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https://www.readbyqxmd.com/read/29789660/multicolor-tm-imaging-in-combined-hamartoma-of-the-retina-and-retinal-pigment-epithelium
#1
Konstantinos Kaprinis, Hannaa Bobat, Gabriella De Salvo
PURPOSE: To describe the principle characteristics of combined hamartoma of the retina and retinal pigment epithelium ('combined harmatoma') on MultiColorTM imaging and evaluate its role as a diagnostic and management tool. METHODS: Retrospective, observational case series comprising three patients with unilateral, juxtapapillary combined harmatoma. Complete ophthalmic examination was performed. MultiColorTM , including green reflectance (GR) and near infra-red reflectance (NIRR), optical coherence tomography (OCT) and autofluorescence (AF) imaging were obtained (Heidelberg Spectralis)...
May 23, 2018: Eye
https://www.readbyqxmd.com/read/29788933/continue-adjust-or-stop-antipsychotic-medication-developing-and-user-testing-an-encounter-decision-aid-for-people-with-first-episode-and-long-term-psychosis
#2
Yaara Zisman-Ilani, David Shern, Patricia Deegan, Julie Kreyenbuhl, Lisa Dixon, Robert Drake, William Torrey, Manish Mishra, Ksenia Gorbenko, Glyn Elwyn
BACKGROUND: People with psychosis struggle with decisions about their use of antipsychotics. They often want to reduce the dose or stop, while facing uncertainty regarding the effects these decisions will have on their treatment and recovery. They may also fear raising this issue with clinicians. The purpose of this study was to develop and test a shared decision making (SDM) tool to support patients and clinicians in making decisions about antipsychotics. METHODS: A diverse editorial research team developed an Encounter Decision Aid (EDA) for patients and clinicians to use as part of the psychiatric consultation...
May 22, 2018: BMC Psychiatry
https://www.readbyqxmd.com/read/29788284/military-service-and-decision-quality-in-the-management-of-knee-osteoarthritis
#3
Eric R Henderson, Alexander J Titus, Benjamin J Keeney, Philip P Goodney, Jon D Lurie, Said A Ibrahim
Background: Decision quality measures the degree to which care decisions are knowledge-based and value-aligned. Because military service emphasizes hierarchy, command, and mandates some healthcare decisions, military service may attenuate patient autonomy in healthcare decisions and lower decision quality. VA is the nation's largest provider of orthopedic care. We compared decision quality in a sample of VA and non-VA patients seeking care for knee osteoarthritis. Methods: Our study sample consisted of patients newly referred to our orthopedic clinic for the management of knee osteoarthritis...
May 18, 2018: Military Medicine
https://www.readbyqxmd.com/read/29788099/biomarkers-for-homologous-recombination-deficiency-in-cancer
#4
Michal M Hoppe, Raghav Sundar, David S P Tan, Anand D Jeyasekharan
Defective DNA repair is a common hallmark of cancer. Homologous recombination is a DNA repair pathway of clinical interest due to the sensitivity of homologous recombination-deficient cells to poly-ADP ribose polymerase (PARP) inhibitors. The measurement of homologous recombination deficiency (HRD) in cancer is therefore vital to the appropriate design of clinical trials incorporating PARP inhibitors. However, methods to identify HRD in tumors are varied and controversial. Understanding existing and new methods to measure HRD is important to their appropriate use in clinical trials and practice...
May 18, 2018: Journal of the National Cancer Institute
https://www.readbyqxmd.com/read/29787590/cost-effectiveness-of-an-autoantibody-test-earlycdt-lung-as-an-aid-to-early-diagnosis-of-lung-cancer-in-patients-with-incidentally-detected-pulmonary-nodules
#5
John Edelsberg, Derek Weycker, Mark Atwood, Geoffrey Hamilton-Fairley, James R Jett
OBJECTIVE: Patients who have incidentally detected pulmonary nodules and an estimated intermediate risk (5-60%) of lung cancer frequently are followed via computed tomography (CT) surveillance to detect nodule growth, despite guidelines for a more aggressive diagnostic strategy. We examined the cost-effectiveness of an autoantibody test (AABT)-Early Cancer Detection Test-Lung (EarlyCDT-LungTM)-as an aid to early diagnosis of lung cancer among such patients. METHODS: We developed a decision-analytic model to evaluate use of the AABT versus CT surveillance alone...
