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Clinical Decision Rule

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81. What Is the Best Imaging Study to Rule Out Pulmonary Embolism in Pregnancy? (SRS diagnosis)

an inconclusive index test result was considered as a positive reference test result. Heterogeneity was assessed by comparing clinical characteristics of the individual studies, such as previous testing and reported clinical decision rule results, stage of pregnancy, and type of imaging modality and technology used. Meta-analysis was not used because of the low methodological quality of the individual studies, as well as increased heterogeneity between the studies. Sensitivity and negative predictive values (...) What Is the Best Imaging Study to Rule Out Pulmonary Embolism in Pregnancy? (SRS diagnosis) What Is the Best Imaging Study to Rule Out Pulmonary Embolism in Pregnancy? TAKE-HOME MESSAGE Both computed tomography (CT) pulmonary angiography and lung scintigraphy (ie, ventilation-perfusion scan) are appropriate imaging options for exclusion of pulmonary embolism during pregnancy. EBEM Commentators Latha Ganti, MD, MBA David Lebowitz, MD Department of Clinical Sciences University of Central Florida

2018 Annals of Emergency Medicine Systematic Review Snapshots

82. Can the HEART Score Rule Out Acute Coronary Syndromes in the ED? (SRS diagnosis)

providers may ?nd this rate acceptable for immediate discharge, including those using decision aids with similar testing characteristics such as the pulmonary embolism rule-out criteria, although the acceptable miss rate for pulmonary embolism may differ from that of major adverse cardiac events. 4 Therefore, this incidence of major adverse cardiac events may not be acceptable to all providers. 5 Rede?ning the low-risk population tothosewithaHEARTscoreof0to2 or performing serial troponin sam- pling may (...) Can the HEART Score Rule Out Acute Coronary Syndromes in the ED? (SRS diagnosis) TAKE-HOME MESSAGE Patients presenting to the emergency department (ED) with possible acute coronary syndrome and a HEART score of 0 to 3 are at low risk for a subsequent major adverse cardiac event. Can the HEART Score Rule Out Acute Coronary Syndromes in the Emergency Department? EBEM Commentators Nathan M. Finnerty, MD Department of Emergency Medicine Intermountain Medical Center Salt Lake City, UT Department

2018 Annals of Emergency Medicine Systematic Review Snapshots

83. BET 1: Can the Manchester Acute Coronary Syndromes and Troponin-only Manchester Acute Coronary Syndromes decision aids rule out acute coronary syndromes in the emergency department? Full Text available with Trip Pro

BET 1: Can the Manchester Acute Coronary Syndromes and Troponin-only Manchester Acute Coronary Syndromes decision aids rule out acute coronary syndromes in the emergency department? A short-cut review was carried out to establish whether the Manchester Acute Coronary Syndromes (MACS) and Troponin-only MACS (T-MACS) decision aids can safely rule out acute coronary syndromes in patients presenting to the ED with suspected cardiac chest pain. Six studies were directly relevant to the question (...) . The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that both rules have high sensitivity for acute coronary syndromes, including the detection of major adverse cardiac events at 30 days. The original MACS algorithm may have marginally greater sensitivity than T-MACS but has inferior specificity and requires the use of a biomarker assay (for heart-type fatty acid binding

2017 Emergency Medicine Journal

84. Evaluating Terminologies to Enable Imaging-Related Decision Rule Sharing Full Text available with Trip Pro

Evaluating Terminologies to Enable Imaging-Related Decision Rule Sharing Purpose: Clinical decision support tools provide recommendations based on decision rules. A fundamental challenge regarding decision rule-sharing involves inadequate expression using standard terminology. We aimed to evaluate the coverage of three standard terminologies for mapping imaging-related decision rules. Methods: 50 decision rules, randomly selected from an existing library, were mapped to Systemized Nomenclature (...) of Medicine (SNOMED CT), Radiology Lexicon (RadLex) and International Classification of Disease (ICD-10-CM). Decision rule attributes and values were mapped to unique concepts, obtaining the best possible coverage with the fewest concepts. Manual and automated mapping using Clinical Text Analysis and Knowledge Extraction System (cTAKES) were performed. Results: Using manual mapping, SNOMED CT provided the greatest concept coverage (83%), compared to RadLex (36%) and ICD-10-CM (8%) (p<0.0001). Combined

