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Clinical Decision Rule

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161. Clinical prediction rule for delayed hemothorax after minor thoracic injury: a multicentre derivation and validation study Full Text available with Trip Pro

Clinical prediction rule for delayed hemothorax after minor thoracic injury: a multicentre derivation and validation study About 75% of patients with minor thoracic injury are discharged after an emergency department visit. However, complications such as delayed hemothorax can occur. We sought to derive and validate a clinical decision rule to predict hemothorax in patients discharged from the emergency department.We conducted a 6-year prospective cohort study in 4 university-affiliated (...) of age or older represented 25.3% (210/830) and 23.7% (131/552) of the derivation and validation cohorts, respectively. The final clinical decision rule included a combination of age (> 70 yr, 2 points; 45-70 yr, 1 point), fracture of any high to mid thorax rib (ribs 3-9, 2 points) and presence of 3 or more rib fractures (1 point). Twenty (30.8%) of the 65 high-risk patients (score ≥ 4) experienced hemothorax during the follow-up period. The clinical decision rule had a high specificity (90.7%, 95

2017 CMAJ open

162. A rule-based electronic phenotyping algorithm for detecting clinically relevant cardiovascular disease cases Full Text available with Trip Pro

A rule-based electronic phenotyping algorithm for detecting clinically relevant cardiovascular disease cases The implementation of electronic medical records (EMR) is becoming increasingly common. Error and data loss reduction, patient-care efficiency increase, decision-making assistance and facilitation of event surveillance, are some of the many processes that EMRs help improve. In addition, they show a lot of promise in terms of data collection to facilitate observational epidemiological (...) studies and their use for this purpose has increased significantly over the recent years. Even though the quantity and availability of the data are clearly improved thanks to EMRs, still, the problem of the quality of the data remains. This is especially important when attempting to determine if an event has actually occurred or not. We sought to assess the sensitivity, specificity, and agreement level of a codes-based algorithm for the detection of clinically relevant cardiovascular (CaVD

2017 BMC research notes

163. Clinical prediction rules for hemodynamically significant angiographic stenoses: a systematic review

Clinical prediction rules for hemodynamically significant angiographic stenoses: a systematic review 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 associated files (...) 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 are not reported

2019 PROSPERO

164. Graphics and statistics for cardiology: clinical prediction rules. Full Text available with Trip Pro

Graphics and statistics for cardiology: clinical prediction rules. Graphs and tables are indispensable aids to quantitative research. When developing a clinical prediction rule that is based on a cardiovascular risk score, there are many visual displays that can assist in developing the underlying statistical model, testing the assumptions made in this model, evaluating and presenting the resultant score. All too often, researchers in this field follow formulaic recipes without exploring (...) the issues of model selection and data presentation in a meaningful and thoughtful way. Some ideas on how to use visual displays to make wise decisions and present results that will both inform and attract the reader are given. Ideas are developed, and results tested, using subsets of the data that were used to develop the ASSIGN cardiovascular risk score, as used in Scotland.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http

2017 Heart

165. Supporting clinical rules engine in the adjustment of medication (SCREAM): protocol of a multicentre, prospective, randomised study. Full Text available with Trip Pro

Supporting clinical rules engine in the adjustment of medication (SCREAM): protocol of a multicentre, prospective, randomised study. In the nursing home population, it is estimated that 1 in every 3 patients is polymedicated and given their considerable frailty, these patients are especially prone to adverse drug reactions. Clinical pharmacist-led medication reviews are considered successful interventions to improve medication safety in the inpatient setting. Due to the limited available (...) evidence concerning the benefits of medication reviews performed in the nursing home setting, we propose a study aiming to demonstrate a positive effect that a clinical decision support system, as a health care intervention, may have on the target population. The primary objective of this study is to reduce the number of patients with at least one event when using the clinical decision support system compared to the regular care. These events consist of hospital referrals, delirium, falls

2017 BMC Geriatrics Controlled trial quality: uncertain

166. Design and implementation of electronic health record integrated clinical prediction rules (iCPR): a randomized trial in diverse primary care settings. Full Text available with Trip Pro