2018: PloS One
https://www.readbyqxmd.com/read/29787391/comparing-wavefront-optimized-wavefront-guided-and-topography-guided-laser-vision-correction-clinical-outcomes-using-an-objective-decision-tree
#6
Karl Stonecipher, Joseph Parrish, Megan Stonecipher
PURPOSE OF REVIEW: This review is intended to update and educate the reader on the currently available options for laser vision correction, more specifically, laser-assisted in-situ keratomileusis (LASIK). In addition, some related clinical outcomes data from over 1000 cases performed over a 1-year are presented to highlight some differences between the various treatment profiles currently available including the rapidity of visual recovery. The cases in question were performed on the basis of a decision tree to segregate patients on the basis of anatomical, topographic and aberrometry findings; the decision tree was formulated based on the data available in some of the reviewed articles...
May 18, 2018: Current Opinion in Ophthalmology
https://www.readbyqxmd.com/read/29785658/incidence-and-risk-factors-for-positive-urine-culture-at-the-time-of-pediatric-urologic-surgery
#7
Michael A Maccini, David J Chalmers, Vijaya M Vemulakonda, Jeffrey B Campbell
PURPOSE: Urinary tract infections are relatively common in pediatric patients. Unrecognized bacteriuria at the time of urologic surgery puts patients at increased risk for perioperative complications. Many pediatric urologists obtain preoperative or intraoperative urine cultures prior to surgery, but data are lacking regarding rates and risk factors for positive intraoperative urine cultures. We conducted a retrospective cohort study of patients undergoing pediatric urologic surgery to examine factors associated with positive intraoperative urine cultures...
May 21, 2018: International Urology and Nephrology
https://www.readbyqxmd.com/read/29783665/identification-of-novel-somatic-tp53-mutations-in-patients-with-high-grade-serous-ovarian-cancer-hgsoc-using-next-generation-sequencing-ngs
#8
Marica Garziera, Erika Cecchin, Vincenzo Canzonieri, Roberto Sorio, Giorgio Giorda, Simona Scalone, Elena De Mattia, Rossana Roncato, Sara Gagno, Elena Poletto, Loredana Romanato, Franca Sartor, Jerry Polesel, Giuseppe Toffoli
Somatic mutations in TP53 are a hallmark of high-grade serous ovarian cancer (HGSOC), although their prognostic and predictive value as markers is not well defined. Next-generation sequencing (NGS) can identify novel mutations with high sensitivity, that may be repurposed as potential druggable anti-cancer targets and aid in therapeutic decisions. Here, a commercial NGS cancer panel comprising 26 genes, including TP53 , was used to identify new genetic markers of platinum resistance and patient prognosis in a retrospective set of patients diagnosed with epithelial ovarian cancer...
May 18, 2018: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/29783012/decisional-conflict-among-patients-considering-treatment-options-for-lumbar-herniated-disc
#9
Hwang Richard, Lambrechts Sylvia, Liu Hui, Christopher S Saigal, Kwan Lorna, Cisneros Crystal, Langston T Holly, Duru O Kenrik
BACKGROUND: Lumbar herniated disc is a "preference-sensitive" condition, in which the optimal treatment choice is crucially dependent on an informed patient's goals and values. Little is known about decisional conflict, defined as an individual's level of uncertainty regarding a decision, in patients considering treatment for lumbar herniated discs. Our work aims to identify factors associated with decisional conflict and areas for improved shared decision-making. METHODS: We prospectively surveyed patients seeking treatment for a lumbar herniated disc at L4-L5 and/or L5-S1 with a physician at the UCLA Spine Center...
May 18, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29781890/complexities-of-the-diagnostic-process
#10
Barbara Schildkrout
The diagnostic process is a highly complex, problem-solving enterprise. Yet, traditional case reports have not focused directly on this endeavor. Physicians could use the case format to present actual experiences of getting to a diagnosis. This approach would allow for modeling of nonjudgmental, self-reflective practices and also provide information to aid in studying the diagnostic endeavor. Given that diagnostic errors in medicine are widespread and constitute a serious public health problem, it is crucial for physicians to understand the diagnostic process as one step toward improving error rates...
