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Clinical decision

Michelle T Nguyen, Laurence B McCullough, Frank A Chervenak
In obstetric practice, each pregnant woman presents with a composite of maternal and fetal characteristics that can alter the risk of significant harm without cesarean intervention. The hospital's availability of resources and the obstetrician's training, experience, and skill level can also alter the risk of significant harm without cesarean intervention. This paper proposes a clinical ethical framework that takes these clinical and organizational factors into account, to promote a deliberative rather than simplistic approach to decision-making and counseling about cesarean delivery...
October 25, 2016: Journal of Perinatal Medicine
Loes A M Leenen, Ben F M Wijnen, Reina J A de Kinderen, Caroline M van Heugten, Silvia M A A Evers, Marian H J M Majoie
INTRODUCTION: Self-management for people with epilepsy (PWE) should lead to shared decision-making and thus to adherence to the treatment plan. eHealth is an important way of supporting PWE in their self-management. METHOD: In this survey, we used a mixed method to explore the following: 1) which factors were monitored by PWE and how (using pen and paper or eHealth-tools), 2) how many PWE own a computer or smartphone, and 3) how do they perceive the use of eHealth...
October 22, 2016: Epilepsy & Behavior: E&B
Jan M Sargeant, Annette M O'Connor
Meta-analysis, the statistical combination of results from multiple studies, can be used to summarize all of the available research on an intervention, etiology, descriptive, or diagnostic test accuracy question. Meta-analysis should be conducted as a component of a systematic review, to increase transparency in the selection of studies and to incorporate an evaluation of the risk of bias in the individual studies included in the meta-analysis. The process of meta-analysis may include a forest plot to graphically display the study results and the calculation of a weighted average summary effect size...
October 2016: Microbiology Spectrum
Kyle Mock, Jessica Keeley, Ashkan Moazzez, David S Plurad, Brant Putnam, Dennis Y Kim
The population of the United States is predicted to age dramatically over the next few decades; as such older patients will comprise an increasing proportion of the injured populations. Due to multiple comorbidities and frailty, the old and very old are at greater risk for mortality than younger patients. To identify predictors of inhospital mortality in these patients, we performed a retrospective cohort study at our Level 1 trauma center. Between April 2009 and October 2014, we identified 193 trauma patients aged 80 years and older admitted to the intensive care unit...
October 2016: American Surgeon
Amanda Elton, Christopher T Smith, Michael H Parrish, Charlotte A Boettiger
Excessively choosing immediate over larger future rewards, or delay discounting (DD), associates with multiple clinical conditions. Individual differences in DD likely depend on variations in the activation of and functional interactions between networks, representing possible endophenotypes for associated disorders, including alcohol use disorders. Numerous fMRI studies have probed the neural bases of DD, but investigations of large-scale networks remain scant. We addressed this gap by testing whether activation within large-scale networks during Now/Later decision-making predicts individual differences in DD...
October 25, 2016: Journal of Cognitive Neuroscience
Yenupini Joyce Adams, Manfred Stommel, Adejoke Ayoola, Mildred Horodynski, Address Malata, Barbara Smith
PURPOSE: The purpose of this study was to examine women's evaluation of postpartum care services (postpartum clinical assessments, health education, and midwife kindness) received from midwives prior to discharge in rural health facilities, and to examine husband-and-wife-farmer dyads' reasons for their decisions to return or not return for 1-week postpartum care visits in rural central Malawi. DESIGN: Cross-sectional matched-pairs survey design. METHODS: Participants included a convenience sample of 70 husband-and-wife-farmer dyads living in rural communities who had a live birth in the past year at one of four health facilities in Ntcheu district, central Malawi...
October 25, 2016: Journal of Nursing Scholarship
Magdalena Zaborowska, Jonatan Tillander, Rickard Brånemark, Lars Hagberg, Peter Thomsen, Margarita Trobos
Staphylococci and enterococci account for most deep infections associated with bone-anchored percutaneous implants for amputation treatment. Implant-associated infections are difficult to treat; therefore, it is important to investigate if these infections have a biofilm origin and to determine the biofilm antimicrobial susceptibility to improve treatment strategies. The aims were: (i) to test a novel combination of the Calgary biofilm device and a custom-made susceptibility MIC plate (Sensititre(®) ), (ii) to determine the biofilm formation and antimicrobial resistance in clinical isolates causing implant-associated osteomyelitis, and (iii) to describe the associated clinical outcome...
