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Stratified medicine

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https://www.readbyqxmd.com/read/27913975/clinical-impact-of-an-antibiotic-stewardship-program-at-a-children-s-hospital
#1
Brian R Lee, Jennifer L Goldman, Diana Yu, Angela L Myers, Leslie M Stach, Erin Hedican, Mary Anne Jackson, Jason G Newland
INTRODUCTION: Antibiotic stewardship programs (ASP) improve appropriate antibiotic use. Data are limited on the clinical benefit of ASPs in children's hospitals. This study's objective was to determine the impact of an ASP on length of stay (LOS) and readmission rate among patients admitted to children's hospitals. METHODS: Data from a prospective-audit-with-feedback ASP were used to examine the ASP review characteristics, including antibiotic(s) prescribed, clinical indication, recommendations made by the ASP, and agreement with recommendations...
December 2, 2016: Infectious Diseases and Therapy
https://www.readbyqxmd.com/read/27910122/one-stage-individual-participant-data-meta-analysis-models-estimation-of-treatment-covariate-interactions-must-avoid-ecological-bias-by-separating-out-within-trial-and-across-trial-information
#2
Hairui Hua, Danielle L Burke, Michael J Crowther, Joie Ensor, Catrin Tudur Smith, Richard D Riley
Stratified medicine utilizes individual-level covariates that are associated with a differential treatment effect, also known as treatment-covariate interactions. When multiple trials are available, meta-analysis is used to help detect true treatment-covariate interactions by combining their data. Meta-regression of trial-level information is prone to low power and ecological bias, and therefore, individual participant data (IPD) meta-analyses are preferable to examine interactions utilizing individual-level information...
December 1, 2016: Statistics in Medicine
https://www.readbyqxmd.com/read/27902695/text-mining-genotype-phenotype-relationships-from-biomedical-literature-for-database-curation-and-precision-medicine
#3
Ayush Singhal, Michael Simmons, Zhiyong Lu
The practice of precision medicine will ultimately require databases of genes and mutations for healthcare providers to reference in order to understand the clinical implications of each patient's genetic makeup. Although the highest quality databases require manual curation, text mining tools can facilitate the curation process, increasing accuracy, coverage, and productivity. However, to date there are no available text mining tools that offer high-accuracy performance for extracting such triplets from biomedical literature...
November 2016: PLoS Computational Biology
https://www.readbyqxmd.com/read/27901055/mediboost-a-patient-stratification-tool-for-interpretable-decision-making-in-the-era-of-precision-medicine
#4
Gilmer Valdes, José Marcio Luna, Eric Eaton, Charles B Simone, Lyle H Ungar, Timothy D Solberg
Machine learning algorithms that are both interpretable and accurate are essential in applications such as medicine where errors can have a dire consequence. Unfortunately, there is currently a tradeoff between accuracy and interpretability among state-of-the-art methods. Decision trees are interpretable and are therefore used extensively throughout medicine for stratifying patients. Current decision tree algorithms, however, are consistently outperformed in accuracy by other, less-interpretable machine learning models, such as ensemble methods...
November 30, 2016: Scientific Reports
https://www.readbyqxmd.com/read/27899030/childhood-vaccine-refusal-and-hesitancy-intentions-in-croatia-insights-from-a-population-based-study
#5
Anja Repalust, Sandra Šević, Stanko Rihtar, Aleksandar Štulhofer
Considering that programmatic data suggest a recent rise in vaccine refusal in Croatia, this study, first of its kind in Southeast Europe, aimed to estimate the prevalence, and sociodemographic, and sociocultural determinants of childhood vaccine refusal and hesitancy (CVRH) intentions among Croatian adults. Multi-stage stratified population-based survey included 1000 individuals aged 18-88 years (Mage = 47.7, SD = 17.8), of whom 51.7% were women. The outcome, a categorical indicator, distinguished among individuals who would approve vaccinating their children (vaccine accepting), those who would approve some but not all vaccines (vaccine hesitant), and those who would refuse vaccination (vaccine refusing)...
