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https://www.readbyqxmd.com/read/28225695/how-should-therapeutic-decisions-about-expensive-drugs-be-made-in-imperfect-environments
#1
Leonard M Fleck, Marion Danis
Clinicians must inevitably make therapeutic decisions under nonideal conditions. They practice in circumstances that involve incomplete evidence. They deliver care in health care systems that are complex and poorly coordinated. Each of the patients that they take care of is unique while research offers evidence regarding relatively homogeneous populations of patients. Under these circumstances, many parties-medical scientists, reviewing agencies, insurers, and accountable care organizations-can and should contribute to optimizing the development, approval, funding, and prescription of therapies-particularly expensive and marginally beneficial therapies...
February 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28223290/nephrologists-perspectives-on-defining-and-applying-patient-centered-outcomes-in-hemodialysis
#2
Allison Tong, Wolfgang C Winkelmayer, David C Wheeler, Wim van Biesen, Peter Tugwell, Braden Manns, Brenda Hemmelgarn, Tess Harris, Sally Crowe, Angela Ju, Emma O'Lone, Nicole Evangelidis, Jonathan C Craig
BACKGROUND AND OBJECTIVES: Patient centeredness is widely advocated as a cornerstone of health care, but it is yet to be fully realized, including in nephrology. Our study aims to describe nephrologists' perspectives on defining and implementing patient-centered outcomes in hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Face-to-face, semistructured interviews were conducted with 58 nephrologists from 27 dialysis units across nine countries, including the United States, the United Kingdom, Australia, Austria, Belgium, Canada, Germany, Singapore, and New Zealand...
February 21, 2017: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/28222363/very-short-term-reactive-forecasting-of-the-solar-ultraviolet-index-using-an-extreme-learning-machine-integrated-with-the-solar-zenith-angle
#3
Ravinesh C Deo, Nathan Downs, Alfio V Parisi, Jan F Adamowski, John M Quilty
Exposure to erythemally-effective solar ultraviolet radiation (UVR) that contributes to malignant keratinocyte cancers and associated health-risk is best mitigated through innovative decision-support systems, with global solar UV index (UVI) forecast necessary to inform real-time sun-protection behaviour recommendations. It follows that the UVI forecasting models are useful tools for such decision-making. In this study, a model for computationally-efficient data-driven forecasting of diffuse and global very short-term reactive (VSTR) (10-min lead-time) UVI, enhanced by drawing on the solar zenith angle (θs) data, was developed using an extreme learning machine (ELM) algorithm...
February 18, 2017: Environmental Research
https://www.readbyqxmd.com/read/28221338/pathways-towards-instability-in-financial-networks
#4
Marco Bardoscia, Stefano Battiston, Fabio Caccioli, Guido Caldarelli
Following the financial crisis of 2007-2008, a deep analogy between the origins of instability in financial systems and complex ecosystems has been pointed out: in both cases, topological features of network structures influence how easily distress can spread within the system. However, in financial network models, the details of how financial institutions interact typically play a decisive role, and a general understanding of precisely how network topology creates instability remains lacking. Here we show how processes that are widely believed to stabilize the financial system, that is, market integration and diversification, can actually drive it towards instability, as they contribute to create cyclical structures which tend to amplify financial distress, thereby undermining systemic stability and making large crises more likely...
February 21, 2017: Nature Communications
https://www.readbyqxmd.com/read/28220485/epidemiology-of-basal-cell-carcinoma-scholarly-review
#5
REVIEW
J A C Verkouteren, K H R Ramdas, M Wakkee, T Nijsten
Basal cell carcinoma (BCC) is the most common cancer in white-skinned individuals with increasing incidence rates worldwide. Patients with BCC place a large burden on healthcare systems, because of the high incidence and the increased risk of synchronous and metachronous BCCs and other ultraviolet radiation (UVR) related skin cancers (i.e. field cancerization). As a result, the disability-adjusted life years and healthcare costs have risen significantly in recent decades. BCC is a complex disease, in which the interplay between UVR, phenotype (UVR-sensitive) and genotype (somatic mutations and germline mutations/polymorphisms) fulfils a key role in the aetiopathogenesis...
February 20, 2017: British Journal of Dermatology
https://www.readbyqxmd.com/read/28212969/lessons-learned-when-introducing-pharmacogenomic-panel-testing-into-clinical-practice
#6
Marc B Rosenman, Brian Decker, Kenneth D Levy, Ann M Holmes, Victoria M Pratt, Michael T Eadon
OBJECTIVES: Implementing new programs to support precision medicine in clinical settings is a complex endeavor. We describe challenges and potential solutions based on the Indiana GENomics Implementation: an Opportunity for the Underserved (INGenious) program at Eskenazi Health-one of six sites supported by the Implementing GeNomics In pracTicE network grant of the National Institutes of Health/National Human Genome Research Institute. INGenious is an implementation of a panel of genomic tests...
