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Integrated clinical prediction rule

Alberto Dolci, Davide Giavarina, Sara Pasqualetti, Dominika Szőke, Mauro Panteghini
During the past decades the healthcare systems have rapidly changed and today hospital care is primarily advocated for critical patients and acute treatments, for which laboratory test results are crucial and need to be always reported in predictably short turnaround time (TAT). Laboratories in the hospital setting can face this challenge by changing their organization from a compartmentalized laboratory department toward a decision making-based laboratory department. This requires the implementation of a core laboratory, that exploits total laboratory automation (TLA) using technological innovation in analytical platforms, track systems and information technology, including middleware, and a number of satellite specialized laboratory sections cooperating with care teams for specific medical conditions...
April 5, 2017: Clinical Biochemistry
David A Feldstein, Rachel Hess, Thomas McGinn, Rebecca G Mishuris, Lauren McCullagh, Paul D Smith, Michael Flynn, Joseph Palmisano, Gheorghe Doros, Devin Mann
BACKGROUND: Clinical prediction rules (CPRs) represent a method of determining individual patient risk to help providers make more accurate decisions at the point of care. Well-validated CPRs are underutilized but may decrease antibiotic overuse for acute respiratory infections. The integrated clinical prediction rules (iCPR) study builds on a previous single clinic study to integrate two CPRs into the electronic health record and assess their impact on practice. This article discusses study design and implementation of a multicenter cluster randomized control trial of the iCPR clinical decision support system, including the tool adaptation, usability testing, staff training, and implementation study to disseminate iCPR at multiple clinical sites across two health care systems...
March 14, 2017: Implementation Science: IS
Shameek Ghosh, Hung Nguyen, Jinyan Li
Critical ICU events like acute hypotension and septic shock are dangerous complications, leading to multiple organ failures and eventual death. Previously, pattern mining algorithms have been employed for extracting interesting rules in various clinical domains. However, the extracted rules are directly investigated by clinicians for diagnosing a disease. Towards this purpose, there is a need to develop advanced prediction models which integrate dynamic patterns to learn a patient's physiological condition...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Clemens Heiser, Benedikt Hofauer
Obstructive sleep apnea is one of the most common diseases in Western industrialized countries. A variety of conservative and surgical treatment options are available for its treatment. In recent years, selective upper airway stimulation (sUAS) has been shown to be effective and safe. Different biomarkers have been investigated as predictive clinical success factors in a number of clinical trials. Age does not matter in sUAS, as compared to its predictive role in other therapies. Weight seems to play a limited role, depending on drug-induced sleep endoscopy to rule out a complete concentric collapse with an increased body mass index...
2017: ORL; Journal for Oto-rhino-laryngology and its related Specialties
Shameek Ghosh, Hung Nguyen, Jinyan Li, Shameek Ghosh, Hung Nguyen, Jinyan Li, Shameek Ghosh, Hung Nguyen, Jinyan Li
Critical ICU events like acute hypotension and septic shock are dangerous complications, leading to multiple organ failures and eventual death. Previously, pattern mining algorithms have been employed for extracting interesting rules in various clinical domains. However, the extracted rules are directly investigated by clinicians for diagnosing a disease. Towards this purpose, there is a need to develop advanced prediction models which integrate dynamic patterns to learn a patient's physiological condition...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Wen Zhang, Yanlin Chen, Feng Liu, Fei Luo, Gang Tian, Xiaohong Li
BACKGROUND: Drug-drug interactions (DDIs) are one of the major concerns in drug discovery. Accurate prediction of potential DDIs can help to reduce unexpected interactions in the entire lifecycle of drugs, and are important for the drug safety surveillance. RESULTS: Since many DDIs are not detected or observed in clinical trials, this work is aimed to predict unobserved or undetected DDIs. In this paper, we collect a variety of drug data that may influence drug-drug interactions, i...