November 29, 2016: Psychology, Health & Medicine
https://www.readbyqxmd.com/read/27898627/publishing-trends-in-the-field-of-pediatric-emergency-medicine-from-2004-to-2013
#6
Nancy S Rixe, Jeffrey Rixe, Joshua Glick, Erik Lehman, Robert P Olympia
OBJECTIVE: To identify publishing trends within the field of pediatric emergency medicine between 2004 and 2013. METHODS: We conducted a MEDLINE search of pediatric emergency medicine articles, filtered by clinical trial, published between 2004 and 2013 in ten journals from the fields of pediatrics, emergency medicine, general medicine, and pediatric emergency medicine. Each article was classified by journal type, study design, results (positive or negative/equivocal), age/type of subjects, and major topic (based on the objective of the study)...
December 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27884964/what-are-the-characteristics-of-and-clinical-outcomes-in-men-who-have-sex-with-men-prescribed-hiv-postexposure-prophylaxis-following-sexual-exposure-pepse-at-sexual-health-clinics-in-england
#7
Holly Mitchell, Martina Furegato, Gwenda Hughes, Nigel Field, Anthony Nardone
OBJECTIVES: To explore the risk factors for, and clinical outcomes in men who have sex with men (MSM) prescribed HIV postexposure prophylaxis following sexual exposure (PEPSE) at sexual health clinics (SHCs) in England. METHODS: National STI surveillance data were extracted from the genitourinary medicine clinic activity dataset (GUMCADv2) for 2011-2014. Quarterly and annual trends in the number of episodes where PEPSE was prescribed were analysed by gender and sexual risk...
November 24, 2016: Sexually Transmitted Infections
https://www.readbyqxmd.com/read/27884579/number-of-daily-antihypertensive-drugs-and-the-risk-of-osteoporotic-fractures-in-older-hypertensive-adults-national-health-insurance-service-senior-cohort
#8
So Yeon Kim, Sunyoung Kim, Sung Eun Choi, Byung Sung Kim, Hyun Rim Choi, Deri Hwang, Chang Won Won
BACKGROUND: Antihypertensive medication represents one of the most common prescriptions for senior individuals. Numerous studies have assessed the influence of antihypertensive treatment on the risk for osteoporotic fracture, yet much controversy remains. We analyzed the relationship between the incidence of osteoporotic fracture and the average number of daily antihypertensive drugs (NDAD) included in the prescription of elderly hypertensive patients. METHODS: The study population was derived from the National Health Insurance Service-Senior Cohort (2002-2013), and consisted of elderly patients (≥60 years) diagnosed with hypertension in 2009, who did not have osteoporotic fractures in 2008, and underwent at least one national health check-up between 2009 and 2013, and had complete records after 2010...
November 21, 2016: Journal of Cardiology
https://www.readbyqxmd.com/read/27879323/issues-and-challenges-in-diagnostic-sequencing-for-inherited-cardiac-conditions
#9
REVIEW
Roddy Walsh, Stuart A Cook
BACKGROUND: Inherited cardiac conditions are a relatively common group of Mendelian diseases associated with ill health and death, often in the young. Research into the genetic causes of these conditions has enabled confirmatory and predictive diagnostic sequencing to become an integral part of the clinical management of inherited cardiomyopathies, arrhythmias, aortopathies, and dyslipidemias. CONTENT: Currently, the principle benefit of clinical genetic testing is the cascade screening of family members of patients with a pathogenic variant, enabling targeted follow up of presymptomatic genotype-positive individuals and discharge of genotype-negative individuals to health...
November 22, 2016: Clinical Chemistry
https://www.readbyqxmd.com/read/27872480/association-of-pre-pregnancy-body-mass-index-gestational-weight-gain-with-cesarean-section-in-term-deliveries-of-china
#10
Chao Xiong, Aifen Zhou, Zhongqiang Cao, Yaqi Zhang, Lin Qiu, Cong Yao, Youjie Wang, Bin Zhang
China has one of the highest rates of cesarean sections in the world. However, limited epidemiological studies have evaluated the risk factors for cesarean section among Chinese women. Thus, the aim of this cohort study was to investigate the associations between pre-pregnancy BMI, gestational weight gain (GWG) and the risk of cesarean section in China. A total of 57,891 women with singleton, live-born, term pregnancies were included in this analysis. We found that women who were overweight or obese before pregnancy had an elevated risk of cesarean section...