Design and implementation of electronic health record integrated clinical prediction rules (iCPR): a randomized trial in diverse primary care settings. Clinical prediction rules (CPRs) represent a method of determining individual patient risk to help providers make more accurate decisions at the point of care. Well-validated CPRs are underutilized but may decrease antibiotic overuse for acute respiratory infections. The integrated clinical prediction rules (iCPR) study builds on a previous (...) single clinic study to integrate two CPRs into the electronic health record and assess their impact on practice. This article discusses study design and implementation of a multicenter cluster randomized control trial of the iCPR clinical decision support system, including the tool adaptation, usability testing, staff training, and implementation study to disseminate iCPR at multiple clinical sites across two health care systems.The iCPR tool is based on two well-validated CPRs, one for strep

2017 Implementation Science Controlled trial quality: uncertain

167. Feasibility of automatic evaluation of clinical rules in general practice. Full Text available with Trip Pro

of assessing and formalizing clinical rules for decision support. Clinical rules that satisfied the criteria outlined in the LERM method were judged to be implementable in automatic evaluation in general practice.Thirty-three out of 81 (40.7%) Dutch-translated ACOVE clinical rules can be automatically evaluated in electronic medical record systems. Seven out of 7 CRs (100%) in the domain of diabetes can be automatically evaluated, 9/17 (52.9%) in medication use, 5/10 (50%) in depression care, 3/6 (50 (...) Feasibility of automatic evaluation of clinical rules in general practice. To assess the extent to which clinical rules (CRs) can be implemented for automatic evaluation of quality of care in general practice.We assessed 81 clinical rules (CRs) adapted from a subset of Assessing Care of Vulnerable Elders (ACOVE) clinical rules, against Dutch College of General Practitioners (NHG) data model. Each CR was analyzed using the Logical Elements Rule METHOD: (LERM). LERM is a stepwise method

2017 International journal of medical informatics

168. MammaPrint test for personalised management of adjuvant chemotherapy decisions in early breast cancer

The evidence 43 7.2 GENERALIZABILITY OF ECONOMIC EVALUATIONS TO THE BELGIAN CONTEXT 46 ¦ APPENDICES 48 ¦ REFERENCES 67 KCE Report 298 MammaPrint ® test in adjuvant chemotherapy decisions for early breast cancer patients 3 LIST OF FIGURES Figure 1 – Flow chart Economic Evaluations 50 LIST OF TABLES Table 1 – Five year HR (95% CI) from the MINDACT trial - clinical high/genomic low risk group 10 Table 2 – Risk of Bias Assessment at study level (RCTs) 11 Table 3 – Selection criteria for full primary economic (...) evaluations 13 Table 4 – Main characteristics of economic evaluations on MammaPrint ® for chemotherapy decisions in early breast cancer 14 Table 5 – Costs of MammaPrint ® (MP) in early breast cancer 17 Table 6 – Outcomes of MammaPrint ® (MP) in early breast cancer 20 Table 7 – ICERs for MammaPrint ® in early breast cancer 21 Table 8 – Clinical risk assessment according to modified Adjuvant!Online 27 Table 9 – Characteristics of patients included in the Belgian analyses – patients with ER+, HER2-, pN0

2018 Belgian Health Care Knowledge Centre

169. Cranky comments: detecting clinical decision support malfunctions through free-text override reasons. Full Text available with Trip Pro

Cranky comments: detecting clinical decision support malfunctions through free-text override reasons. Rule-base clinical decision support alerts are known to malfunction, but tools for discovering malfunctions are limited.Investigate whether user override comments can be used to discover malfunctions.We manually classified all rules in our database with at least 10 override comments into 3 categories based on a sample of override comments: "broken," "not broken, but could be improved (...) ," and "not broken." We used 3 methods (frequency of comments, cranky word list heuristic, and a Naïve Bayes classifier trained on a sample of comments) to automatically rank rules based on features of their override comments. We evaluated each ranking using the manual classification as truth.Of the rules investigated, 62 were broken, 13 could be improved, and the remaining 45 were not broken. Frequency of comments performed worse than a random ranking, with precision at 20 of 8 and AUC = 0.487. The cranky