January 2017: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
https://www.readbyqxmd.com/read/28212642/beyond-cultural-stereotyping-views-on-end-of-life-decision-making-among-religious-and-secular-persons-in-the-usa-germany-and-israel
#7
Mark Schweda, Silke Schicktanz, Aviad Raz, Anita Silvers
BACKGROUND: End-of-life decision making constitutes a major challenge for bioethical deliberation and political governance in modern democracies: On the one hand, it touches upon fundamental convictions about life, death, and the human condition. On the other, it is deeply rooted in religious traditions and historical experiences and thus shows great socio-cultural diversity. The bioethical discussion of such cultural issues oscillates between liberal individualism and cultural stereotyping...
February 17, 2017: BMC Medical Ethics
https://www.readbyqxmd.com/read/28210563/neoadjuvant-therapy-for-treatment-of-breast-cancer-the-way-forward-or-simply-a-convenient-option-for-patients
#8
COMMENT
Abhishek Chatterjee, John K Erban
The complexity of managing early stage breast cancer is well known. Optimal treatment is increasingly multidisciplinary and in the modern era informed by sophisticated molecular tools to help select and guide therapy. Major phase III trials have determined that the order of systemic therapy relative to surgery does not influence important endpoints such as event free survival and overall survival (OS), but questions remain as to how best to utilize these most essential services. For example, there is still uncertainty regarding the ideal timing, intensity, and duration of proposed therapy...
February 2017: Gland Surgery
https://www.readbyqxmd.com/read/28195556/how-neuroscience-can-inform-the-study-of-individual-differences-in-cognitive-abilities
#9
Dennis J McFarland
Theories of human mental abilities should be consistent with what is known in neuroscience. Currently, tests of human mental abilities are modeled by cognitive constructs such as attention, working memory, and speed of information processing. These constructs are in turn related to a single general ability. However, brains are very complex systems and whether most of the variability between the operations of different brains can be ascribed to a single factor is questionable. Research in neuroscience suggests that psychological processes such as perception, attention, decision, and executive control are emergent properties of interacting distributed networks...
February 14, 2017: Reviews in the Neurosciences
https://www.readbyqxmd.com/read/28187896/hydra-a-web-based-system-for-cardiovascular-analysis-diagnosis-and-treatment
#10
J Novo, A Hermida, M Ortega, N Barreira, M G Penedo, J E López, C Calvo
BACKGROUND AND OBJECTIVE: Cardiovascular (CV) risk stratification is a highly complex process involving an extensive set of clinical trials to support the clinical decision-making process. There are many clinical conditions (e.g. diabetes, obesity, stress, etc.) that can lead to the early diagnosis or establishment of cardiovascular disease. In order to determine all these clinical conditions, a complete set of clinical patient analyses is typically performed, including a physical examination, blood analysis, electrocardiogram, blood pressure (BP) analysis, etc...
February 2017: Computer Methods and Programs in Biomedicine
https://www.readbyqxmd.com/read/28187885/automated-characterization-and-counting-of-ki-67-protein-for-breast-cancer-prognosis-a-quantitative-immunohistochemistry-approach
#11
Tushar Mungle, Suman Tewary, Indu Arun, Bijan Basak, Sanjit Agarwal, Rosina Ahmed, Sanjoy Chatterjee, Asok Kumar Maity, Chandan Chakraborty
Ki-67 protein expression plays an important role in predicting the proliferative status of tumour cells and deciding the future course of therapy in breast cancer. Immunohistochemical (IHC) determination of Ki-67 score or labelling index, by estimating the fraction of Ki67 positively stained tumour cells, is the most widely practiced method to assess tumour proliferation (Dowsett et al. 2011). Accurate manual counting of these cells (specifically nuclei) due to complex and dense distribution of cells, therefore, becomes critical and presents a major challenge to pathologists...
February 2017: Computer Methods and Programs in Biomedicine
https://www.readbyqxmd.com/read/28187165/the-influence-of-resilience-based-management-on-coral-reef-monitoring-a-systematic-review
#12
Vivian Y Y Lam, Christopher Doropoulos, Peter J Mumby
With rapid changes taking place on coral reefs, managers and scientists are faced with prioritising interventions that might avoid undesirable losses in ecosystem health. The property of resilience captures how reefs react and respond to stressors and environmental changes. Therefore, in principle, management goals are more likely to be realised if resilience theory is used to inform decision making and help set realistic expectations for reef outcomes. Indeed, a new approach to reef management has been termed 'resilience-based management' (RBM)...
2017: PloS One
https://www.readbyqxmd.com/read/28186050/a-survey-of-standard-information-models-for-clinical-decision-support-systems
#13
Seyed Ali Mussavi Rizi, Abdul Roudsari
HL7 CDA, vMR, and openEHR archetypes have been utilized as standard information models for clinical decision support systems. Compared to openEHR archetypes, vMR typically requires less time to develop and extend which makes it a good fit for rapid prototyping and pilot projects, while openEHR archetypes handle the data and semantic specification better. Using CDA for clinical decision support systems is discouraged due to its complexity, steep learning curve, and potential safety issues.
