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Integrated clinical prediction rule

Michela Franchini, Stefania Pieroni, Claudio Passino, Michele Emdin, Sabrina Molinaro
Modern medicine remains dependent on the accurate evaluation of a patient's health state, recognizing that disease is a process that evolves over time and interacts with many factors unique to that patient. The CARPEDIEM project represents a concrete attempt to address these issues by developing reproducible algorithms to support the accuracy in detection of complex diseases. This study aims to establish and validate the CARPEDIEM approach and algorithm for identifying those patients presenting with or at risk of heart failure (HF) by studying 153,393 subjects in Italy, based on patient information flow databases and is not reliant on the electronic health record to accomplish its goals...
2018: Frontiers in Public Health
Renaud Lafage, Sébastien Pesenti, Virginie Lafage, Frank J Schwab
PURPOSE: In past decades, the role of sagittal alignment has been widely demonstrated in the setting of spinal conditions. As several parameters can be affected, identifying the driver of the deformity is the cornerstone of a successful treatment approach. Despite the importance of restoring sagittal alignment for optimizing outcome, this task remains challenging. Self-learning computers and optimized algorithms are of great interest in spine surgery as in that they facilitate better planning and prediction of postoperative alignment...
February 9, 2018: European Spine Journal
Jean-Francois Esculier, Laurent J Bouyer, Blaise Dubois, Jean Leblond, Mélanie Brisson, Luc Chau, Jean-Sébastien Roy
OBJECTIVES: To identify predictors of outcome to a rehabilitation program focused on education and management of training loads in runners with patellofemoral pain (PFP). DESIGN: Secondary analyses of a randomized clinical trial. METHODS: Fifty-eight runners with PFP (62% female, aged 31.2±6.6years, running 20.3±5.6km/week) were included in analyses. Following baseline collection of demographics, anthropometry, symptomatology, isometric strength, running mechanics and radiological data, runners were randomized to one of the three 8-week intervention program: (1) Education on symptoms management and training modifications; (2) Education+Exercise program; (3) Education+Gait retraining...
January 27, 2018: Journal of Science and Medicine in Sport
Kelly R Reveles, Eric M Mortensen, Jim M Koeller, Kenneth A Lawson, Mary Jo V Pugh, Sarah A Rumbellow, Jacqueline R Argamany, Christopher R Frei
STUDY OBJECTIVE: Prior studies have identified risk factors for recurrent Clostridium difficile infection (CDI), but few studies have integrated these factors into a clinical prediction rule that can aid clinical decision making. The objective of this study was to derive and validate a CDI recurrence prediction rule to identify patients at risk for first recurrence in a national cohort of veterans. DESIGN: Retrospective cohort study. DATA SOURCE: Veterans Affairs Informatics and Computing Infrastructure...
February 2, 2018: Pharmacotherapy
Syed F Ali, Gordian J Hubert, Jeffrey A Switzer, Jennifer J Majersik, Roland Backhaus, L Wylie Shepard, Kishore Vedala, Lee H Schwamm
BACKGROUND AND PURPOSE: Up to 30% of acute stroke evaluations are deemed stroke mimics, and these are common in telestroke as well. We recently published a risk prediction score for use during telestroke encounters to differentiate stroke mimics from ischemic cerebrovascular disease derived and validated in the Partners TeleStroke Network. Using data from 3 distinct US and European telestroke networks, we sought to externally validate the TeleStroke Mimic (TM) score in a broader population...
March 2018: Stroke; a Journal of Cerebral Circulation
Chung-Han Ho, Fu-Wen Liang, Jhi-Joung Wang, Chung-Ching Chio, Jinn-Rung Kuo
Traumatic brain injury (TBI) is an important health issue with high mortality. Various complications of physiological and cognitive impairment may result in disability or death after TBI. Grouping of these complications could be treated as integrated post-TBI syndromes. To improve risk estimation, grouping TBI complications should be investigated, to better predict TBI mortality. This study aimed to estimate mortality risk based on grouping of complications among TBI patients. Taiwan's National Health Insurance Research Database was used in this study...
2018: PloS One
Mohana Rao Patibandla, Cheng-Chia Lee, Athreya Tata, Gokul Chowdary Addagada, Jason P Sheehan
OBJECTIVE Research over the past 2 decades has been characterizing the role of stereotactic radiosurgery (SRS) in the treatment of benign intracranial tumors, including meningiomas. However, few studies have examined the long-term outcomes of SRS treatment for posterior fossa meningiomas (PFMs). Furthermore, previous studies have typically used single diameter measurements when reporting outcomes, which can yield misleading results. The authors describe the use of SRS in the treatment of benign WHO grade I PFMs and correlate volumetric analysis with long-term outcomes...