2018 Journal of the American Medical Informatics Association

170. Modeling Contextual Knowledge for Clinical Decision Support Full Text available with Trip Pro

Modeling Contextual Knowledge for Clinical Decision Support In theory, the logic of decision rules should be atomic. In practice, this is not always possible; initially simple logic statements tend to be overloaded with additional conditions restricting the scope of such rules. By doing so, the original logic soon becomes encumbered with contextual knowledge. Contextual knowledge is re-usable on its own and could be modeled separately from the logic of a rule without losing the intended (...) functionality. We model constraints to explicitly define the context where knowledge of decision rules is actionable. We borrowed concepts from Semantic Web, Complex Adaptive Systems, and Contextual Reasoning. The proposed approach provides the means for identifying and modeling contextual knowledge in a simple, sound manner. The methodology presented herein facilitates rule authoring, fosters consistency in rules implementation and maintenance; facilitates developing authoritative knowledge repositories

2018 AMIA Annual Symposium Proceedings

171. "I Never Would Have Caught That Before": Pharmacist Perceptions of Using Clinical Decision Support for Antimicrobial Stewardship in the United States. (Abstract)

"I Never Would Have Caught That Before": Pharmacist Perceptions of Using Clinical Decision Support for Antimicrobial Stewardship in the United States. To systematically improve the appropriateness of antibiotic prescribing, antimicrobial stewardship programs have been developed. There is a paucity of literature examining how pharmacists perform antimicrobial stewardship using a clinical decision support system in a hospital setting. The purpose of this qualitative study was to develop a model (...) exploring how pharmacists perform antimicrobial stewardship to identify areas for programmatic improvement. Semistructured interviews were conducted across a health care system until saturation of themes was reached. Pharmacists identified that self-efficacy and time were vital for antimicrobial stewardship to be performed, while culture of the hospital and attitude facilitated the process of stewardship. Antimicrobial stewardship programs using clinical decision support tools should ensure pharmacists

2018 Qualitative Health Research

172. Using statistical anomaly detection models to find clinical decision support malfunctions. Full Text available with Trip Pro

Using statistical anomaly detection models to find clinical decision support malfunctions. 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.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. We analyzed 4 CDS alerts with known malfunctions from the Longitudinal Medical Record (LMR) and Epic® (Epic Systems Corporation, Madison, WI, USA) at Brigham and Women's Hospital, Boston, MA. The 4 rules recommend lead testing in children, aspirin therapy in patients with coronary artery disease, pneumococcal vaccination

2018 Journal of the American Medical Informatics Association

173. A Pilot Study to Reduce Computed Tomography Utilization for Pediatric Mild Head Injury in the Emergency Department Using a Clinical Decision Support Tool and a Structured Parent Discussion Tool. (Abstract)

A Pilot Study to Reduce Computed Tomography Utilization for Pediatric Mild Head Injury in the Emergency Department Using a Clinical Decision Support Tool and a Structured Parent Discussion Tool. The American College of Emergency Physicians embarked on the "Choosing Wisely" campaign to avoid computed tomographic (CT) scans in patients with minor head injury who are at low risk based on validated decision rules. We hypothesized that a Pediatric Mild Head Injury Care Path could be developed (...) and implemented to reduce inappropriate CT utilization with support of a clinical decision support tool (CDST) and a structured parent discussion tool.A quality improvement project was initiated for 9 weeks to reduce inappropriate CT utilization through 5 interventions: (1) engagement of leadership, (2) provider education, (3) incorporation of a parent discussion tool to guide discussion during the emergency department (ED) visit between the parent and the provider, (4) CDST embedded in the electronic medical

2018 Pediatric Emergency Care

174. Development of a clinical decision support system for living kidney donor assessment based on national guidelines. (Abstract)

Development of a clinical decision support system for living kidney donor assessment based on national guidelines. Live donor nephrectomy is an operation that places the donor at risk of complications without the possibility of medical benefit. Rigorous donor selection and assessment is therefore essential to ensure minimization of risk and for this reason robust national guidelines exist. Previous studies have demonstrated poor adherence to donor guidelines.We developed a clinical decision (...) support system (CDSS), based on national living donor guidelines, to facilitate the identification of contraindications, additional investigations, special considerations, and the decision as to nephrectomy side in potential living donors. The CDSS was then tested with patient data from 45 potential kidney donors.The CDSS comprises 17 core tasks completed by either patient or nurse, and 17 optional tasks that are triggered by certain patient demographics or conditions. Decision rules were able