November 22, 2016: Scientific Reports
https://www.readbyqxmd.com/read/27863834/correlation-between-united-states-medical-licensing-examination-and-comprehensive-osteopathic-medical-licensing-examination-scores-for-applicants-to-a-dually-approved-emergency-medicine-residency
#11
Kathleen E Kane, Dawn Yenser, Kevin R Weaver, Gavin C Barr, Terrence E Goyke, Shawn M Quinn, Charles C Worrilow, Andre J Burckhart, Adam L Leonetti, Isamu E Yoshioka, Stephen W Dusza, Bryan G Kane
BACKGROUND: It is important for emergency medicine (EM) residency programs to be able to correlate the United States (US) Medical Licensing Examination (USMLE) and Comprehensive Osteopathic Medical Licensing Examination (COMLEX) scores of applicants. OBJECTIVE: We sought to determine the correlation between USMLE and COMLEX scores for EM residency applicants. METHODS: Retrospectively, from 2006 through 2013, USMLE and COMLEX examination scores for applicants to our 4-year, 56-member, dually approved EM residency were analyzed...
November 15, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27863809/efficacy-and-safety-of-tau-aggregation-inhibitor-therapy-in-patients-with-mild-or-moderate-alzheimer-s-disease-a-randomised-controlled-double-blind-parallel-arm-phase-3-trial
#12
Serge Gauthier, Howard H Feldman, Lon S Schneider, Gordon K Wilcock, Giovanni B Frisoni, Jiri H Hardlund, Hans J Moebius, Peter Bentham, Karin A Kook, Damon J Wischik, Bjoern O Schelter, Charles S Davis, Roger T Staff, Luc Bracoud, Kohkan Shamsi, John M D Storey, Charles R Harrington, Claude M Wischik
BACKGROUND: Leuco-methylthioninium bis(hydromethanesulfonate; LMTM), a stable reduced form of the methylthioninium moiety, acts as a selective inhibitor of tau protein aggregation both in vitro and in transgenic mouse models. Methylthioninium chloride has previously shown potential efficacy as monotherapy in patients with Alzheimer's disease. We aimed to determine whether LMTM was safe and effective in modifying disease progression in patients with mild to moderate Alzheimer's disease...
November 15, 2016: Lancet
https://www.readbyqxmd.com/read/27862181/identification-of-biomarker-by-treatment-interactions-in-randomized-clinical-trials-with-survival-outcomes-and-high-dimensional-spaces
#13
Nils Ternès, Federico Rotolo, Georg Heinze, Stefan Michiels
Stratified medicine seeks to identify biomarkers or parsimonious gene signatures distinguishing patients that will benefit most from a targeted treatment. We evaluated 12 approaches in high-dimensional Cox models in randomized clinical trials: penalization of the biomarker main effects and biomarker-by-treatment interactions (full-lasso, three kinds of adaptive lasso, ridge+lasso and group-lasso); dimensionality reduction of the main effect matrix via linear combinations (PCA+lasso (where PCA is principal components analysis) or PLS+lasso (where PLS is partial least squares)); penalization of modified covariates or of the arm-specific biomarker effects (two-I model); gradient boosting; and univariate approach with control of multiple testing...
November 15, 2016: Biometrical Journal. Biometrische Zeitschrift
https://www.readbyqxmd.com/read/27849442/to-genotype-or-phenotype-for-personalized-medicine-cyp450-drug-metabolizing-enzyme-genotype-phenotype-concordance-and-discordance-in-the-ecuadorian-population
#14
Fernando De Andrés, Santiago Terán, Francisco Hernández, Enrique Terán, Adrián LLerena
Genetic variations within the cytochrome P450 (CYP450) superfamily of drug metabolizing enzymes confer substantial person-to-person and between-population differences in pharmacokinetics, and by extension, highly variable clinical effects of medicines. In this context, "personalized medicine," "precision medicine," and "stratified medicine" are related concepts attributed to what is essentially targeted therapeutics and companion diagnostics, aimed at improving safety and effectiveness of health interventions...
November 16, 2016: Omics: a Journal of Integrative Biology
https://www.readbyqxmd.com/read/27846850/comorbidities-and-characteristics-of-coronary-heart-disease-patients-their-impact-on-health-related-quality-of-life
#15
Ksenija Tušek-Bunc, Davorina Petek
BACKGROUND: Patients with coronary heart disease (CHD) commonly present with more than one comorbid condition, contributing to poorer health-related quality of life (HRQoL). The aim of our study was to identify the associations between HRQoL and patient characteristics, vascular comorbidities and anxiety/depression disorders. METHODS: This observational study was conducted in 36 family medicine practices selected by random stratified sampling from all regions of Slovenia...
