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Clinical Decision Rule

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101. Development and validation of a clinical rule for recognition of early inflammatory arthritis. (PubMed)

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

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2019 BMJ open

102. Hot Off the Press: Hospital Observation Upon Reversal (HOUR) With Naloxone: A Prospective Clinical Prediction Rule Validation Study. (PubMed)

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.

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2019 Academic Emergency Medicine

103. 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

104. 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

105. 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

106. To CT, or not to CT? Clinical Decision Rules for Concussion

To CT, or not to CT? Clinical Decision Rules for Concussion To CT, or not to CT? Clinical Decision Rules for Concussion | Cochrane Child Health Passionate about Cochrane evidence for kids! Search Main menu Post navigation by May 11, 2015 – This week’s blog post is also available from (Translating Emergency Knowledge for Kids). Attribution: Wikimedia Commons Head trauma. Headache. Nausea. Loss of balance. Dizziness. Difficulty concentrating. Confusion. Behavioural changes. Sleep changes (...) it is linked to better outcomes, lower admission rates, and serves as the diagnostic standard for identifying intracranial injury ( ). However, it isn’t feasible or necessary to conduct this scan with all children presenting with concussion symptoms. This makes a clinical decision rule for CT scans important. With summer around the corner, and team sports ramping up for the season, understanding and using effective and validated clinical decision rules is essential to identify children at risk

2015 Cochrane Child Health Blog

107. HER2 Testing and Clinical Decision Making in Gastroesophageal Adenocarcinoma

HER2 Testing and Clinical Decision Making in Gastroesophageal Adenocarcinoma CAP Laboratory Improvement Programs HER2 Testing and Clinical Decision Making in Gastroesophageal Adenocarcinoma Guideline From the College of American Pathologists, American Society for Clinical Pathology, and American Society of Clinical Oncology Angela N. Bartley, MD; Mary Kay Washington, MD, PhD; Christina B. Ventura, MT(ASCP); Nofisat Ismaila, MD; Carol Colasacco, MLIS, SCT(ASCP); Al B. Benson III, MD; Alfredo (...) . Objectives.—To establish an evidence-based guideline for HER2 testing in patients with GEA, to formalize the algorithms for methods to improve the accuracy of HER2 testing while addressing which patients and tumor speci- mens are appropriate, and to provide guidance on clinical decision making. Design.—The College of American Pathologists, Amer- ican Society for Clinical Pathology, and American Society of Clinical Oncology convened an expert panel to conduct a systematic review of the literature

2016 College of American Pathologists

108. HER2 Testing and Clinical Decision Making in Gastroesophageal Adenocarcinoma

HER2 Testing and Clinical Decision Making in Gastroesophageal Adenocarcinoma HER2 Testing and Clinical Decision Making in Gastroesophageal Adenocarcinoma: Guideline From the College of American Pathologists, American Society for Clinical Pathology, and the American Society of Clinical Oncology"/> HER2 Testing and Clinical Decision Making in Gastroesophageal Adenocarcinoma: Guideline From the College of American Pathologists, American Society for Clinical Pathology, and the American Society (...) of Clinical Oncology | Journal of Clinical Oncology Search in: Menu Article Tools ASCO SPECIAL ARTICLE Article Tools OPTIONS & TOOLS COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.2016.69.4836 Journal of Clinical Oncology - published online before print November 14, 2016 PMID: HER2 Testing and Clinical Decision Making in Gastroesophageal Adenocarcinoma: Guideline From the College of American Pathologists, American Society for Clinical Pathology, and the American Society

2016 American Society of Clinical Oncology Guidelines

109. Safely Ruling Out Deep Vein Thrombosis in Pregnancy With the LEFt Clinical Decision Rule and D-Dimer

Safely Ruling Out Deep Vein Thrombosis in Pregnancy With the LEFt Clinical Decision Rule and D-Dimer Safely Ruling Out Deep Vein Thrombosis in Pregnancy With the LEFt Clinical Decision Rule and D-Dimer - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please (...) remove one or more studies before adding more. Safely Ruling Out Deep Vein Thrombosis in Pregnancy With the LEFt Clinical Decision Rule and D-Dimer (LEaD) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. of clinical studies and talk to your health care provider before participating. Read our for details. ClinicalTrials.gov Identifier: NCT02507180

2015 Clinical Trials

110. 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. (PubMed)

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

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2017 Journal of medical Internet research

111. Can Emergency Physician Gestalt "Rule In" or "Rule Out" Acute Coronary Syndrome: Validation in a Multicenter Prospective Diagnostic Cohort Study. (PubMed)

Can Emergency Physician Gestalt "Rule In" or "Rule Out" Acute Coronary Syndrome: Validation in a Multicenter Prospective Diagnostic Cohort Study. Chest pain is a common problem presenting to the emergency department (ED). Many decision aids and accelerated diagnostic protocols have been developed to help clinicians differentiate those needing admission from those who can be safely discharged. Some early evidence has suggested that clinician judgment or gestalt alone could be sufficient.Our aim (...) cardiac troponin (cTn) concentration, 100.0% sensitivity and NPV could be achieved. However, this strategy only applied to 4.1% of patients. If patients with "probably not" ACS who had normal ECG and cTn were also ruled out (n = 418, 30.8%), sensitivity fell to 86.2% with 99.2% NPV. Using gestalt "definitely" ACS to rule in ACS gave a specificity of 98.5% and positive predictive value of 71.2%.Clinician gestalt is not sufficiently accurate or safe to either rule in or rule out ACS as a decision-making

2019 Academic Emergency Medicine

112. Can emergency physician gestalt "rule in" or "rule out" acute coronary syndrome: validation in a multi-center prospective diagnostic cohort study. (PubMed)

Can emergency physician gestalt "rule in" or "rule out" acute coronary syndrome: validation in a multi-center prospective diagnostic cohort study. We thank Dr de Souza and Dr Sinert for their comments regarding our study. Indeed we heartily concur that our study took an entirely pragmatic approach, allowing all doctors of sufficient seniority to make clinical decisions to participate. We also acknowledge that doctors were not blinded to initial cardiac troponin or electrocardiogram results (...) . As the study took place in real time involving real patients, we realized in advance that it would have been unethical to blind physicians to such important clinical information.© 2019 by the Society for Academic Emergency Medicine.