2017 AMIA Annual Symposium Proceedings

85. Quality Improvement in Pediatric Head Trauma with PECARN Rules Implementation as Computerized Decision Support Full Text available with Trip Pro

Quality Improvement in Pediatric Head Trauma with PECARN Rules Implementation as Computerized Decision Support For the 1.4 million emergency department (ED) visits for traumatic brain injury (TBI) annually in the United States, computed tomography (CT) may be over utilized. The Pediatric Emergency Care Applied Research Network developed 2 prediction rules to identify children at very low risk of clinically important TBI. We implemented these prediction rules as decision support within our (...) electronic health record (EHR) to reduce CT.To test EHR decision support implementation in reducing CT rates for head trauma at 2 pediatric EDs.We compared monthly CT rates 1 year before [preimplementation (PRE)] and 1 year after [postimplementation (POST)] decision support implementation. The primary outcome was change in CT use rate over time, measured using statistical process control charts. Secondary analyses included multivariate comparisons of PRE to POST. Balancing measures included ED length

2017 Pediatric Quality & Safety

86. A meta-analysis of studies examining the external validity of the dual antiplatelet therapy (DAPT) score and its decision rule

A meta-analysis of studies examining the external validity of the dual antiplatelet therapy (DAPT) score and its decision rule Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record, any (...) . No metastases/ only primary tumor 4. No control group 5. Combination therapy or contamination 6. Not about analgesics used in the clinic Full text-screening: As above, with the addition of: 7. No relevant outcome measure reported ">Prioritise the exclusion criteria Example: Two reviewers will independently extract data from each article. We first try to extract numerical data from tables, text or figures. If these are not reported, we will extract data from graphs using digital ruler software. In case data

2019 PROSPERO

87. Prospective study of a non-restrictive decision rule for acute aortic syndrome. (Abstract)

Prospective study of a non-restrictive decision rule for acute aortic syndrome. To determine the impact of a non-restrictive clinical decision rule on CT utilization for Emergency Department patients suspected of having an acute aortic syndrome (AAS).We prospectively assessed the performance of a previously described, collaboratively designed, non-restrictive clinical decision rule for AAS. Emergency Department patients with suspected AAS were stratified into low and high-risk groups based (...) on decision rule results, from July 2013-August 2014. Patients with acute trauma, prior AAS or aortic surgery were excluded. CT dose reduction protocols were concurrently implemented as a quality improvement measure. Bivariate analysis was performed to compare the prospective cohort with the historical derivation cohort for CT utilization rates, results of CT, AAS incidence and radiation exposure. The performance of the clinical decision rule was evaluated.Compared with the historic cohort, the study

2017 American Journal of Emergency Medicine

88. CanadiEM MVP Infographic Series – The Canadian C-spine rule for radiography in alert and stable trauma patients

and stable trauma patients” published by Stiell et al. 1 Prior to the use of clinical decision rules, such as the Canadian C-spine Rule (CCR), clinicians varied up to 6-fold in how often they ordered C-spine X-rays. Although such X-rays have a low individual cost, they carry a high systems-level cost due to the volume of tests ordered. As such, a good clinical decision rule with high sensitivity to rule out C-spine injuries was much needed. Prior to the development of the CCR, the NEXUS criteria (...) CanadiEM MVP Infographic Series – The Canadian C-spine rule for radiography in alert and stable trauma patients CanadiEM MVP Infographic Series - The Canadian C-spine rule for radiography in alert and stable trauma patients - CanadiEM CanadiEM MVP Infographic Series – The Canadian C-spine rule for radiography in alert and stable trauma patients In , , by Kevin Lam January 25, 2019 This issue of the MVP Infographic Series is focused on “The Canadian C-spine rule for radiography in alert