January 5, 2017: BMC Bioinformatics
Stefan Gröschel, Martin Bommer, Barbara Hutter, Jan Budczies, David Bonekamp, Christoph Heining, Peter Horak, Martina Fröhlich, Sebastian Uhrig, Daniel Hübschmann, Christina Geörg, Daniela Richter, Nicole Pfarr, Katrin Pfütze, Stephan Wolf, Peter Schirmacher, Dirk Jäger, Christof von Kalle, Benedikt Brors, Hanno Glimm, Wilko Weichert, Albrecht Stenzinger, Stefan Fröhling
Identification of the tissue of origin in cancer of unknown primary (CUP) poses a diagnostic challenge and is critical for directing site-specific therapy. Currently, clinical decision-making in patients with CUP primarily relies on histopathology and clinical features. Comprehensive molecular profiling has the potential to contribute to diagnostic categorization and, most importantly, guide CUP therapy through identification of actionable lesions. We here report the case of an advanced-stage malignancy initially mimicking poorly differentiated soft-tissue sarcoma that did not respond to multiagent chemotherapy...
November 2016: Cold Spring Harbor Molecular Case Studies
Margaux Luck, Gildas Bertho, Mathilde Bateson, Alexandre Karras, Anastasia Yartseva, Eric Thervet, Cecilia Damon, Nicolas Pallet
1H Nuclear Magnetic Resonance (NMR)-based metabolic profiling is very promising for the diagnostic of the stages of chronic kidney disease (CKD). Because of the high dimension of NMR spectra datasets and the complex mixture of metabolites in biological samples, the identification of discriminant biomarkers of a disease is challenging. None of the widely used chemometric methods in NMR metabolomics performs a local exhaustive exploration of the data. We developed a descriptive and easily understandable approach that searches for discriminant local phenomena using an original exhaustive rule-mining algorithm in order to predict two groups of patients: 1) patients having low to mild CKD stages with no renal failure and 2) patients having moderate to established CKD stages with renal failure...
2016: PloS One
J G Peacock, V M Timpone
BACKGROUND AND PURPOSE: Cauda equina syndrome typically requires emergent MR imaging to detect compressive lesions on the cauda equina, which may require surgical decompression. While CT is sometimes performed as a complementary imaging technique to evaluate osseous integrity in patients with cauda equina syndrome, the accuracy of CT in detecting significant spinal stenosis and cauda equina impingement is not well-defined in the literature. We hypothesized that percentage thecal sac effacement on CT of the lumbar spine would have high sensitivity and high negative predictive value in evaluating significant spinal stenosis and cauda equina impingement...
October 27, 2016: AJNR. American Journal of Neuroradiology
Shruti Agrawal, Nandita Maitra
BACKGROUND: This study was conducted to evaluate how the preeclampsia integrated estimate of risk (fullPIERS) model performs in the prediction of adverse maternal outcomes when the predictor variables are all obtained within 24-h of admission for preeclampsia. METHODS: A prospective cohort study on 323 women who fulfilled definite inclusion and exclusion criteria was conducted. Subjects were monitored for clinical symptoms of preeclampsia, biochemical parameters, and adverse maternal and neonatal outcomes...
October 2016: Journal of Obstetrics and Gynaecology of India
Michael Nagler, Tamam Bakchoul
A rapid diagnostic work-up is required in patients with suspected heparin-induced thrombocytopenia (HIT). However, diagnosis of HIT is challenging due to a number of practical issues and methodological limitations. Many laboratory tests and a few clinical scoring systems are available but the individual characteristics and the diagnostic accuracy of these are hard to appraise. The 4Ts score is a well evaluated clinical assessment tool with the potential to rule out HIT in many patients. Still, it requires experience and is subject to a relevant inter-observer variability...
