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Clinical Decision Rule

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121. Comparing the diagnostic performance of 2 clinical decision rules to rule out deep vein thrombosis in primary care patients (PubMed)

Comparing the diagnostic performance of 2 clinical decision rules to rule out deep vein thrombosis in primary care patients The Wells rule is widely used for clinical assessment of patients with suspected deep vein thrombosis (DVT), especially in the secondary care setting. Recently a new clinical decision rule for primary care patients (the primary care rule) has been proposed, because the Wells rule is not sufficient to rule out DVT in this setting. The objective was to compare the ability (...) of both rules to safely rule out DVT and to efficiently reduce the number of referrals for leg ultrasound investigation that would result in a negative finding.Family physicians collected data on 1,086 patients to calculate the scores for both decision rules before leg ultrasonography was performed. In all patients D-dimer (dimerized plasmin fragment D) testing was performed using a rapid point-of-care assay. Patients were stratified into risk categories defined by each rule and the D-dimer result

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2011 EvidenceUpdates

122. Outcome variation among Canadian trauma centres: toward a clinical prediction rule for standardizing approaches to clinical assessment of hemorrhage (PubMed)

Outcome variation among Canadian trauma centres: toward a clinical prediction rule for standardizing approaches to clinical assessment of hemorrhage 28930038 2017 11 20 2018 12 02 1488-2310 60 5 2017 10 Canadian journal of surgery. Journal canadien de chirurgie Can J Surg Outcome variation among Canadian trauma centres: toward a clinical prediction rule for standardizing approaches to clinical assessment of hemorrhage. E3 Tran Alexandre A From the Ottawa Hospital, Ottawa, Ont. Matar Maher M (...) From the Ottawa Hospital, Ottawa, Ont. Lampron Jacinthe J From the Ottawa Hospital, Ottawa, Ont. Steyerberg Ewout E From the Ottawa Hospital, Ottawa, Ont. Vaillancourt Christian C From the Ottawa Hospital, Ottawa, Ont. Taljaard Monica M From the Ottawa Hospital, Ottawa, Ont. eng Journal Article Comment Canada Can J Surg 0372715 0008-428X IM Can J Surg. 2017 Feb;60(1):45-52 28234589 Canada Decision Support Techniques Humans Neck Injuries Trauma Centers 2017 9 21 6 0 2017 9 21 6 0 2017 11 29 6 0

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2017 Canadian Journal of Surgery

123. Prediction of Early Recurrence of Liver Cancer by a Novel Discrete Bayes Decision Rule for Personalized Medicine (PubMed)

JIS, and the TNM classification have been proposed as liver scoring systems, none of these scoring systems have met the needs of clinical practice. In this paper, we convert continuous and discrete data to categorical data and keep the natively categorical data as is. Then, we propose a discrete Bayes decision rule that can deal with the categorical data. This may lead to its use with various types of laboratory data. Experimental results show that the proposed method produced a sensitivity (...) Prediction of Early Recurrence of Liver Cancer by a Novel Discrete Bayes Decision Rule for Personalized Medicine We discuss a novel diagnostic method for predicting the early recurrence of liver cancer with high accuracy for personalized medicine. The difficulty with cancer treatment is that even if the types of cancer are the same, the cancers vary depending on the patient. Thus, remarkable attention has been paid to personalized medicine. Unfortunately, although the Tokyo Score, the Modified

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2016 BioMed research international

124. Creating a Diagnostic Decision Rule for Shoulder Injury: CASH-trial

Sponsor: Zaans Medisch Centrum Information provided by (Responsible Party): K. Rijsbergen, Zaans Medisch Centrum Study Details Study Description Go to Brief Summary: What combination of ≤ 6 clinical variables will give the highest specificity for indicating significant shoulder injuries (fractures or dislocations) with a set sensitivity of ≥ 97%? Although shoulder trauma is a common injury, there is no clinical decision rule to determine the necessity for radiography for these traumas. With this trial (...) the investigators aim to develop such a rule to reduce the amount of radiographs without missing any significant injuries. The primary objective is to compose a set of clinical diagnostic criteria predictive of shoulder fractures or dislocations that would reduce the amount of radiographs without missing any significant injuries. A second objective is to determine if the clinical decision rule is applicable for triage use. Condition or disease Intervention/treatment Phase Trauma Other: Standard diagnostic item

