to determine whether patients have achieved complete remission (CR). Approximately half of the adult patients who entered CR will relapse within 12 months due to the outgrowth of residual AML cells in the bone marrow. The quantitation of these remaining leukemia cells, known as minimal or measurable residual disease (MRD), can be a robust biomarker for the prediction of these relapses. Moreover, retrospective analysis of several studies has shown that the presence of MRD in the bone marrow of AML patients correlates with poor survival...
March 5, 2018: Journal of Visualized Experiments: JoVE
Shaden Jobran, Randa Kattan, Jamal Shamaa, Hiyam Marzouqa, Musa Hindiyeh
BACKGROUND: Human adenoviruses have an important role in paediatric respiratory tract infections. They are estimated to cause 2-5% of the overall respiratory tract infections and 4-10% of all pneumonias. The aim of this study was to evaluate the clinical presentation and effect of adenoviral infection on the management of infected infants. METHODS: Data were collected from the medical records of patients infected with adenovirus and admitted to Caritas Baby Hospital...
February 21, 2018: Lancet
Nikhil Satchidanand, Timothy J Servoss, Ranjit Singh, Angela M Bosinski, Penny Tirpak, Linda L Horton, Bruce J Naughton
BACKGROUND: Early, data-driven discussion surrounding palliative care can improve care delivery and patient experience. OBJECTIVE: To develop a 30-day mortality prediction tool for older patients in intensive care unit (ICU) with pneumonia that will initiate palliative care earlier in hospital course. DESIGN: Retrospective Electronic Health Record (EHR) review. SETTING: Four urban and suburban hospitals in a Western New York hospital system...
January 1, 2018: American Journal of Hospice & Palliative Care
Jun-Hua Zhang, You-Ping Li, Bo-Li Zhang
The introduction and popularization of evidence-based medicine has opened up a new research field of clinical efficacy evaluation of traditional Chinese medicine(TCM), produced new research ideas and methods, and promoted the progress of clinical research of TCM. After about 20 years assiduous study and earnest practice, the evidence based evaluation method and technique, which conforms to the characteristics of TCM theory and practice, has been developing continuously. Evidence-based Chinese medicine (EBCM) has gradually formed and become an important branch of evidence-based medicine...
January 2018: Zhongguo Zhong Yao za Zhi, Zhongguo Zhongyao Zazhi, China Journal of Chinese Materia Medica
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