October 28, 2016: Thrombosis and Haemostasis
Wen Sun, Bibo Hao, Yiqin Yu, Jing Li, Gang Hu, Guotong Xie
With the rapid growth of clinical data and knowledge, feature construction for clinical analysis becomes increasingly important and challenging. Given a clinical dataset with up to hundreds or thousands of columns, the traditional manual feature construction process is usually too labour intensive to generate a full spectrum of features with potential values. As a result, advanced large-scale data analysis technologies, such as feature selection for predictive modelling, cannot be fully utilized for clinical data analysis...
2016: Studies in Health Technology and Informatics
Alan W Kulig, Rebecca D Blanchard
BACKGROUND: It is difficult to assess applicants' higher-order cognitive thinking skills during conventional resident interviews. Application metrics currently employed are useful indicators of academic and personal success in targeted areas, yet value of this information in predicting future clinical performance is limited. OBJECTIVE: We developed an assessment tool to evaluate higher-order cognitive function in real time during anesthesiology resident applicant interviews...
July 2016: Journal of Graduate Medical Education
Minjung Kathy Chae, Eun Kyoung Kim, Ka-Young Jung, Tae Gun Shin, Min Seob Sim, Ik-Joon Jo, Keun Jeong Song, Sung-A Chang, Young Bin Song, Joo-Yong Hahn, Seung Hyuk Choi, Hyeon-Cheol Gwon, Sang-Hoon Lee, Sung Mok Kim, Hong Eo, Yeon Hyeon Choe, Jin-Ho Choi
AIMS: Clinical evidence supporting triple rule-out computed tomography (TRO-CT) for rapid screening of cardiovascular disease is limited. We investigated the clinical value of TRO-CT in patients with acute chest pain. METHODS: We retrospectively enrolled 1024 patients who visited the emergency department (ED) with acute chest pain and underwent TRO-CT using a 128-slice CT system. TRO-CT was classified as "positive" if it revealed clinically significant cardiovascular disease including obstructive coronary artery disease, pulmonary thromboembolism, or acute aortic syndrome...
July 2016: Journal of Cardiovascular Computed Tomography
Rachel Pardes Berger, Janet Fromkin, Bruce Herman, Mary Clyde Pierce, Richard A Saladino, Lynda Flom, Elizabeth C Tyler-Kabara, Tom McGinn, Rudolph Richichi, Patrick M Kochanek
BACKGROUND: Abusive head trauma is the leading cause of death from physical abuse. Misdiagnosis of abusive head trauma as well as other types of brain abnormalities in infants is common and contributes to increased morbidity and mortality. We previously derived the Pittsburgh Infant Brain Injury Score (PIBIS), a clinical prediction rule to assist physicians deciding which high-risk infants should undergo computed tomography of the head. METHODS: Well-appearing infants 30 to 364 days of age with temperature <38...
July 2016: Pediatrics
Chun-Kuei Chen, Shen-Che Lin, Chin-Chieh Wu, Li-Min Chen, I-Shiang Tzeng, Kuan-Fu Chen
Sepsis is a common condition in the emergency department that is associated with high mortality. Red blood cell distribution width (RDW) has been used as a simple prognosis predictor for patients with community-acquired pneumonia, gram-negative bacteremia, and severe sepsis or septic shock. To evaluate the performance of RDW to predict in-hospital mortality among septic patients, we conducted a hospital-based retrospective cohort study in an emergency department of a tertiary teaching hospital. RDW was compared with other commonly used clinical prediction scores (Systemic Inflammatory Response Syndrome (SIRS), Mortality in Emergency Department Sepsis (MEDS) and the Confusion, Urea nitrogen, Respiratory rate, Blood pressure, 65 years of age and older (CURB65))...
June 2016: Medicine (Baltimore)
Ya Zhang, Ao Li, Chen Peng, Minghui Wang
Glioblastoma multiforme (GBM) is a highly aggressive type of brain cancer with very low median survival. In order to predict the patient's prognosis, researches have proposed rules to classify different glioma cancer cell subtypes. However, survival time of different subtypes of GBM is often various due to different individual basis. Recent development in gene testing has evolved classic subtype rules to more specific classification rules based on single biomolocular features. These classification methods are proven to perform better than traditional simple rules in GBM prognosis prediction...