2019 CandiEM

89. Efficacy and Safety of Outpatient Treatment Based on the Hestia Clinical Decision Rule With or Without NT-proBNP Testing in Patients With Acute Pulmonary Embolism: A Randomized Clinical Trial. (Abstract)

Efficacy and Safety of Outpatient Treatment Based on the Hestia Clinical Decision Rule With or Without NT-proBNP Testing in Patients With Acute Pulmonary Embolism: A Randomized Clinical Trial. Outpatient treatment of pulmonary embolism (PE) may lead to improved patient satisfaction and reduced healthcare costs. However, trials to assess its safety and the optimal method for patient selection are scarce.To validate the utility and safety of selecting patients with PE for outpatient treatment (...) three patients (1.1%; 95% CI, 0.2-3.2%) in the direct discharge group (P = 0.65).Outpatient treatment of patients with PE selected on the basis of the Hestia criteria alone was associated with a low risk of adverse events. Given the low number of patients with elevated NT-proBNP levels, this trial was unable to draw definite conclusions regarding the incremental value of NT-proBNP testing in patients who fulfill the Hestia criteria. Clinical trial registered with www.trialregister.nl/trialreg/admin

2016 American Journal of Respiratory and Critical Care Medicine Controlled trial quality: predicted high

90. Clinical decision rules for pulmonary embolism in hospitalized patients: a systematic literature review and meta-analysis

Clinical decision rules for pulmonary embolism in hospitalized patients: a systematic literature review and meta-analysis Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email salutation (e.g. "Dr Smith" or "Joanne") for correspondence (...) analgesics used in the clinic Full text-screening: As above, with the addition of: 7. No relevant outcome measure reported ">Prioritise the exclusion criteria Example: Two reviewers will independently extract data from each article. We first try to extract numerical data from tables, text or figures. If these are not reported, we will extract data from graphs using digital ruler software. In case data are not reported or unclear, we will attempt to contact authors by e-mail (max. 2 attempts). In case

2017 PROSPERO

91. Agile Acceptance Test–Driven Development of Clinical Decision Support Advisories: Feasibility of Using Open Source Software Full Text available with Trip Pro

Agile Acceptance Test–Driven Development of Clinical Decision Support Advisories: Feasibility of Using Open Source Software Moving to electronic health records (EHRs) confers substantial benefits but risks unintended consequences. Modern EHRs consist of complex software code with extensive local configurability options, which can introduce defects. Defects in clinical decision support (CDS) tools are surprisingly common. Feasible approaches to prevent and detect defects in EHR configuration (...) ), regression testing (once live), and "living" design documentation. Rapid-cycle development or "agile" methods are being successfully applied to CDS development. The agile practice of automated test-driven development is not widely adopted, perhaps because most EHR software code is vendor-developed. However, key CDS advisory configuration design decisions and rules stored in the EHR may prove amenable to automated testing as "executable requirements."We aimed to establish feasibility of acceptance test

2018 JMIR medical informatics

92. Development and validation of a clinical rule for recognition of early inflammatory arthritis. Full Text available with Trip Pro

Development and validation of a clinical rule for recognition of early inflammatory arthritis. National and international guidelines recommend prompt referral of patients presenting with inflammatory arthritis (IA), but general practitioners (GPs) feel uncertain in their proficiency to detect synovitis through joint examination, the method of choice to identify IA. Our objective was to develop and validate a rule composed of clinical characteristics to assist GPs and other physicians (...) items was derived and validated, yielding an area under the receiver operator characteristic curve (AUC) of 0.74 (95% CI 0.70 to 0.78) in the derivation data set. Validation yielded an AUC of 0.71 (95% CI 0.67 to 0.75). Finally, the model was repeated to study predicted probabilities with a lower prevalence of inflammatory arthritis to simulate performance in primary care settings.Our rule, composed of clinical parameters, had reasonable discriminative ability for IA and could assist physicians

2019 BMJ open

93. Development and implementation of "Check of Medication Appropriateness" (CMA): advanced pharmacotherapy-related clinical rules to support medication surveillance. Full Text available with Trip Pro

