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https://www.readbyqxmd.com/read/28101972/an-evaluation-of-the-quality-of-evidence-available-to-inform-current-bone-conduction-hearing-device-national-policy
#1
Rishi Mandavia, Alex Carter, Nadine Haram, Elias Mossialos, Anne Gm Schilder
OBJECTIVES: In 2016 NHS England published the commissioning policy on Bone Conducting Hearing Devices (BCHDs). This policy was informed by updated evidence on the clinical and cost effectiveness of BCHDs as well as by the 2013 Bone Anchored Hearing Aid (BAHA) policy. Commissioning policies set the criteria for service delivery and therefore have a major impact on the care received by patients. It is important that stakeholders have a good appreciation of the available evidence informing policy, since this will promote engagement both with the policy as well as with future research leading on from the policy...
January 18, 2017: Clinical Otolaryngology
https://www.readbyqxmd.com/read/28100114/borderline-personality-disorder-and-the-ethics-of-risk-management
#2
Dan Warrender
Patients with borderline personality disorder are frequent users of inpatient mental health units, with inpatient crisis intervention often used based on the risk of suicide. However, this can present an ethical dilemma for nursing and medical staff, with these clinician responses shifting between the moral principles of beneficence and non-maleficence, dependent on the outcomes of the actions of containing or tolerating risk. This article examines the use of crisis intervention through moral duties, intentions and consequences, culminating in an action/consequence model of risk management, used to explore potential outcomes...
January 1, 2017: Nursing Ethics
https://www.readbyqxmd.com/read/28095957/point-of-care-ultrasound-utility-and-potential-for-high-altitude-crew-recovery-missions
#3
Laura A Galdamez, Jonathan B Clark, Erik L Antonsen
INTRODUCTION: Flights to high altitude can lead to exposure and unique pathology not seen in normal commercial aviation. METHODS: This paper assesses the potential for point-of-care ultrasound to aid in management and disposition of injured crewmembers from a high altitude incident. This was accomplished through a systematic literature review regarding current diagnostic and therapeutic uses of ultrasound for injuries expected in high altitude free fall and parachuting...
February 1, 2017: Aerospace Medicine and Human Performance
https://www.readbyqxmd.com/read/28095592/a-practical-approach-to-address-uncertainty-in-stakeholder-deliberations
#4
Robin Gregory, Ralph L Keeney
This article addresses the difficulties of incorporating uncertainty about consequence estimates as part of stakeholder deliberations involving multiple alternatives. Although every prediction of future consequences necessarily involves uncertainty, a large gap exists between common practices for addressing uncertainty in stakeholder deliberations and the procedures of prescriptive decision-aiding models advanced by risk and decision analysts. We review the treatment of uncertainty at four main phases of the deliberative process: with experts asked to describe possible consequences of competing alternatives, with stakeholders who function both as individuals and as members of coalitions, with the stakeholder committee composed of all stakeholders, and with decisionmakers...
January 17, 2017: Risk Analysis: An Official Publication of the Society for Risk Analysis
https://www.readbyqxmd.com/read/28094850/discriminating-solitary-cysts-from-soft-tissue-lesions-in-mammography-using-a-pretrained-deep-convolutional-neural-network
#5
Thijs Kooi, Bram van Ginneken, Nico Karssemeijer, Ard den Heeten
PURPOSE: It is estimated that 7% of women in the western world will develop palpable breast cysts in their lifetime. Even though cysts have been correlated with risk of developing breast cancer, many of them are benign and do not require follow-up. We develop a method to discriminate benign solitary cysts from malignant masses in digital mammography. We think a system like this can have merit in the clinic as a decision aid or complementary to specialised modalities. METHODS: We employ a deep Convolutional Neural Network (CNN) to classify cyst and mass patches...
January 17, 2017: Medical Physics
https://www.readbyqxmd.com/read/28093726/a-preoperative-and-intraoperative-scoring-system-to-predict-nodal-metastasis-in-endometrial-cancer
#6
Andressa M S Teixeira, Reitan Ribeiro, Kathleen M Schmeler, Thomas J Herzog, Sergio M Nicolau, Renato M Marques
OBJECTIVE: To develop a scoring system that guides surgical decision-making regarding the need to perform lymphadenectomy. METHODS: A retrospective study was performed of patients who underwent complete surgical staging of endometrial cancer between 2003 and 2014 at three centers in Brazil. Preoperative and intraoperative risk factors were used to develop a scoring system to predict lymph node metastasis. RESULTS: Among 329 patients included, 71 (21...