April 7, 2016: IEEE/ACM Transactions on Computational Biology and Bioinformatics
Yan-Yan Zhang, Houfu Liu, Scott G Summerfield, Christopher N Luscombe, Jasminder Sahi
Estimation of uptake across the blood-brain barrier (BBB) is key to designing central nervous system (CNS) therapeutics. In silico approaches ranging from physicochemical rules to quantitative structure-activity relationship (QSAR) models are utilized to predict potential for CNS penetration of new chemical entities. However, there are still gaps in our knowledge of (1) the relationship between marketed human drug derived CNS-accessible chemical space and preclinical neuropharmacokinetic (neuroPK) data, (2) interpretability of the selected physicochemical descriptors, and (3) correlation of the in vitro human P-glycoprotein (P-gp) efflux ratio (ER) and in vivo rodent unbound brain-to-blood ratio (Kp,uu), as these are assays routinely used to predict clinical CNS exposure, during drug discovery...
May 2, 2016: Molecular Pharmaceutics
Riccardo Liga, Jan Vontobel, Daniele Rovai, Martina Marinelli, Chiara Caselli, Mikko Pietila, Anna Teresinska, Santiago Aguadé-Bruix, Maria Nazarena Pizzi, Giancarlo Todiere, Alessia Gimelli, Dante Chiappino, Paolo Marraccini, Stephen Schroeder, Tanja Drosch, Rosa Poddighe, Giancarlo Casolo, Constantinos Anagnostopoulos, Francesca Pugliese, Francois Rouzet, Dominique Le Guludec, Francesco Cappelli, Serafina Valente, Gian Franco Gensini, Camilla Zawaideh, Selene Capitanio, Gianmario Sambuceti, Fabio Marsico, Pasquale Perrone Filardi, Covadonga Fernández-Golfín, Luis M Rincón, Frank P Graner, Michiel A de Graaf, Julia Stehli, Eliana Reyes, Sandy Nkomo, Maija Mäki, Valentina Lorenzoni, Giuseppe Turchetti, Clara Carpeggiani, Stefano Puzzuoli, Maurizio Mangione, Paolo Marcheschi, Daniela Giannessi, Stephan Nekolla, Massimo Lombardi, Rosa Sicari, Arthur J H A Scholte, José L Zamorano, S Richard Underwood, Juhani Knuuti, Philipp A Kaufmann, Danilo Neglia, Oliver Gaemperli
AIMS: Hybrid imaging provides a non-invasive assessment of coronary anatomy and myocardial perfusion. We sought to evaluate the added clinical value of hybrid imaging in a multi-centre multi-vendor setting. METHODS AND RESULTS: Fourteen centres enrolled 252 patients with stable angina and intermediate (20-90%) pre-test likelihood of coronary artery disease (CAD) who underwent myocardial perfusion scintigraphy (MPS), CT coronary angiography (CTCA), and quantitative coronary angiography (QCA) with fractional flow reserve (FFR)...
September 2016: European Heart Journal Cardiovascular Imaging
Thomas Krahn, Daniel Wibberg, Irena Maus, Anika Winkler, Séverine Bontron, Alexander Sczyrba, Patrice Nordmann, Alfred Pühler, Laurent Poirel, Andreas Schlüter
The species Acinetobacter baumannii is one of the most important multidrug-resistant human pathogens. To determine its virulence and antibiotic resistance determinants, the genome of the nosocomial blaNDM-1-positive A. baumannii strain R2090 originating from Egypt was completely sequenced. Genome analysis revealed that strain R2090 is highly related to the community-acquired Australian A. baumannii strain D1279779. The two strains belong to sequence type 267 (ST267). Isolate R2090 harbored the chromosomally integrated transposon Tn125 carrying the carbapenemase gene blaNDM-1 that is not present in the D1279779 genome...
May 2016: Antimicrobial Agents and Chemotherapy
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