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Integrated clinical prediction rule

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...
September 8, 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
Cheng Ni, Ming Yan, Jia Zhang, Ruhong Cheng, Jianying Liang, Dan Deng, Zhen Wang, Ming Li, Zhirong Yao
Olmsted syndrome (OS) is a rare keratinization disorder, typically characterized by two primary diagnostic hallmarks--mutilating palmoplanter and periorificial keratoderma. However, there's a growing body of literature reporting on the phenotypic diversity of OS, including the absence of aforementioned hallmarks and the presence of some unusual clinical features. Here we presented an atypical familial case of OS that could be confused with Huriez syndrome due to the presence of a scleodactyly-like appearance and tapered fingers in the proband...
2016: Scientific Reports
Howard S Goldberg, Marilyn D Paterno, Robert W Grundmeier, Beatriz H Rocha, Jeffrey M Hoffman, Eric Tham, Marguerite Swietlik, Molly H Schaeffer, Deepika Pabbathi, Sara J Deakyne, Nathan Kuppermann, Peter S Dayan
OBJECTIVE: To evaluate the architecture, integration requirements, and execution characteristics of a remote clinical decision support (CDS) service used in a multicenter clinical trial. The trial tested the efficacy of implementing brain injury prediction rules for children with minor blunt head trauma. MATERIALS AND METHODS: We integrated the Epic(®) electronic health record (EHR) with the Enterprise Clinical Rules Service (ECRS), a web-based CDS service, at two emergency departments...
March 2016: International Journal of Medical Informatics
Michael B Streiff, Giancarlo Agnelli, Jean M Connors, Mark Crowther, Sabine Eichinger, Renato Lopes, Robert D McBane, Stephan Moll, Jack Ansell
This guidance document focuses on the diagnosis and treatment of venous thromboembolism (VTE). Efficient, cost effective diagnosis of VTE is facilitated by combining medical history and physical examination with pre-test probability models, D dimer testing and selective use of confirmatory imaging. Clinical prediction rules, biomarkers and imaging can be used to tailor therapy to disease severity. Anticoagulation options for acute VTE include unfractionated heparin, low molecular weight heparin, fondaparinux and the direct oral anticoagulants (DOACs)...
January 2016: Journal of Thrombosis and Thrombolysis
Mamata V Kene, Dustin W Ballard, David R Vinson, Adina S Rauchwerger, Hilary R Iskin, Anthony S Kim
INTRODUCTION: We evaluated emergency physicians' (EP) current perceptions, practice, and attitudes towards evaluating stroke as a cause of dizziness among emergency department patients. METHODS: We administered a survey to all EPs in a large integrated healthcare delivery system. The survey included clinical vignettes, perceived utility of historical and exam elements, attitudes about the value of and requisite post-test probability of a clinical prediction rule for dizziness...
September 2015: Western Journal of Emergency Medicine
Junsheng Ma, Francesco C Stingo, Brian P Hobbs
Efforts to personalize medicine in oncology have been limited by reductive characterizations of the intrinsically complex underlying biological phenomena. Future advances in personalized medicine will rely on molecular signatures that derive from synthesis of multifarious interdependent molecular quantities requiring robust quantitative methods. However, highly parameterized statistical models when applied in these settings often require a prohibitively large database and are sensitive to proper characterizations of the treatment-by-covariate interactions, which in practice are difficult to specify and may be limited by generalized linear models...
June 2016: Biometrics
Guowei Li, Anne Holbrook, Thomas Delate, Daniel M Witt, Mitchell Ah Levine, Lehana Thabane
INTRODUCTION: Clinical prediction rules have been validated and widely used in patients with atrial fibrillation (AF) to predict stroke and major bleeding. However, these prediction rules were not developed in the same population, and do not provide the key information that patients and prescribers need at the time anticoagulants are being considered-what is the individual patient-specific risk of both benefit (decreased stroke) and harm (increased major bleeding). In this study, our primary objective is to develop and validate a prediction model for patients' individual combined benefit and harm outcomes (stroke, major bleeding and neither event) with and without warfarin therapy...
2015: BMJ Open
G Middleton, L R Crack, S Popat, C Swanton, S J Hollingsworth, R Buller, I Walker, T H Carr, D Wherton, L J Billingham
BACKGROUND: The management of NSCLC has been transformed by stratified medicine. The National Lung Matrix Trial (NLMT) is a UK-wide study exploring the activity of rationally selected biomarker/targeted therapy combinations. PATIENTS AND METHODS: The Cancer Research UK (CRUK) Stratified Medicine Programme 2 is undertaking the large volume national molecular pre-screening which integrates with the NLMT. At study initiation, there are eight drugs being used to target 18 molecular cohorts...
December 2015: Annals of Oncology: Official Journal of the European Society for Medical Oncology
Qingcai Chen, Haodi Li, Buzhou Tang, Xiaolong Wang, Xin Liu, Zengjian Liu, Shu Liu, Weida Wang, Qiwen Deng, Suisong Zhu, Yangxin Chen, Jingfeng Wang
Despite recent progress in prediction and prevention, heart disease remains a leading cause of death. One preliminary step in heart disease prediction and prevention is risk factor identification. Many studies have been proposed to identify risk factors associated with heart disease; however, none have attempted to identify all risk factors. In 2014, the National Center of Informatics for Integrating Biology and Beside (i2b2) issued a clinical natural language processing (NLP) challenge that involved a track (track 2) for identifying heart disease risk factors in clinical texts over time...
December 2015: Journal of Biomedical Informatics
Kenneth C Bilchick, Augustus Mealor, Jorge Gonzalez, Patrick Norton, David Zhuo, Pamela Mason, John D Ferguson, Rohit Malhotra, J Michael Mangrum, Andrew E Darby, John DiMarco, Klaus Hagspiel, John Dent, Christopher M Kramer, George J Stukenborg, Michael Salerno
BACKGROUND: Computed tomography angiography (CTA) can identify and rule out left atrial appendage (LAA) thrombus when delayed imaging is also performed. OBJECTIVE: In patients referred for CTA to evaluate pulmonary vein anatomy before the ablation of atrial fibrillation (AF) or left atrial flutter (LAFL), we sought to determine the effectiveness of a novel clinical protocol for integrating results of CTA delayed LAA imaging into preprocedure care. METHODS: After making delayed imaging of the LAA part of our routine preablation CTA protocol, we integrated early reporting of preablation CTA LAA imaging results into clinical practice as part of a formal protocol in June 2013...
January 2016: Heart Rhythm: the Official Journal of the Heart Rhythm Society
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