January 17, 2017: International Journal of Gynaecology and Obstetrics
https://www.readbyqxmd.com/read/28091867/arterial-aortic-stiffness-in-patients-with-resistant-hypertension-from-assessment-to-treatment
#7
REVIEW
James E Sharman, Pierre Boutouyrie, Stéphane Laurent
PURPOSE OF REVIEW: The purpose of the review is to examine whether measurement of aortic stiffness could be especially value-adding for risk stratification and treatment among patients with resistant hypertension (RH). RECENT FINDINGS: Adverse arterial remodeling and increased aortic stiffness is associated with RH, and it may be of additional clinical benefit to measure aortic stiffness in these patients. However, there is insufficient evidence to determine whether aortic stiffness is excessively high relative to the level of blood pressure (BP) among people with RH...
January 2017: Current Hypertension Reports
https://www.readbyqxmd.com/read/28090793/development-and-validation-of-a-predictor-of-insufficient-enhancement-during-the-hepatobiliary-phase-of-gd-eob-dtpa-enhanced-magnetic-resonance-imaging
#8
Enming Cui, Wansheng Long, Liangping Luo, Maoqing Hu, Liebin Huang, Xiangmeng Chen
Background Insufficient enhancement of liver parenchyma negatively affects diagnostic accuracy of Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI). Currently, there is no reliable method for predicting insufficient enhancement during the hepatobiliary phase (HBP) in Gd-EOB-DTPA-enhanced MRI. Purpose To develop a predictor for insufficient enhancement of liver parenchyma during HBP in Gd-EOB-DTPA-enhanced MRI. Material and Methods In order to formulate a HBP enhancement test (HBP-ET), clinical factors associated with relative enhancement ratio (RER) of liver parenchyma were retrospectively determined from the datasets of 156 patients (Development group) who underwent Gd-EOB-DTPA-enhanced MRI between November 2012 and May 2015...
January 1, 2017: Acta Radiologica
https://www.readbyqxmd.com/read/28090399/breastfeeding-in-samoa-a-study-to-explore-women-s-knowledge-and-the-factors-which-influence-infant-feeding-practices
#9
Lucy E Archer, Thomas F Dunne, Lauren J Lock, Lucy A Price, Zubair Ahmed
A decline in breastfeeding rates in Samoa has been reported over the last century. To assess the length of time women breastfeed, their knowledge of both the advantages of and recommendations for breastfeeding, and the factors that influence their decisions to continue or discontinue breastfeeding, a questionnaire was distributed at Tupua Tamasese Meaole Hospital. One hundred and twenty-one eligible participants were included aged 18-50 years (mean age 28.2). Ninety percent of participants initiated breastfeeding, and the majority (78%) of babies were exclusively breastfed for at least the recommended 6 months...
January 2017: Hawai'i Journal of Medicine & Public Health: a Journal of Asia Pacific Medicine & Public Health
https://www.readbyqxmd.com/read/28089767/the-correlation-between-a-short-term-conventional-electroencephalography-in-the-first-day-of-life-and-brain-magnetic-resonance-imaging-in-newborns-undergoing-hypothermia-for-hypoxic-ischemic-encephalopathy
#10
Rawad Obeid, Yoshimi Sogawa, Satyanarayana Gedela, Monica Naik, Vince Lee, Richard Telesco, Jessica Wisnowski, Christine Magill, Michael J Painter, Ashok Panigrahy
OBJECTIVE: Electroencephalograph recorded in the first day of life in newborns treated with hypothermia for hypoxic-ischemic encephalopathy could be utilized as a predictive tool for the severity of brain injury on magnetic resonance imaging and mortality. STUDY DESIGN: This work was a retrospective study of newborns who were admitted for therapeutic hypothermia due to hypoxic-ischemic encephalopathy. All enrolled infants underwent encephalography within the first 24 hours of life and underwent brain magnetic resonance imaging after rewarming...