May 17, 2018: Journal of Nervous and Mental Disease
https://www.readbyqxmd.com/read/29780240/feasibility-of-visual-aids-for-risk-evaluation-by-hospitalized-patients-with-coronary-artery-disease-results-from-face-to-face-interviews
#11
Carlos Alberto da Silva Magliano, Andrea Liborio Monteiro, Bernardo Rangel Tura, Claudia Silvia Rocha Oliveira, Amanda Rebeca de Oliveira Rebelo, Claudia Cristina de Aguiar Pereira
Purpose: Communicating information about risk and probability to patients is considered a difficult task. In this study, we aim to evaluate the use of visual aids representing perioperative mortality and long-term survival in the communication process for patients diagnosed with coronary artery disease at the National Institute of Cardiology, a Brazilian public hospital specializing in cardiology. Patients and methods: One-on-one interviews were conducted between August 1 and November 20, 2017...
2018: Patient Preference and Adherence
https://www.readbyqxmd.com/read/29779961/patient-satisfaction-with-the-consent-discussion-is-not-improved-by-showing-patients-their-computed-tomography-or-angiography-images-before-they-undergo-vascular-surgery
#12
Dominic LeBlanc, Adam H Power, Guy DeRose, Audra Duncan, Luc Dubois
OBJECTIVE: Patient-based decision aids and other multimedia tools have been developed to help enrich the preoperative discussion between surgeon and patient. Use of these tools, however, can be time-consuming and logistically challenging. We investigated whether simply showing patients their images from preoperative computed tomography (CT) or angiography would improve patients' satisfaction with the preoperative discussion. We also examined whether this improved the patient's understanding and trust and whether it contributed to increased preoperative anxiety...
May 18, 2018: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29779361/palliative-and-end-of-life-care-for-heart-failure-patients-in-an-aging-society
#13
Takahiro Okumura, Akinori Sawamura, Toyoaki Murohara
The populations of Asian countries are expected to age rapidly in the near future, with a dramatic increase in the number of heart failure (HF) patients also anticipated. The need for palliative and end-of-life care for elderly patients with advanced HF is currently recognized in aging societies. However, palliative care and active treatment for HF are not mutually exclusive, and palliative care should be provided to reduce suffering occurring at any stage of symptomatic HF after the point of diagnosis. HF patients are at high risk of sudden cardiac death from the early stages of the disease onwards...
May 23, 2018: Korean Journal of Internal Medicine
https://www.readbyqxmd.com/read/29775736/surgical-consent-practice-in-the-uk-following-the-montgomery-ruling-a-national-cross-sectional-questionnaire-study
#14
Chris McKinnon, Dafydd Loughran, Roísín Finn, Madeline Coxwell-Matthewman, Deva Sanjeeva Jeyaretna, Adam P Williams
BACKGROUND: The Supreme Court case of Montgomery vs Lanarkshire Health Board in 2015 was a landmark case for consent practice in the UK which shifted focus from a traditional paternalistic model of consent towards a more patient-centered approach. Widely recognised as the most significant legal judgment on informed consent in the last 30 years, the case was predicted to have a major impact on the everyday practice of surgeons working in the UK National Health Service (NHS). Two years after the legal definition of informed consent was redefined, we carried out an audit of surgical consent practice across the UK to establish the impact of the Montgomery ruling on clinical practice...
May 15, 2018: International Journal of Surgery
https://www.readbyqxmd.com/read/29775092/a-prospective-multi-centre-us-clinical-trial-to-determine-accuracy-of-febridx-point-of-care-testing-for-acute-upper-respiratory-infections-with-and-without-a-confirmed-fever
#15
Nathan I Shapiro, Wesley H Self, Jeffrey Rosen, Stephan C Sharp, Michael R Filbin, Peter C Hou, Amisha D Parekh, Michael C Kurz, Robert Sambursky
BACKGROUND: FebriDx is a 10-minute disposable point-of-care test designed to identify clinically significant systemic host immune responses and aid in the differentiation of bacterial and viral respiratory infection by simultaneously detecting C-reactive protein (CRP) and myxovirus resistance protein A (MxA) from a fingerstick blood sample. FebriDx diagnostic accuracy was evaluated in the emergency room and urgent care setting. METHODS: A prospective, multicentre, observational cohort study of acute upper respiratory tract infections (URIs), with and without a confirmed fever at the time of enrolment, was performed to evaluate the diagnostic accuracy of FebriDx to identify clinically significant bacterial infection with host response and acute pathogenic viral infection...