2016 Clinical Trials

125. External Validation of the Manchester Acute Coronary Syndromes Decision Rule. (PubMed)

at presentation to the ED. The objective was to externally validate the MACS decision rule and establish its diagnostic accuracy as a discharge tool in a new set of prospectively recruited ED patients.In this preplanned analysis of a prospectively recruited single-center cohort, consecutive ED patients ≥18 years with suspected ACS were included. Testing for h-FABP and high-sensitivity troponin T was undertaken on serum drawn on arrival, and any clinical features required to calculate the MACS rule were (...) External Validation of the Manchester Acute Coronary Syndromes Decision Rule. The Manchester Acute Coronary Syndromes (MACS) decision rule has been shown to be a powerful diagnostic tool in emergency department (ED) patients with suspected acute coronary syndromes (ACS). It has the potential to improve system efficiency by identifying patients suitable for discharge after a single blood draw for high-sensitivity troponin and heart-type fatty acid-binding protein (h-FABP) analysis

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2016 Academic Emergency Medicine

126. Utility of Decision Rules for Transcutaneous Bilirubin Measurements. (PubMed)

Utility of Decision Rules for Transcutaneous Bilirubin Measurements. Transcutaneous bilirubin (TcB) meters are widely used for screening newborns for jaundice, with a total serum bilirubin (TSB) measurement indicated when the TcB value is classified as "positive" by using a decision rule. The goal of our study was to assess the clinical utility of 3 recommended TcB screening decision rules.Paired TcB/TSB measurements were collected at 34 newborn nursery sites. At 27 sites (sample 1), newborns (...) were routinely screened with a TcB measurement. For sample 2, sites that typically screen with TSB levels also obtained a TcB measurement for the study. Three decision rules to define a positive TcB measurement were evaluated: ≥75th percentile on the Bhutani nomogram, 70% of the phototherapy level, and within 3 mg/dL of the phototherapy threshold. The primary outcome was a TSB level at/above the phototherapy threshold. The rate of false-negative TcB screens and percentage of blood draws avoided

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2016 Pediatrics

127. Validation of thoracic injury rule out criteria as a decision instrument for screening of chest radiography in blunt thoracic trauma (PubMed)

Validation of thoracic injury rule out criteria as a decision instrument for screening of chest radiography in blunt thoracic trauma Thoracic injury rule out criteria (TIRC) were first introduced as a decision instrument for selective chest radiography in blunt thoracic trauma in 2014. However, the validity of this model has not been assessed in other studies. In this regard, the present survey evaluates the validity of TIRC model in a multi-center setting.In this cross-sectional study (...) , clinical presentations and chest radiograms of multiple trauma patients referring to 6 educational hospitals in Iran were evaluated. Data were gathered prospectively during 2015. In each center, data collection and interpretation of radiograms were conducted by two different emergency medicine specialists. Measures were then taken for assessment of discriminatory power and calibration of the model.Data from 2905 patients were gathered (73.17% were male; the mean age was 33.53 ± 15.42 years). Area under

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2016 Journal of clinical orthopaedics and trauma

128. Nexus Chest CT Decision Rule in Blunt Trauma

rules have poor and is useful only when negative Use clinical judgment to determine CT indications VI. References Lin and Rodriguez in Herbert (2016) EM:Rap 16(2): 10-11 Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Nexus Chest CT Decision Rule in Blunt Trauma." Click on the image (or right click) to open the source website in a new browser window. Related Studies (from Trip Database) Related Topics in Radiology About (...) Nexus Chest CT Decision Rule in Blunt Trauma Nexus Chest CT Decision Rule in Blunt Trauma Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer

2018 FP Notebook

129. Computerized clinical decision support systems for drug prescribing and management: a decision-maker-researcher partnership systematic review

Computerized clinical decision support systems for drug prescribing and management: a decision-maker-researcher partnership systematic review Computerized clinical decision support systems for drug prescribing and management: a decision-maker-researcher partnership systematic review Computerized clinical decision support systems for drug prescribing and management: a decision-maker-researcher partnership systematic review Hemens BJ, Holbrook A, Tonkin M, Mackay JA, Weise-Kelly L, Navarro T (...) , Wilczynski NL, Haynes RB; CCDSS Systematic Review Team CRD summary The review assessed the effects of computerised clinical decision support systems for drug therapy management on process of care and patient outcomes. The authors concluded that results showed inconsistent improvement. Due the basic synthesis adopted, the reliability of the author's conclusions is uncertain. Authors' objectives To assess the effects of computerised clinical decision support systems for drug therapy management on process

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2011 DARE.

130. Computerized clinical decision support systems for acute care management: A decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes

Computerized clinical decision support systems for acute care management: A decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes Computerized clinical decision support systems for acute care management: A decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes Computerized clinical decision support systems for acute care management: A decision-maker-researcher partnership systematic review (...) of effects on process of care and patient outcomes Sahota N, Lloyd R, Ramakrishna A, Mackay JA, Prorok JC, Weise-Kelly L, Navarro T, Wilczynski NL, Haynes RB, CCDSS Systematic Review Team CRD summary The review concluded that most computerised clinical decision support systems improved process of care, but patient outcomes were rarely assessed. Systems have not matured sufficiently to enable application in acute care settings. Wide variability in studies and limitations surrounding the determination

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2011 DARE.

131. Chest pain for coronary heart disease in general practice: clinical judgement and a clinical decision rule. (PubMed)

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

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2015 British Journal of General Practice

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

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

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

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

134. Accuracy of the "traffic light" clinical decision rule for serious bacterial infections in young children with fever: a retrospective cohort study. (PubMed)

Accuracy of the "traffic light" clinical decision rule for serious bacterial infections in young children with fever: a retrospective cohort study. To determine the accuracy of a clinical decision rule (the traffic light system developed by the National Institute for Health and Clinical Excellence (NICE)) for detecting three common serious bacterial infections (urinary tract infection, pneumonia, and bacteraemia) in young febrile children.Retrospective analysis of data from a two year

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2013 BMJ

135. Development of a clinical prediction rule to diagnose Pneumocystis jirovecii pneumonia in the World Health Organization’s algorithm for seriously ill HIV-infected patients (PubMed)

. The area under the receiver operating characteristic curve of the clinical prediction rule models was 0.761 (95% CI 0.683-0.840) for the respiratory rate model and 0.797 (95% CI 0.725-0.868) for the oxygen saturation model. Both models had zero probability for PJP for scores of zero, and positive likelihood ratios exceeded 10 for high scores.We developed simple clinical prediction rules for PJP, which, if externally validated, could assist decision-making in the WHO seriously ill algorithm. (...) Development of a clinical prediction rule to diagnose Pneumocystis jirovecii pneumonia in the World Health Organization’s algorithm for seriously ill HIV-infected patients The World Health Organization (WHO) algorithm for the diagnosis of tuberculosis in seriously ill HIV-infected patients recommends that treatment for Pneumocystis jirovecii pneumonia (PJP) should be considered without giving clear guidance on selecting patients for empiric PJP therapy. PJP is a common cause

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2018 Southern African journal of HIV medicine

136. Editor’s picks: Clinical prediction rules: Use the babies and throw the bathwater?

to maintain autonomy in decision-making. That is, participants wanted a CPR to guide their decision-making, not dictate a course of action. You might call this the “I’m not a robot, don’t tell me what to do” effect, which I think raises a nice question: How then do these tools ideally fit within our practice? Despite the HIGHLY unfortunate nomenclature, clinical prediction RULES probably shouldn’t be considered rules at all (at least not in the dictatorial sense – perhaps in the statistical sense (...) of development of prediction models for primary care physical therapy: a systematic review. Journal of Clinical Epidemiology. 2012;65(12):1257-1266. [3] Stiell IG, Bennett C. Implementation of Clinical Decision Rules in the Emergency Department. Academic Emergency Medicine. 2007;14(11):955-959. [4] Hill JC, Whitehurst DG, Lewis M, et al. Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. The Lancet. 2011;378(9802):1560