Development and implementation of "Check of Medication Appropriateness" (CMA): advanced pharmacotherapy-related clinical rules to support medication surveillance. To improve medication surveillance and provide pharmacotherapeutic support in University Hospitals Leuven, a back-office clinical service, called "Check of Medication Appropriateness" (CMA), was developed, consisting of clinical rule based screening for medication inappropriateness. The aim of this study is twofold: 1) describing (...) the development of CMA and 2) evaluating the preliminary results, more specifically the number of clinical rule alerts, number of actions on the alerts and acceptance rate by physicians.CMA focuses on patients at risk for potentially inappropriate medication and involves the daily checking by a pharmacist of high-risk prescriptions generated by advanced clinical rules integrating patient specific characteristics with details on medication. Pharmacists' actions are performed by adding an electronic note

2019 Medical Informatics and Decision Making

94. Hot Off the Press: Hospital Observation Upon Reversal (HOUR) With Naloxone: A Prospective Clinical Prediction Rule Validation Study. Full Text available with Trip Pro

Hot Off the Press: Hospital Observation Upon Reversal (HOUR) With Naloxone: A Prospective Clinical Prediction Rule Validation Study. This is a prospective observational study looking to validate a previously derived decision rule designed to help safely discharge opioid overdose patients from the emergency department after 1 hour. They included a convenience sample of 538 adult patients who had received naloxone pre-hospital and compared the Hospital Observation Upon Reversal (HOUR) rule (...) with clinical judgement. The primary outcome of interest was a broadly defined composite of adverse events. The HOUR rule had a sensitivity of 84.1% (95% CI 76.2-92.1%) and a specificity of 62.1% (95% CI 57.6-66.5%), which was very similar to clinical judgement. Clinical judgement would have missed 12 adverse events, while the HOUR rule would have missed 13, although most of those adverse events were probably minor.© 2019 by the Society for Academic Emergency Medicine.

2019 Academic Emergency Medicine

95. Shared decision making

Shared decision making Shared decision making Shared decision making Key therapeutic topic Published: 1 March 2019 nice.org.uk/guidance/ktt23 pathways K Ke ey points y points In the context of medicines optimisation, shared decision making involves healthcare professionals and patients (patients should be understood to include all people who use NHS services), working together to make choices about medicines based on clinical evidence and the patient's informed preferences about what they hope (...) they make a decision that others consider unwise. Shared decision making: what it is and what it is not A widely quoted definition of shared decision making states: Shared decision making is a process in which healthcare professionals and patients work together to select tests, treatments, management or support packages, based on clinical evidence and the patient's informed preferences. It involves the provision of evidence-based information about options, outcomes and uncertainties, together

2019 National Institute for Health and Clinical Excellence - Advice

96. Chest pain for coronary heart disease in general practice: clinical judgement and a clinical decision rule. Full Text available with Trip Pro

Chest pain for coronary heart disease in general practice: clinical judgement and a clinical decision rule. The Marburg Heart Score (MHS) is a simple, valid, and robust clinical decision rule assisting GPs in ruling out coronary heart disease (CHD) in patients presenting with chest pain.To investigate whether using the rule adds to the GP's clinical judgement.A comparative diagnostic accuracy study was conducted using data from 832 consecutive patients with chest pain in general practice.Three (...) diagnostic strategies were defined using the MHS: diagnosis based solely on the MHS; using the MHS as a triage test; and GP's clinical judgement aided by the MHS. Their accuracy was compared with the GPs' unaided clinical judgement.Sensitivity and specificity of the GPs' unaided clinical judgement was 82.9% (95% confidence interval [CI] = 72.4 to 89.9) and 61.0% (95% CI = 56.7 to 65.2), respectively. In comparison, the sensitivity of the MHS was higher (difference 8.5%, 95% CI = -2.4 to 19.6

2015 British Journal of General Practice

97. Effectiveness and safety of a clinical decision rule for guiding the management of children with pneumonia vaccinated against pneumococcal disease: A controlled clinical trial. (Abstract)