May 18, 2018: Annals of Medicine
https://www.readbyqxmd.com/read/29771683/an-individualized-strategy-to-estimate-the-effect-of-deformable-registration-uncertainty-on-accumulated-dose-in-the-upper-abdomen
#16
Yibing Wang, Steven F Petit, Eliana Vasquez Osorio, Vikas Gupta, Alejandra Méndez Romero, Ben J M Heijmen
In the abdomen, it is challenging to assess the accuracy of deformable image registration (DIR) for individual patients, due to the lack of clear anatomical landmarks, which can hamper clinical applications that require high accuracy DIR, such as adaptive radiotherapy. In this study, we propose and evaluate a methodology for estimating the impact of uncertainties in DIR on calculated accumulated dose in the upper abdomen, in order to aid decision making in adaptive treatment approaches. 
 Sixteen liver metastasis patients treated with SBRT were evaluated...
May 17, 2018: Physics in Medicine and Biology
https://www.readbyqxmd.com/read/29766138/risk-stratification-tools-in-emergency-general-surgery
#17
REVIEW
Joaquim Michael Havens, Alexandra B Columbus, Anupamaa J Seshadri, Carlos V R Brown, Gail T Tominaga, Nathan T Mowery, Marie Crandall
The use of risk stratification tools (RST) aids in clinical triage, decision making and quality assessment in a wide variety of medical fields. Although emergency general surgery (EGS) is characterized by a comorbid, physiologically acute patient population with disparately high rates of perioperative morbidity and mortality, few RST have been explicitly examined in this setting. We examined the available RST with the intent of identifying a tool that comprehensively reflects an EGS patients perioperative risk for death or complication...
2018: Trauma surgery & acute care open
https://www.readbyqxmd.com/read/29764891/developing-a-complex-intervention-to-support-timely-engagement-with-palliative-care-for-patients-with-advanced-cancer-in-primary-and-secondary-care-in-the-uk-a-study-protocol
#18
Julia Hackett, Hilary Bekker, Michael I Bennett, Paul Carder, Jean Gallagher, Claire Henry, Suzanne Kite, Sally Taylor, Galina Velikova, Lucy Ziegler
INTRODUCTION: For patients with advanced cancer, timely access to palliative care can improve quality of life and enable patients to participate in decisions about their end-of-life care. However, in a UK population of 2500 patients who died from cancer, one-third did not receive specialist palliative care, and of those who did, the duration of involvement was too short to maximise the benefits. Initiating a conversation about palliative care is challenging for some health professionals and patients often have unmet information needs and misconceptions about palliative care...
May 14, 2018: BMJ Open
https://www.readbyqxmd.com/read/29762678/using-statistical-anomaly-detection-models-to-find-clinical-decision-support-malfunctions
#19
Soumi Ray, Dustin S McEvoy, Skye Aaron, Thu-Trang Hickman, Adam Wright
Objective: Malfunctions in Clinical Decision Support (CDS) systems occur due to a multitude of reasons, and often go unnoticed, leading to potentially poor outcomes. Our goal was to identify malfunctions within CDS systems. Methods: We evaluated 6 anomaly detection models: (1) Poisson Changepoint Model, (2) Autoregressive Integrated Moving Average (ARIMA) Model, (3) Hierarchical Divisive Changepoint (HDC) Model, (4) Bayesian Changepoint Model, (5) Seasonal Hybrid Extreme Studentized Deviate (SHESD) Model, and (6) E-Divisive with Median (EDM) Model and characterized their ability to find known anomalies...
May 11, 2018: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/29760822/influence-of-lateral-cephalometric-radiographs-on-orthodontic-treatment-planning-of-class-ii-patients
#20
Irina Stupar, Enver Yetkiner, Daniel Wiedemeier, Thomas Attin, Rengin Attin
Background: Lateral Cephalometric Radiographs (LCR) are a common decision-making aid in orthodontic treatment planning and are routinely used in clinical practice. The aim of this present study was to test the null hypothesis that LCR evaluation does not alter specific components of orthodontic treatment planning in Class II patients. Materials and Methods: Records of 75 patients, who had been treated at the Department of Orthodontics, Centre of Dental Medicine, University of Zurich comprised the study material...
2018: Open Dentistry Journal
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