October 25, 2016: Journal of Biomedical Materials Research. Part B, Applied Biomaterials
Wafa Skalli, Claudio Vergari, Eric Ebermeyer, Isabelle Courtois, Xavier Drevelle, Remi Kohler, Kariman Abelin-Genevois, Jean Dubousset
STUDY DESIGN: Early detection of progressive adolescent idiopathic scoliosis (AIS) was assessed based on 3D quantification of the deformity. OBJECTIVE: Based on 3D quantitative description of scoliosis curves, the aim is to assess a specific phenotype that could be an early detectable severity index for progressive AIS. SUMMARY OF BACKGROUND DATA: Early detection of progressive scoliosis is important for adapted treatment to limit progression...
October 24, 2016: Spine
Da Hae Lee, Bart Keymeulen, Robert Hilbrands, Zhidong Ling, Ursule Van de Velde, Daniel Jacobs-Tulleneers-Thevissen, Geert Maleux, Bruno Lapauw, Laurent Crenier, Christophe De Block, Chantal Mathieu, Daniel Pipeleers, Pieter Gillard
BACKGROUND: Induction therapy with a T cell depleting agent followed by mycophenolate mofetil (MMF) and tacrolimus (Tac) is presently the most frequently used immune suppression (IS) regimen in islet transplantation. This study assesses its safety and tolerability in nonuremic type 1 diabetic recipients. METHODS: Fifty-one patients (ages between 29-63 years) with high glycemic variability and problematic hypoglycemia received intraportal islet grafts under anti-thymocyte globulin (ATG)-MMF-Tac protocol...
October 25, 2016: Transplantation
Yoon Soo Park, Matthew Lineberry, Abbas Hyderi, Georges Bordage, Kuan Xing, Rachel Yudkowsky
PURPOSE: Medical schools administer locally developed graduation competency examinations (GCEs) following the structure of the United States Medical Licensing Examination Step 2 Clinical Skills that combine standardized patient (SP)-based physical examination and the patient note (PN) to create integrated clinical encounter (ICE) scores. This study examines how different subcomponent scoring weights in a locally developed GCE affect composite score reliability and pass-fail decisions for ICE scores, contributing to internal structure and consequential validity evidence...
November 2016: Academic Medicine: Journal of the Association of American Medical Colleges
Prateek Prasanna, Jay Patel, Sasan Partovi, Anant Madabhushi, Pallavi Tiwari
OBJECTIVE: Despite 90 % of glioblastoma (GBM) recurrences occurring in the peritumoral brain zone (PBZ), its contribution in patient survival is poorly understood. The current study leverages computerized texture (i.e. radiomic) analysis to evaluate the efficacy of PBZ features from pre-operative MRI in predicting long- (>18 months) versus short-term (<7 months) survival in GBM. METHODS: Sixty-five patient examinations (29 short-term, 36 long-term) with gadolinium-contrast T1w, FLAIR and T2w sequences from the Cancer Imaging Archive were employed...
October 24, 2016: European Radiology
Kun Zhong, Wei Wang, Chuanbao Zhang, Falin He, Shuai Yuan, Zhiguo Wang
BACKGROUND: Clinical laboratory tests are important for clinicians to make diagnostic decisions, but discrepancies may directly lead to incorrect diagnosis. We would like to introduce some statistical methods to evaluate the comparability of chemistry analytes while comparing the performances of different measurement systems. METHODS: We used a panel of 10 fresh-frozen single donation serum samples to assess assays for the measurement of glucose and other 13 analytes...
2016: SpringerPlus
Naser Aslanabadi, Samad Ghaffari, Naser Khezerlouy Aghdam, Masoumeh Ahmadzade, Babak Kazemi, Babak Nasiri, Ahmad Separham, Bahram Sohrabi, Mohamadreza Taban, Arash Aslanabadi
Introduction: Atrial fibrillation (AF) is the most common arrhythmia in patients with mitral stenosis (MS) and it may increase complications and decreases success rates of percutaneous balloon mitral valvotomy (PBMV). This study aimed to investigate the short and long term results of PBMV in patients with AF compared to sinus rhythm (SR). Methods: In this cross sectional study, 1000 patients with MS who had undergone PBMV between 1999 and 2013 were enrolled including 585 and 415 patients with AF and SR respectively...