January 5, 2018: Journal of Neurosurgery
Antonio Martinez-Millana, Jose-Luis Bayo-Monton, María Argente-Pla, Carlos Fernandez-Llatas, Juan Francisco Merino-Torres, Vicente Traver-Salcedo
Life expectancy is increasing and, so, the years that patients have to live with chronic diseases and co-morbidities. Type 2 diabetes is one of the most prevalent chronic diseases, specifically linked to being overweight and ages over sixty. Recent studies have demonstrated the effectiveness of new strategies to delay and even prevent the onset of type 2 diabetes by a combination of active and healthy lifestyle on cohorts of mid to high risk subjects. Prospective research has been driven on large groups of the population to build risk scores that aim to obtain a rule for the classification of patients according to the odds for developing the disease...
December 29, 2017: Sensors
Raquel Galante, Terezinha J A Pinto, Rogério Colaço, Ana Paula Serro
Despite the beneficial properties and outstanding potential of hydrogels for biomedical applications, several unmet challenges must be overcome, especially regarding to their known sensitivity to conventional sterilization methods. It is crucial for any biomaterial to withstand an efficient sterilization to obtain approval from regulatory organizations and to safely proceed to clinical trials. Sterility assurance minimizes the incidence of medical device-related infections, which still constitute a major concern in health care...
December 16, 2017: Journal of Biomedical Materials Research. Part B, Applied Biomaterials
Sibylle Schirm, Christoph Engel, Sibylle Loibl, Markus Loeffler, Markus Scholz
PURPOSE: Although G-CSF is widely used to prevent or ameliorate leukopenia during cytotoxic chemotherapies, its optimal use is still under debate and depends on many therapy parameters such as dosing and timing of cytotoxic drugs and G-CSF, G-CSF pharmaceuticals used and individual risk factors of patients. METHODS: We integrate available biological knowledge and clinical data regarding cell kinetics of bone marrow granulopoiesis, the cytotoxic effects of chemotherapy and pharmacokinetics and pharmacodynamics of G-CSF applications (filgrastim or pegfilgrastim) into a comprehensive model...
November 4, 2017: Journal of Cancer Research and Clinical Oncology
Joseph R Imbus, Reese W Randle, Susan C Pitt, Rebecca S Sippel, David F Schneider
BACKGROUND: 20%-25% of patients with primary hyperparathyroidism will have multigland disease (MGD). Preoperatative imaging can be inaccurate or unnecessary in MGD. Identification of MGD could direct the need for imaging and inform operative approach. The purpose of this study is to use machine learning (ML) methods to predict MGD. METHODS: Retrospective review of a prospective database. The ML platform, Waikato Environment for Knowledge Analysis, was used, and we selected models for (1) overall accuracy and (2) preferential identification of MGD...
November 2017: Journal of Surgical Research
Dan E Ganz, Briana Sexton-Stallone, Emily L Brackett, Neil S Forbes
A method to predict the effect of tissue transport on the scheduling of chemotherapeutic treatment could increase efficacy. Many drugs with desirable pharmacokinetic properties fail in vivo due to poor transport through tissue. To predict the effect of treatment schedule on drug efficacy we developed an in silico method that integrates diffusion through tissue and cell binding into a pharmacokinetic model. The model was evaluated with an array of theoretical drugs that had different rates of diffusivity, binding, and clearance...
February 7, 2018: Journal of Theoretical Biology
Asok C Antony
Although a low serum folate concentration is a useful biomarker of pure folate deficiency, the presence of vitamin B12 deficiency or hemolysis or both in individuals with low folate status predictably raises serum folate levels. Therefore, in resource-limited settings where dietary folate deficiency can coexist with vitamin B12 deficiency or malaria or both, the serum folate concentration can range from normal to high, leading to serious underestimation of tissue folate status. This review traces the genesis of an inappropriate overreliance on the serum folate concentration to rule out folate deficiency in vulnerable populations of women and children...
August 1, 2017: Nutrition Reviews
Gary I Britton, Graham C L Davey
Emerging evidence suggests that many of the clinical constructs used to help understand and explain obsessive-compulsive (OC) symptoms, and negative mood, may be causally interrelated. One approach to understanding this interrelatedness is a motivational systems approach. This approach suggests that rather than considering clinical constructs and negative affect as separable entities, they are all features of an integrated threat management system, and as such are highly coordinated and interdependent. The aim of the present study was to examine if clinical constructs related to OC symptoms and negative mood are best treated as separable or, alternatively, if these clinical constructs and negative mood are best seen as indicators of an underlying superordinate variable, as would be predicted by a motivational systems approach...