Effectiveness and safety of a clinical decision rule for guiding the management of children with pneumonia vaccinated against pneumococcal disease: A controlled clinical trial. Although most cases of pneumonia in children younger than 5 years old have a viral nature, in everyday practice, they are frequently treated with antibiotics. A clinical decision rule (BPS:Bacterial Pneumonia Score) proved to be effective for identifying which children with pneumonia required antibiotics, but its (...) performance has not been assessed in the population vaccinated against pneumococcal disease. Our objective was to assess whether using the BPS would allow to reduce antibiotic use compared to routine management of children with community acquired pneumonia vaccinated against pneumococcal disease.Randomized, controlled, partially-blinded clinical trial with parallel groups comparing two approaches in the management of children aged 3-60 months old in an outpatient setting because of pneumonia, who had been

2015 Archivos argentinos de pediatria Controlled trial quality: uncertain

98. Evaluation of clinical rules in a standalone pharmacy based clinical decision support system for hospitalized and nursing home patients. (Abstract)

Evaluation of clinical rules in a standalone pharmacy based clinical decision support system for hospitalized and nursing home patients. To improve the current standalone pharmacy clinical decision support system (CDSS) by identifying and quantifying the benefits and limitations of the system.Alerts and handling of the executed clinical rules were extracted from the CDSS from the period September 2011 to December 2011. The number of executed clinical rule alerts, number of actions on alerts (...) , and the reason why alerts were classified as not relevant were analyzed. The alerts where considered clinically relevant when the pharmacist needed to contact the physician.The 4065 alerts have been separated into: 1137 (28.0%) new alerts, 2797 (68.8%) repeat alerts and 131 (3.2%) double alerts. When the alerts were analyzed, only 3.6% were considered clinically relevant. Reasons why alerts were considered as not to be relevant were: (a) the dosage was correct or already adjusted, (b) the drug

2015 International journal of medical informatics

99. The One-hour High Sensitivity Troponin to Rule-Out MI

of the serial high-sensitivity cardiac troponin assays themselves, raising the specter of . Most importantly, the current evidence is limited to providing negative and positive predictive values for the various algorithms. Future studies will need to assess the clinical impact of using the algorithms on decision-making, disposition times, and patient outcomes in order to demonstrate efficacy and safety. It likely the lack of such studies that has kept these algorithms out of our practice in the US, and out (...) The One-hour High Sensitivity Troponin to Rule-Out MI Emergency Medicine > Journal Club > Archive > July 2016 Toggle navigation July 2016 The One-hour High Sensitivity Troponin to Rule-Out MI Vignette You are working your 0irst ever shift as an intern in the Barnes-Jewish Emergency Department on July 1st when you encounter Mrs. P, a forty-year old woman whose chief complaint is chest pain. She reports that 1 hour prior to arrival, while sitting at her desk at work, she developed a sharp

2017 Washington University Emergency Medicine Journal Club

100. Patient-Centered Decision Support: Formative Usability Evaluation of Integrated Clinical Decision Support With a Patient Decision Aid for Minor Head Injury in the Emergency Department. Full Text available with Trip Pro

Patient-Centered Decision Support: Formative Usability Evaluation of Integrated Clinical Decision Support With a Patient Decision Aid for Minor Head Injury in the Emergency Department. The Canadian Computed Tomography (CT) Head Rule, a clinical decision rule designed to safely reduce imaging in minor head injury, has been rigorously validated and implemented, and yet expected decreases in CT were unsuccessful. Recent work has identified empathic care as a key component in decreasing CT overuse (...) . Health information technology can hinder the clinician-patient relationship. Patient-centered decision tools to support the clinician-patient relationship are needed to promote evidence-based decisions.Our objective is to formatively evaluate an electronic tool that not only helps clinicians at the bedside to determine the need for CT use based on the Canadian CT Head Rule but also promotes evidence-based conversations between patients and clinicians regarding patient-specific risk and patients

2017 Journal of medical Internet research

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