November 15, 2016: Health and Quality of Life Outcomes
https://www.readbyqxmd.com/read/27846280/development-and-application-of-a-microfluidics-based-panel-in-the-basal-luminal-transcriptional-characterization-of-archival-bladder-cancers
#16
Doris Kim, YounJeong Choi, James Ireland, Oded Foreman, Rachel N Tam, Rajesh Patel, Erica B Schleifman, Maipelo Motlhabi, Dorothy French, Cheryl V Wong, Eric Peters, Luciana Molinero, Rajiv Raja, Lukas C Amler, Garret M Hampton, Mark R Lackner, Omar Kabbarah
In the age of personalized medicine stratifying tumors into molecularly defined subtypes associated with distinctive clinical behaviors and predictable responses to therapies holds tremendous value. Towards this end, we developed a custom microfluidics-based bladder cancer gene expression panel for characterization of archival clinical samples. In silico analysis indicated that the content of our panel was capable of accurately segregating bladder cancers from several public datasets into the clinically relevant basal and luminal subtypes...
2016: PloS One
https://www.readbyqxmd.com/read/27837553/biobanking-an-important-resource-for-precision-medicine-in-glioblastoma
#17
Si Yan Melanie Tan, Edwin Sandanaraj, Carol Tang, Beng Ti Christopher Ang
The Cancer Genome Atlas effort has generated significant interest in a new paradigm shift in tumor tissue analysis, patient diagnosis and subsequent treatment decision. Findings have highlighted the limitation of sole reliance on histology, which can be confounded by inter-observer variability. Such studies demonstrate that histologically similar grade IV brain tumors can be divided into four molecular subtypes based on gene expression, with each subtype demonstrating unique genomic aberrations and clinical outcome...
2016: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/27828869/knowledge-of-medical-professionalism-in-medical-students-and-physicians-at-shahid-beheshti-university-of-medical-sciences-and-affiliated-hospitals-iran
#18
Mehran Seif-Farshad, Shabnam Bazmi, Farzad Amiri, Faeze Fattahi, Mehrzad Kiani
Although medical professionalism is a fundamental aspect of competence in medicine and a distinct facet of physicians' competence, evidence suggests that the subject of professionalism is not taught or assessed as part of medical students' curricula in Iran and many other countries. Assessing the knowledge of medical students and physicians about medical professionalism seems to be helpful in identifying the weaknesses of training in the field of professionalism and devise plans for future training on the subject...
November 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27821143/prevalence-of-mental-distress-and-associated-factors-among-hawassa-university-medical-students-southern-ethiopia-a-cross-sectional-study
#19
Biniam Melese, Birhanu Bayu, Fikir Wondwossen, Kalkidan Tilahun, Seti Lema, Moges Ayehu, Eskindir Loha
BACKGROUND: Mental distress is a mental health problem expressed with variable levels of depressive, anxiety, panic or somatic symptoms. Owing to several factors tertiary level students are among the population with higher prevalence of mental distress and an even more higher prevalence has been reported in medical students. The aim of this study was to determine the prevalence of mental distress among medical students, and to evaluate contextually relevant associated factors. METHODS: A cross-sectional study was conducted among medical students attending Hawassa University College of Medicine and Health Sciences in 2013/2014 academic year...
November 8, 2016: BMC Research Notes
https://www.readbyqxmd.com/read/27819294/big-genomics-and-clinical-data-analytics-strategies-for-precision-cancer-prognosis
#20
Ghim Siong Ow, Vladimir A Kuznetsov
The field of personalized and precise medicine in the era of big data analytics is growing rapidly. Previously, we proposed our model of patient classification termed Prognostic Signature Vector Matching (PSVM) and identified a 37 variable signature comprising 36 let-7b associated prognostic significant mRNAs and the age risk factor that stratified large high-grade serous ovarian cancer patient cohorts into three survival-significant risk groups. Here, we investigated the predictive performance of PSVM via optimization of the prognostic variable weights, which represent the relative importance of one prognostic variable over the others...
November 7, 2016: Scientific Reports
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