2017: Frontiers in Psychology
Lishuang Qi, Tianhao Li, Gengen Shi, Jiasheng Wang, Xin Li, Sainan Zhang, Libin Chen, Yuan Qin, Yunyan Gu, Wenyuan Zhao, Zheng Guo
Our laboratory previously reported an individual-level signature consisting of nine gene pairs, named 9-GPS. This signature was developed by training on microarray expression data and validated using three independent integrated microarray data sets, with samples of stage I non-small-cell lung cancer after complete surgical resection. In this study, we first validated the cross-platform robustness of 9-GPS by demonstrating that 9-GPS could significantly stratify the overall survival of 213 stage I lung adenocarcinoma (LUAD) patients detected with RNA-sequencing platform in The Cancer Genome Atlas (TCGA; log-rank P = 0...
November 2017: Molecular Oncology
Letícia M Raposo, Flavio F Nobre
Resistance to antiretrovirals (ARVs) is a major problem faced by HIV-infected individuals. Different rule-based algorithms were developed to infer HIV-1 susceptibility to antiretrovirals from genotypic data. However, there is discordance between them, resulting in difficulties for clinical decisions about which treatment to use. Here, we developed ensemble classifiers integrating three interpretation algorithms: Agence Nationale de Recherche sur le SIDA (ANRS), Rega, and the genotypic resistance interpretation system from Stanford HIV Drug Resistance Database (HIVdb)...
August 30, 2017: Journal of Medical Systems
K Jayaprakash, V P Dilu, Raju George
INTRODUCTION: An integrated approach that incorporates two dimensional, M mode and Doppler echocardiographic evaluation has become the standard means for accurate quantification of severity of valvular aortic stenosis. Maximal separation of the aortic valve cusps during systole has been shown to correlate well with the severity of aortic stenosis measured by other echocardiographic parameters. AIM: To study the correlation between Maximal Aortic valve Cusp Separation (MACS) and severity of aortic valve stenosis and to find cut-off values of MACS for detecting severe and mild aortic stenosis...
June 2017: Journal of Clinical and Diagnostic Research: JCDR
Muthiah Subramanian, Sowmya Gopalan, Srinivasan Ramadurai, Preetam Arthur, Mukund A Prabhu, Rajesh Thachathodiyl, Kumaraswamy Natarajan
Accurate identification of low-risk patients with acute pulmonary embolism (PE) who may be eligible for outpatient treatment or early discharge can have substantial cost-saving benefit. The purpose of this study was to derive and validate a prediction model to effectively identify patients with PE at low risk of short-term mortality, right ventricular dysfunction, and other nonfatal outcomes. This study analyzed data from 400 consecutive patients with acute PE. We derived and internally validated our prediction rule based on clinically significant variables that are routinely available at initial examination and that were categorized and weighted using coefficients in the multivariate logistic regression...
August 15, 2017: American Journal of Cardiology
Bhavesh Mehta, Nadine Griffiths, Kaye Spence, Sharon Laing
AIM: Amplitude-integrated electroencephalogram (aEEG) is widely used in neonates to detect electrical seizure and predict outcome following hypoxic ischaemic encephalopathy and other encephalopathy. Because accurate interpretation is important for clinical decision-making and family counselling, inter-observer reliability is a major concern. We aimed to evaluate inter-observer reliability in the interpretation of aEEG tracings in a neonatal intensive care unit. METHODS: Three neonatal intensive care unit clinicians with different levels of experience in reading aEEG independently reviewed and scored aEEG traces using standardised criteria, categories and interpretation rules...
October 2017: Journal of Paediatrics and Child Health
Jenny Svärd, Sabina Mugusi, Doreen Mloka, Ujjwal Neogi, Genny Meini, Ferdinand Mugusi, Francesca Incardona, Maurizio Zazzi, Anders Sönnerborg
INTRODUCTION: Antiretroviral therapy (ART) has been successfully introduced in low-middle income countries. However an increasing rate of ART failure with resistant virus is reported. We therefore described the pattern of drug resistance mutations at antiretroviral treatment (ART) failure in a real-life Tanzanian setting using the remote genotyping procedure and thereafter predicted future treatment options using rule-based algorithm and the EuResist bioinformatics predictive engine. According to national guidelines, the default first-line regimen is tenofovir + lamivudine + efavirenz, but variations including nevirapine, stavudine or emtricitabine can be considered...
2017: PloS One
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