2016: Journal of Cardiovascular and Thoracic Research
Karsten A van Loon, Pim W Teunissen, Erik W Driessen, Fedde Scheele
BACKGROUND : Entrustable professional activities (EPAs) seek to translate essential physician competencies into clinical practice. Until now, it is not known whether EPA-based curricula offer enhanced assessment and feedback to trainees. OBJECTIVE : This study examined program directors' and senior residents' justifications for entrustment decisions and what role generic, cross-specialty competencies (such as communication skills, collaboration, and understanding health care systems) play in these decisions...
October 2016: Journal of Graduate Medical Education
D Costa Santos, F Barros, M Frazão, M Maia
Face burns expose patients to a higher respiratory risk, and early prophylactic intubation before they enter the burn unit might be life-saving. However, unnecessary intubation may compromise their clinical evolution. Hence, the decision to perform pre-burn centre endotracheal intubation remains a clinical challenge. A retrospective study was developed to characterize the experience of the tertiary burn unit of the Hospital da Prelada with face burn patients arriving endotracheally-intubated between January 2009 and September 2013...
December 31, 2015: Annals of Burns and Fire Disasters
Kendra Johnson, Lukasz Mazur, Janet Chadwick, Pegah Pooya, Alison Amos, John McCreery
PURPOSE: To explore how Lean can add value during the schematic phase of design through providing additional resources and support to project leadership and the architectural design team. BACKGROUND: This case study-based research took place at one large academic hospital during design efforts of surgical tower to house 19 operating rooms (ORs) and support spaces including pre- and post-op, central processing and distribution, and materials management. Surgical services project leadership asked for Lean practitioners' support during the design process...
October 24, 2016: HERD
Bobby Yanagawa, Gosta B Pettersson, Gilbert Habib, Marc Ruel, Gustavo Saposnik, David A Latter, Subodh Verma
There has been an overall improvement in surgical mortality for patients with infective endocarditis (IE), presumably because of improved diagnosis and management, centered around a more aggressive early surgical approach. Surgery is currently performed in approximately half of all cases of IE. Improved survival in surgery-treated patients is correlated with a reduction in heart failure and the prevention of embolic sequelae. It is reported that between 20% and 40% of patients with IE present with stroke or other neurological conditions...
October 25, 2016: Circulation
Paul Kurlansky, Morley Herbert, Syma Prince, Michael Mack
BACKGROUND: Multiple studies have compared coronary artery bypass graft (CABG) with percutaneous coronary interventions (PCI) for coronary revascularization. There is considerable evidence that adherence to medical therapy can affect the outcomes of therapeutic interventions. However, the long-term influence of compliance with recommended medical therapy on the comparative outcomes of CABG versus PCI remains to be defined. METHODS: All non-ST-segment-elevation myocardial infarction patients undergoing coronary revascularization in an 8-hospital network were followed for up to 8 years to determine medication history and major adverse cardiac events: all-cause mortality, nonfatal myocardial infarction, and reintervention...
October 25, 2016: Circulation
T Schmitz
OBJECTIVE: To evaluate short- and long-term benefits and risks associated with antenatal administration of a single course of corticosteroids and the related strategies: multiple and rescue courses. METHODS: The PubMed database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted. RESULTS: Antenatal administration of a single course of corticosteroids before 34 weeks of gestation is associated in the neonatal period with a significant reduction of respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC) and death (LE1), and in possibly childhood with a reduction of cerebral palsy and increased psychomotor development index and intact survival (LE3)...
October 21, 2016: Journal de Gynécologie, Obstétrique et Biologie de la Reproduction
Marlies Decleer, Andreja Rajkovic, Benedikt Sas, Annemieke Madder, Sarah De Saeger
Rapid and accurate UPLC-MS/MS methods for the simultaneous determination of beauvericin and the related enniatins (A, A1, B, B1), together with cereulide were successfully developed and validated in cereal and cereal-based food matrices such as wheat, maize, rice and pasta. Although these emerging foodborne toxins are of different microbial origin, the similar structural, toxicological and food safety features provided rationale for their concurrent detection in relevant food matrices. A Waters Acquity UPLC system coupled to a Waters Quattro Premier XE™ Mass Spectrometer operating in ESI+ mode was employed...
October 4, 2016: Journal of Chromatography. A
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