2019 Academic Emergency Medicine

113. 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

114. Agile Acceptance Test–Driven Development of Clinical Decision Support Advisories: Feasibility of Using Open Source Software (PubMed)

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

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2018 JMIR medical informatics

115. The Massachusetts abscess rule: a clinical decision rule using ultrasound to identify methicillin-resistant Staphylococcus aureus in skin abscesses. (PubMed)

The Massachusetts abscess rule: a clinical decision rule using ultrasound to identify methicillin-resistant Staphylococcus aureus in skin abscesses. Treatment failure rates for incision and drainage (I&D) of skin abscesses have increased in recent years and may be attributable to an increased prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). Previous authors have described sonographic features of abscesses, such as the presence of interstitial fluid (...) , characteristics of abscess debris, and depth of abscess cavity. It is possible that the sonographic features are associated with MRSA and can be used to predict the presence of MRSA. The authors describe a potential clinical decision rule (CDR) using sonographic images to predict the presence of CA-MRSA.This was a pilot CDR derivation study using databases from two emergency departments (EDs) of patients presenting to the ED with uncomplicated skin abscesses who underwent I&D and culture of the abscess

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2014 Academic Emergency Medicine

116. A simple clinical decision rule to rule out appendicitis in patients with nondiagnostic ultrasound results. (PubMed)

A simple clinical decision rule to rule out appendicitis in patients with nondiagnostic ultrasound results. The objective was to identify a set of clinical features that can rule out appendicitis in patients with suspected acute appendicitis and nondiagnostic ultrasound (US) results, allowing safe discharge and next-day reevaluation without initial computed tomography (CT) or magnetic resonance imaging (MRI).Data on clinical and US evaluation, including a number of prespecified variables (...) potentially associated with acute appendicitis, were prospectively collected in two diagnostic accuracy studies of imaging. These studies included patients with suspected appendicitis seen in the emergency department (ED). For development and validation of the clinical decision rule (CDR), only patients with inconclusive or negative US results were included. There were 199 (of 422) patients in the development cohorts and 120 (of 211) patients in the validation cohort. Logistic regression analysis was used

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2014 Academic Emergency Medicine

117. A prospective observational study to assess the diagnostic accuracy of clinical decision rules for children presenting to emergency departments after head injuries (protocol): the Australasian Paediatric Head Injury Rules Study (APHIRST). (PubMed)

A prospective observational study to assess the diagnostic accuracy of clinical decision rules for children presenting to emergency departments after head injuries (protocol): the Australasian Paediatric Head Injury Rules Study (APHIRST). Head injuries in children are responsible for a large number of emergency department visits. Failure to identify a clinically significant intracranial injury in a timely fashion may result in long term neurodisability and death. Whilst cranial computed (...) tomography (CT) provides rapid and definitive identification of intracranial injuries, it is resource intensive and associated with radiation induced cancer. Evidence based head injury clinical decision rules have been derived to aid physicians in identifying patients at risk of having a clinically significant intracranial injury. Three rules have been identified as being of high quality and accuracy: the Canadian Assessment of Tomography for Childhood Head Injury (CATCH) from Canada, the Children's Head

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2014 BMC Pediatrics

118. 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

119. Rare adverse events in clinical trials: understanding the rule of three

Rare adverse events in clinical trials: understanding the rule of three Rare adverse events in clinical trials: understanding the rule of three | BMJ EBM Spotlight by Investigators should report rare and very rare adverse events in clinical trials: Igho Onakpoya reports why it is important that all events are reported irrespective of their frequency. Even though they may not give a signal in any single trial, a meta-analysis could reveal potentially important drug-adverse event associations (...) that might require further verification. Data from a meta-analysis of such rare events can shorten the time to decision making by regulatory agencies and/or drug manufacturers, especially in cases where the reported harms are severe. The benefit-harm profiles of new medicines are usually not fully known at the time of regulatory approval. This is because most trials are powered to detect benefits but not adverse events and also because adverse events or . One issue is the number of trial subjects

2017 Evidence-Based Medicine blog

120. Development and Validation of a Clinical Prediction Rule for Bacteremia among Maintenance Hemodialysis Patients in Outpatient Settings. (PubMed)

Development and Validation of a Clinical Prediction Rule for Bacteremia among Maintenance Hemodialysis Patients in Outpatient Settings. To our knowledge, no reliable clinical prediction rule (CPR) for identifying bacteremia in hemodialysis (HD) patients has been established. The aim of this study was to develop a CPR for bacteremia in maintenance HD patients visiting the outpatient department.This multicenter cohort study involved consecutive maintenance HD patients who visited the outpatient (...) % and 51.4%, respectively.We established a simple CPR for bacteremia in maintenance HD patients using routinely obtained clinical information in an outpatient setting. This model may facilitate more appropriate clinical decision making.

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2017 PLoS ONE

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