2018 Body in Mind blog

137. Effectiveness and Safety of a Clinical Assessment and 0h/1h Troponin Rule-Out Protocol

Effectiveness and Safety of a Clinical Assessment and 0h/1h Troponin Rule-Out Protocol Effectiveness and Safety of a Clinical Assessment and 0h/1h Troponin Rule-Out Protocol - 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. Effectiveness and Safety of a Clinical Assessment and 0h/1h Troponin Rule-Out Protocol (ESC-TROP) 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: NCT03421873 Recruitment Status : Recruiting First Posted

2018 Clinical Trials

138. The Development and Validation of a Clinical Prediction Rule to Predict Transmission of Methicillin-Resistant Staphylococcus aureus in Nursing Homes. (PubMed)

, resident dependency on HCWs for care, the presence of any medical device, diabetes mellitus, and chronic skin breakdown, showed good performance (C statistic = 0.70; sensitivity = 76%, specificity = 49%) in the development set. The decision curve analysis indicated that this model has greater clinical utility than use of a nares surveillance culture for MRSA colonization, which is current clinical practice for placing hospital inpatients on Contact Precautions. The prediction rule demonstrated less (...) The Development and Validation of a Clinical Prediction Rule to Predict Transmission of Methicillin-Resistant Staphylococcus aureus in Nursing Homes. The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization among nursing home residents is high. Health-care workers (HCWs) often serve as a vector in MRSA transmission. The ability to identify residents who are likely to transmit MRSA to HCWs' hands and clothing during clinical care is important so that infection control

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2018 American Journal of Epidemiology

139. Clinical prediction rules for abusive head trauma: a systematic review. (PubMed)

Clinical prediction rules for abusive head trauma: a systematic review. Misdiagnosis of abusive head trauma (AHT) has serious consequences for children and families. This systematic review identifies and compares clinical prediction rules (CPredRs) assisting clinicians in assessing suspected AHT.We searched MEDLINE, Embase, PubMed and Cochrane databases (January 1996 to August 2016). Externally validated CPredRs focusing on the detection of AHT in the clinical setting were included.Of 110 (...) potential articles identified, three studies met the inclusion criteria: the Pediatric Brain Injury Research Network (PediBIRN) 4-Variable AHT CPredR, the Predicting Abusive Head Trauma (PredAHT) tool and the Pittsburgh Infant Brain Injury Score (PIBIS). The CPredRs were designed for different populations and purposes: PediBIRN: intensive care unit admissions (<3 years) with head injury, to inform early decisions to launch or forego an evaluation for abuse (sensitivity 0.96); PredAHT: hospital

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2018 Archives of Disease in Childhood

140. Prediction of violent crime on discharge from secure psychiatric hospitals: A clinical prediction rule (FoVOx) (PubMed)

Prediction of violent crime on discharge from secure psychiatric hospitals: A clinical prediction rule (FoVOx) Current approaches to assess violence risk in secure hospitals are resource intensive, limited by accuracy and authorship bias and may have reached a performance ceiling. This study seeks to develop scalable predictive models for violent offending following discharge from secure psychiatric hospitals.We identified all patients discharged from secure hospitals in Sweden between January (...) secure hospitals that can assist in clinical decision-making. Scalable predictive models for violence risk are possible in specific patient groups and can free up clinical time for treatment and management. Further evaluation in other countries is needed.Wellcome Trust (202836/Z/16/Z) and the Swedish Research Council. The funding sources had no involvement in writing of the manuscript or decision to submit or in data collection, analysis or interpretation or any aspect pertinent

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2018 European Psychiatry

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