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Patient decision aid

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https://www.readbyqxmd.com/read/28091867/arterial-aortic-stiffness-in-patients-with-resistant-hypertension-from-assessment-to-treatment
#1
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
#2
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/28089292/assessing-quality-of-life-of-patients-with-hypospadias-a-systematic-review-of-validated-patient-reported-outcome-instruments
#3
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/28087371/use-of-the-heart-pathway-with-high-sensitivity-cardiac-troponins-a-secondary-analysis
#4
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/28076893/-pseudo-feeders-on-fetal-mri-predict-outcome-in-vein-of-galen-malformations
#5
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/28073294/circulating-tumor-cells-and-dna-for-real-time-egfr-detection-and-monitoring-of-non-small-cell-lung-cancer
#6
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
#7
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
#8
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
https://www.readbyqxmd.com/read/28069398/objective-decision-making-between-conventional-and-oncoplastic-breast-conserving-surgery-or-mastectomy-an-aesthetic-and-functional-prospective-cohort-study
#9
D Pukancsik, P Kelemen, M Újhelyi, E Kovács, N Udvarhelyi, N Mészáros, I Kenessey, T Kovács, M Kásler, Z Mátrai
BACKGROUND: Breast-conserving surgery (BCS) is considered the standard treatment for early-stage breast cancer. However, fair to poor cosmetic outcomes following conventional BCS have been observed in as many as one-third of cases. The aim of this study was to determine the critical tumor-to-breast volume ratio for each quadrant of the breast beyond which conventional BCS would no longer offer acceptable cosmetic and functional results or satisfactory quality of life for the patient. METHODS: A prospective cohort study was performed between December 2011 and December 2013 involving 350 patients younger than 70 years with early-stage unifocal (T ≤ 30 mm) breast cancer who underwent wide excision and axillary sentinel lymph node biopsy followed by whole-breast irradiation...
December 5, 2016: European Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28068753/retrospective-matched-pair-cohort-study-on-effect-of-bisegmental-fenestration-versus-hemilaminectomy-for-bisegmental-spinal-canal-stenosis-at-l3-l4-and-l4-l5
#10
Julia Schüppel, Friedrich Weber
Background The main symptoms of degenerative lumbar spinal canal stenosis are progressive back pain, spinal claudication, and, occasionally, sensory and motor deficits. Impairments particularly occur during walking, standing, and sitting. Thus social and vocational activities are increasingly restricted, causing considerable suffering for patients. Surgical therapies are superior to conservative ones. This article studies the outcome of 2-level fenestration versus hemilaminectomy for bisegmental spinal stenosis decompression...
January 9, 2017: Journal of Neurological Surgery. Part A, Central European Neurosurgery
https://www.readbyqxmd.com/read/28063462/going-digital-a-narrative-overview-of-the-clinical-and-organisational-impacts-of-ehealth-technologies-in-hospital-practice
#11
Justin Keasberry, Ian A Scott, Clair Sullivan, Andrew Staib, Richard Ashby
Objective The aim of the present study was to determine the effects of hospital-based eHealth technologies on quality, safety and efficiency of care and clinical outcomes.Methods Systematic reviews and reviews of systematic reviews of eHealth technologies published in PubMed/Medline/Cochrane Library between January 2010 and October 2015 were evaluated. Reviews of implementation issues, non-hospital settings or remote care or patient-focused technologies were excluded from analysis. Methodological quality was assessed using a validated appraisal tool...
January 9, 2017: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/28062651/an-activist-s-argument-that-participant-values-should-guide-risk-benefit-ratio-calculations-in-hiv-cure-research
#12
David Evans
The patient empowerment movement, spurred by AIDS activism in the 1980s, quickly evolved to encompass how study participants are considered and treated in clinical research. Initially, people fearing death of AIDS sought early access to experimental medications that had not undergone rigorous testing in hopes of extending their lives. Thirty years on, scientists are asking a different set of ethical questions about clinical research, this time in the pursuit of either a sterilising cure or long-term remission for HIV...
January 6, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28061041/other-ways-of-knowing
#13
Negin Hajizadeh, Melissa J Basile, Andrzej Kozikowski, Meredith Akerman, Tara Liberman, Thomas McGinn, Michael A Diefenbach
BACKGROUND: Patients with advanced-stage chronic obstructive pulmonary disease (COPD) may suffer severe respiratory exacerbations and need to decide between accepting life-sustaining treatments versus foregoing these treatments (choosing comfort care only). We designed the InformedTogether decision aid to inform this decision and describe results of a pilot study to assess usability focusing on participants' trust in the content of the decision aid, acceptability, recommendations for improvement, and emotional reactions to this emotionally laden decision...
December 1, 2016: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/28050972/registration-of-mri-to-intraoperative-radiographs-for-target-localization-in-spinal-interventions
#14
T De Silva, A Uneri, M D Ketcha, S Reaungamornrat, J Goerres, M W Jacobson, S Vogt, G Kleinszig, A J Khanna, J-P Wolinsky, J H Siewerdsen
Decision support to assist in target vertebra localization could provide a useful aid to safe and effective spine surgery. Previous solutions have shown 3D-2D registration of preoperative CT to intraoperative radiographs to reliably annotate vertebral labels for assistance during level localization. We present an algorithm (referred to as MR-LevelCheck) to perform 3D-2D registration based on a preoperative MRI to accommodate the increasingly common clinical scenario in which MRI is used instead of CT for preoperative planning...