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/28185581/does-decentralization-influence-efficiency-of-health-units-a-study-of-opinion-and-perception-of-health-workers-in-odisha
#14
Bhuputra Panda, Harshad P Thakur, Sanjay P Zodpey
BACKGROUND: Health systems in low and middle income countries are struggling to improve efficiency in the functioning of health units of which workforce is one of the most critical building blocks. In India, Rogi Kalyan Samiti (RKS) was established at every health unit as institutions of local decision making in order to improve productive efficiency and quality. Measuring efficiency of health units is a complex task. This study aimed at assessing the perception (opinion and satisfaction) of health workers about influence of RKS on improving efficiency of peripheral decision making health units (DMHU); examining differences between priority and non-priority set-ups; identifying predictors of satisfaction at work; and discussing suggestions to improve performance...
October 31, 2016: BMC Health Services Research
https://www.readbyqxmd.com/read/28182618/the-evolving-landscape-of-hiv-drug-resistance-diagnostics-for-expanding-testing-in-resource-limited-settings
#15
Seth C Inzaule, Raph L Hamers, Roger Paredes, Chunfu Yang, Rob Schuurman, Tobias F Rinke de Wit
Global scale-up of antiretroviral treatment (ART) has dramatically changed the prospects of HIV/AIDS disease rendering life-long chronic care and treatment a reality for millions of HIV-infected patients. Affordable technologies to monitor ART are needed to ensure long-term durability of limited available drug regimens. HIV drug resistance tests can complement existing strategies in optimizing clinical decision-making for patients with treatment failure, in addition to facilitating population-based surveillance of HIV drug resistance...
February 9, 2017: AIDS Reviews
https://www.readbyqxmd.com/read/28176529/biosimilars
#16
James G Stevenson, Robert Popovian, Ira Jacobs, Susan Hurst, Lesley G Shane
OBJECTIVE: To review the scientific and regulatory aspects of biosimilar development and practical considerations for the use of biosimilars that are relevant to pharmacists. DATA SOURCES: Literature searches of PubMed and congress abstracts for publications pertaining to biosimilars were conducted from January 2016 to January 2017. Individual drug company web pages and governmental, regulatory, and other agency websites were also reviewed. STUDY SELECTION/DATA EXTRACTION: Published articles, regulatory guidelines, and other sources covering biologic/biosimilar development and approval, reporting results of biosimilar studies or survey research, and/or identifying biosimilars in development or approved for use in Europe or the United States were reviewed and included...
February 1, 2017: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/28165024/cell-fate-decisions-emerge-as-phages-cooperate-or-compete-inside-their-host
#17
Jimmy T Trinh, Tamás Székely, Qiuyan Shao, Gábor Balázsi, Lanying Zeng
The system of the bacterium Escherichia coli and its virus, bacteriophage lambda, is paradigmatic for gene regulation in cell-fate development, yet insight about its mechanisms and complexities are limited due to insufficient resolution of study. Here we develop a 4-colour fluorescence reporter system at the single-virus level, combined with computational models to unravel both the interactions between phages and how individual phages determine cellular fates. We find that phages cooperate during lysogenization, compete among each other during lysis, and that confusion between the two pathways occasionally occurs...
February 6, 2017: Nature Communications
https://www.readbyqxmd.com/read/28162822/doses-per-vaccine-vial-container-an-understated-and-underestimated-driver-of-performance-that-needs-more-evidence
#18
REVIEW
Alexis Heaton, Kirstin Krudwig, Tina Lorenson, Craig Burgess, Andrew Cunningham, Robert Steinglass
The widespread use of multidose vaccine containers in low and middle income countries' immunization programs is assumed to have multiple benefits and efficiencies for health systems, yet the broader impacts on immunization coverage, costs, and safety are not well understood. To document what is known on this topic, how it has been studied, and confirm the gaps in evidence that allow us to assess the complex system interactions, the authors undertook a review of published literature that explored the relationship between doses per container and immunization systems...
February 2, 2017: Vaccine
https://www.readbyqxmd.com/read/28152900/hardwiring-advance-directives-into-an-electronic-medical-record
#19
Tyler Buckley, Andrew Badke, Amy Horyna, Julie Howell, Lisa Gren, Anna Catherine Beck
: 146 Background: Patient preference at the end of life has been extensively researched and documented. Advance Directives (AD) have been shown to make a difference for patients in the areas of quality, cost, and patient satisfaction. Organizations struggle with meeting federal laws and accreditation expectations due to our complex systems. Literature supports "hardwiring" AD documentation into the EMR and providing "one click" accessibility to AD's. Changing EMR vendors provides a unique opportunity to optimize access to AD's, both through patient education /endorsement, review of providers' role, and engagement of IT...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152826/patient-and-clinician-perspectives-on-treatment-decision-making-for-african-american-men-with-prostate-cancer
#20
Sarah Abramson, Daniel Walker, Lindsey Sova, Jenny J Lin, Kezhen Fei, Rebeca Franco, Ann Scheck McAlearney
: 186 Background: Prostate cancer is the most common cancer for men in the US, yet the burden of this disease falls disproportionately on African Americans (AAs). The disparity's etiology is complex. Surgery and radiotherapy offer similar survival but historically have different rates of performance with younger and white men more likely to undergo surgery and AAs more likely to experience underuse. This study aims to examine treatment decision-making (TDM) processes for AA men from patient and physician perspectives...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
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