November 3, 2016: Pediatric Neurology
https://www.readbyqxmd.com/read/28089292/assessing-quality-of-life-of-patients-with-hypospadias-a-systematic-review-of-validated-patient-reported-outcome-instruments
#11
REVIEW
K J Sullivan, Z Hunter, V Andrioli, L Guerra, M Leonard, A Klassen, M A Keays
BACKGROUND: Patient-reported outcomes have the potential to provide invaluable information for evaluation of hypospadias patients, aid in decision-making, performance assessment, and improvement in quality of care. To appropriately measure patient-relevant outcomes, well-developed and validated patient-reported outcome (PRO) instruments are essential. OBJECTIVE: To identify and evaluate existing PRO instruments designed to measure quality of life and/or satisfaction of individuals with hypospadias that have been developed and validated in a hypospadias population...
December 5, 2016: Journal of Pediatric Urology
https://www.readbyqxmd.com/read/28088349/stroke-biomarkers-in-clinical-practice-a-critical-appraisal
#12
REVIEW
Geelyn J L Ng, Amy M L Quek, Christine Cheung, Thiruma V Arumugam, Raymond C S Seet
Biomarkers provide critical mechanistic insights to key biologic processes that occur during cerebral ischemia which, when carefully applied, can improve clinical decision-making in acute stroke management. The translation of a blood-based biomarker in ischemic stroke to clinical practice is challenging, in part, due to the complexity of ischemic stroke pathogenesis and the presence of a blood-brain barrier that restricts the release of brain-specific markers into the circulation. The pathologic and clinical aspects of ischemic stroke are described in this review, where a non-exhaustive list of biomarkers that interrogate different aspects of ischemic stroke such as oxidative damage, inflammation, thrombus formation, cardiac function and brain injury are described...
January 11, 2017: Neurochemistry International
https://www.readbyqxmd.com/read/28087402/accuracy-is-in-the-eyes-of-the-pathologist-the-visual-interpretive-process-and-diagnostic-accuracy-with-digital-whole-slide-images
#13
Tad T Brunyé, Ezgi Mercan, Donald L Weaver, Joann G Elmore
Digital whole slide imaging is an increasingly common medium in pathology, with application to education, telemedicine, and rendering second opinions. It has also made it possible to use eye tracking devices to explore the dynamic visual inspection and interpretation of histopathological features of tissue while pathologists review cases. Using whole slide images, the present study examined how a pathologist's diagnosis is influenced by fixed case-level factors, their prior clinical experience, and their patterns of visual inspection...
January 10, 2017: Journal of Biomedical Informatics
https://www.readbyqxmd.com/read/28087371/use-of-the-heart-pathway-with-high-sensitivity-cardiac-troponins-a-secondary-analysis
#14
Simon A Mahler, Jason P Stopyra, Fred S Apple, Robert F Riley, Gregory B Russell, Brian C Hiestand, James W Hoekstra, Cedric W Lefebvre, Bret A Nicks, David M Cline, Kim L Askew, David M Herrington, Gregory L Burke, Chadwick D Miller
OBJECTIVES: The HEART Pathway combines a decision aid and serial contemporary cardiac troponin I (cTnI) measures to achieve >99% sensitivity for major adverse cardiac events (MACE) at 30days and early discharge rates >20%. However, the impact of integrating high-sensitivity troponin (hs-cTn) measures into the HEART Pathway has yet to be determined. In this analysis we compare test characteristics of the HEART Pathway using hs-cTnI, hs-cTnT, or cTnI. DESIGN & METHODS: A secondary analysis of participants enrolled in the HEART Pathway RCT was conducted...
January 10, 2017: Clinical Biochemistry
https://www.readbyqxmd.com/read/28087072/enhancing-delirium-case-definitions-in-electronic-health-records-using-clinical-free-text
#15
Thomas H McCoy, Deanna C Chaukos, Leslie A Snapper, Kamber L Hart, Theodore A Stern, Roy H Perlis
BACKGROUND: Delirium is an acute confusional state, associated with morbidity and mortality in diverse medically ill populations. Delirium is preventable and treatable when diagnosed but the diagnosis is often missed. This important and difficult diagnosis is an attractive candidate for computer-aided decision support if it can be reliably identified at scale. OBJECTIVE: Here, using an electronic health record-based case definition of delirium, we characterize incidence of this highly morbid condition in 2 large academic medical centers...