January 4, 2017: Physics in Medicine and Biology
https://www.readbyqxmd.com/read/28048623/tu-fg-201-10-quality-management-of-accelerated-partial-breast-irradiation-apbi-plans
#15
H Ji, V Lorio, G Cernica, J Han, M Nurhussien, N Nasr, R Hong
PURPOSE: Since 2008, over 700 patients received high dose rate (HDR) APBI treatment at Virginia Hospital Center. The complexity involved in the planning process demonstrated a broad variation between patient geometry across all applicators, in relation to anatomical regions of interest. A quality management program instituting various metrics was implemented in March 2013 with the goal of ensuring an optimal plan is achieved for each patient. METHODS: For each plan, an in-house complexity index, geometric conformity index, and plan quality index were defined...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28048225/th-cd-209-09-quickly-identifying-good-candidates-for-proton-therapy-from-geometric-considerations
#16
D Hall, A Trofimov, B Winey, N Liebsch, H Paganetti
PURPOSE: We developed a knowledge-based model that can predict the patient-specific benefits of proton therapy based upon geometric considerations. The model could also aid patient selection in model-based clinical trials or help justify clinical decisions to insurance companies. METHODS: The knowledge-based method trains a model upon existing proton treatment plans, exploiting correlations between dose and distance-to-target. Each OAR is split into concentric subvolumes surrounding the target volume, and a skew-normal PDF is fit to the dose distribution found within each shell...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28048017/tu-d-207b-01-a-prediction-model-for-distinguishing-radiation-necrosis-from-tumor-progression-after-gamma-knife-radiosurgery-based-on-radiomics-features-from-mr-images
#17
Z Zhang, A Ho, X Wang, P Brown, N Guha-Thakurta, S Ferguson, X Fave, L Zhang, D Mackin, L Court, J Li, J Yang
PURPOSE: To develop and validate a prediction model using radiomics features extracted from MR images to distinguish radiation necrosis from tumor progression for brain metastases treated with Gamma knife radiosurgery. METHODS: The images used to develop the model were T1 post-contrast MR scans from 71 patients who had had pathologic confirmation of necrosis or progression; 1 lesion was identified per patient (17 necrosis and 54 progression). Radiomics features were extracted from 2 images at 2 time points per patient, both obtained prior to resection...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28043904/liver-cancer-cell-of-origin-molecular-class-and-effects-on-patient-prognosis
#18
REVIEW
Daniela Sia, Augusto Villanueva, Scott L Friedman, Josep M Llovet
Primary liver cancer is the second leading cause of cancer-related death worldwide and therefore a major public health challenge. We review hypotheses of the cell of origin of liver tumorigenesis, and clarify the classes of liver cancer, based on molecular features and how these affect patient prognosis. Primary liver cancer comprises hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (iCCA), and other rare tumors, notably fibrolamellar carcinoma and hepatoblastoma. The molecular and clinical features of HCC vs iCCA are distinct, although they have overlapping risk factors and pathways of oncogenesis...
December 30, 2016: Gastroenterology
https://www.readbyqxmd.com/read/28034307/interventions-and-assessment-tools-addressing-key-concepts-people-need-to-know-to-appraise-claims-about-treatment-effects-a-systematic-mapping-review
#19
Astrid Austvoll-Dahlgren, Allen Nsangi, Daniel Semakula
BACKGROUND: People's ability to appraise claims about treatment effects is crucial for informed decision-making. Our objective was to systematically map this area of research in order to (a) provide an overview of interventions targeting key concepts that people need to understand to assess treatment claims and (b) to identify assessment tools used to evaluate people's understanding of these concepts. The findings of this review provide a starting point for decisions about which key concepts to address when developing new interventions, and which assessment tools should be considered...
December 29, 2016: Systematic Reviews
https://www.readbyqxmd.com/read/28033246/postsurgical-treatment-with-adjuvant-transarterial-chemoembolization-in-patients-with-hepatitis-b-related-hepatocellular-carcinoma-a-strobe-compliant-article
#20
Hao Hu, Rong Liu, Xiao Ran Long, Xi Kun Han, Jia Fan, Zhi Ping Yan, Jian Hua Wang
This study sought to develop a reliable and easy-to-use scoring model to guide the decision to perform postsurgical adjuvant transarterial chemoembolization (PA-TACE) in patients with hepatitis B-related hepatocellular carcinoma (HCC).The study included 235 consecutive patients with hepatitis B-related HCC undergoing PA-TACE at our medical center. Patients were assigned to 2 sets according to the PA-TACE date: initial (2005-2007; n = 130) and internal validation (2008-2009; n = 105) sets. With the aid of a Cox regression model, we developed a risk-scoring model from the independent predictive factors of our initial set designed as a guide for PA-TACE, and the performance of the model was validated with an internal set...
December 2016: Medicine (Baltimore)
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