October 27, 2016: Psychosomatics
https://www.readbyqxmd.com/read/28076893/-pseudo-feeders-on-fetal-mri-predict-outcome-in-vein-of-galen-malformations
#16
Guillaume Saliou, Irène Vraka, Jean-Paul Teglas, Marie-Victoire Senat, Philippe Durand, Claire Colmant, Augustin Ozanne, Jelena Martinovic, Pierre Tissiere, Catherine Adamsbaum
OBJECTIVE: While vein of Galen aneurysmal malformations (VGAM) can be diagnosed in the fetus, the challenge is predicting the occurrence of its two major complications: cardiopulmonary failure and encephalomalacia. This study attempts to determine which fetal brain MRI features might be used to predict the development of these complications at birth. METHODS: The cohort was extracted from a prospectively-assembled database of VGAM cases managed at a single referral centre from 2000 to 2014...
January 11, 2017: Annals of Neurology
https://www.readbyqxmd.com/read/28076532/-trajectories-of-women-living-with-hiv-aids-in-brazil-progress-and-permanence-of-the-response-to-the-epidemic
#17
Wilza Vieira Villela, Regina Maria Barbosa
This article analyzes the trajectories of 85 women living with HIV/AIDS in six Brazilian cities: Belém, São Paulo, Ribeirão Preto, Goiânia, Recife and Pelotas, to understand some specific aspects of their experiences before and after diagnosis. It is based on in-depth interviews conducted in 2009 addressing women diagnosed with HIV between 1 and 20 years previously. The results show a profile characterized by limited access to school, health services and labor and a marked presence of violence. The reasons for applying HIV tests vary over time and there is an increase in prenatal testing, although no modifications in the context of the infection are apparent...
January 2017: Ciência & Saúde Coletiva
https://www.readbyqxmd.com/read/28073294/circulating-tumor-cells-and-dna-for-real-time-egfr-detection-and-monitoring-of-non-small-cell-lung-cancer
#18
Jinfeng He, Wei Tan, Jingping Ma
AIM: We investigate the suitability of circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA) in non-small-cell lung cancer management, which is challenging in conventional biopsies. MATERIALS & METHODS: We performed serial blood extraction from 120 patients of varying EGFR status. Molecular profiling was performed using droplet digital PCR and correlated to survival outcome. RESULTS: Overall, we observed 95% agreement using CTCs and ctDNA with conventional tissue biopsies, which indicated the disease's close correlation...
January 11, 2017: Future Oncology
https://www.readbyqxmd.com/read/28071987/a-computer-aided-diagnosis-system-using-artificial-intelligence-for-the-diagnosis-and-characterization-of-thyroid-nodules-on-ultrasound-initial-clinical-assessment
#19
Young Jun Choi, Jung Hwan Baek, Hye Sun Park, Woo Hyun Shim, Tae Yong Kim, YoungKee Shong, Jeong Hyun Lee
Background We describe an initial clinical assessment of a new, commercially available, computer-aided diagnosis (CAD) system using artificial intelligence (AI) for thyroid ultrasound, and evaluate its performance in the diagnosis of malignant thyroid nodules and categorization of nodule characteristics. Methods This prospective study protocol was reviewed and approved by the institutional review board. Patients with thyroid nodules with decisive diagnosis, whether benign or malignant on the basis of cytopathologic or US results, were consecutively enrolled from November 2015 to February 2016...
January 10, 2017: Thyroid: Official Journal of the American Thyroid Association
https://www.readbyqxmd.com/read/28070916/non-invasive-assessment-of-muscle-oxygenation-may-aid-in-optimising-transfusion-threshold-decisions-in-ambulatory-paediatric-patients
#20
K A Schenkman, D S Hawkins, W A Ciesielski, M Delaney, L S L Arakaki
OBJECTIVE: To assess the potential utility of a novel non-invasive muscle oxygen measurement to determine the presence of muscle hypoxia in patients with anaemia. BACKGROUND: Recent assessment of the risk/benefit ratio of blood transfusion has led to clinical strategies optimising transfusion decisions. These decisions are primarily based on haematocrit (Hct) but not oxygen delivery, the primary function of red blood cells (RBCs). We hypothesised that muscle oxygenation (MOx) would correlate with Hct in patients with anaemia and may be a physiologically relevant determinant of the transfusion threshold...
January 10, 2017: Transfusion Medicine
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