2018 Transplantation

175. Assessment of the Feasibility of automated, real-time clinical decision support in the emergency department using electronic health record data. Full Text available with Trip Pro

aim was to determine the feasibility of automating CDSSs within electronic health records (EHRs) by investigating the timing, data categorization, and completeness of documentation of their individual components of two common Clinical Decision Rules (CDRs) in the Emergency Department.The CURB-65 severity score and HEART score were randomly selected from a list of the top emergency medicine CDRs. Emergency department (ED) visits with ICD-9 codes applicable to our CDRs were eligible. The charts were (...) Assessment of the Feasibility of automated, real-time clinical decision support in the emergency department using electronic health record data. The use of big data and machine learning within clinical decision support systems (CDSSs) has the potential to transform medicine through better prognosis, diagnosis and automation of tasks. Real-time application of machine learning algorithms, however, is dependent on data being present and entered prior to, or at the point of, CDSS deployment. Our

2018 BMC Emergency Medicine

176. Ultrasound First Clinical Decision Support for Suspected Nephrolithiasis

Ultrasound First Clinical Decision Support for Suspected Nephrolithiasis Ultrasound First Clinical Decision Support for Suspected Nephrolithiasis - 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. Ultrasound (...) First Clinical Decision Support for Suspected Nephrolithiasis 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: NCT03461536 Recruitment Status : Recruiting First Posted : March 12, 2018 Last Update Posted : January 4, 2019 See

2018 Clinical Trials

177. Myocardial infarction (acute): Early rule out using high-sensitivity troponin tests (Elecsys Troponin T high-sensitive, ARCHITECT STAT High Sensitive Troponin-I and AccuTnI+3 assays)

limit should be set at the 99 th percentile. Results should be interpreted along with clinical judgement and the results of clinical assessment. Healthcare professionals should take into account the pre-test probability of NSTEMI, the length of time since the suspected acute coronary syndrome, the possibility of chronically elevated troponin levels in some patients and that 99 th percentile thresholds for troponin I and T may differ between sexes. When NSTEMI is not ruled out using an 'early rule (...) -out protocol' , further clinical assessment is required to determine whether a diagnosis of NSTEMI is appropriate. 1.3 The AccuTnI+3 assay is only recommended for use in clinical research, for early rule out of NSTEMI in people presenting to an emergency department with chest pain and suspected acute coronary syndrome (see section 7.1). 1.4 Healthcare professionals using 'early rule-out protocols' including the Elecsys Troponin T high-sensitive or the ARCHITECT STAT High Sensitive Troponin-I

2014 National Institute for Health and Clinical Excellence - Diagnostics Guidance

178. Randomised controlled trial: Evidence-based clinical decision support improves the appropriate use of antibiotics and rapid strep testing

Randomised controlled trial: Evidence-based clinical decision support improves the appropriate use of antibiotics and rapid strep testing Evidence-based clinical decision support improves the appropriate use of antibiotics and rapid strep testing | BMJ Evidence-Based Medicine We use cookies to improve our service and to tailor our content and advertising to you. You can manage your cookie settings via your browser at any time. To learn more about how we use cookies, please see our . Log (...) in using your username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? Search for this keyword Search for this keyword Main menu Log in using your username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? You are here Evidence-based clinical decision support improves the appropriate use of antibiotics and rapid strep testing Article Text Quality

2014 Evidence-Based Medicine

179. Validating the TeleStroke Mimic Score: A Prediction Rule for Identifying Stroke Mimics Evaluated Over Telestroke Networks Full Text available with Trip Pro

ability to predict the presence of a stroke mimic during telestroke consultation in these diverse cohorts was similar to its performance in our original cohort. Predictive decision-support tools like the TM score may help highlight key clinical differences between mimics and patients with stroke during complex, time-critical telestroke evaluations.© 2018 American Heart Association, Inc. (...) Validating the TeleStroke Mimic Score: A Prediction Rule for Identifying Stroke Mimics Evaluated Over Telestroke Networks Up to 30% of acute stroke evaluations are deemed stroke mimics, and these are common in telestroke as well. We recently published a risk prediction score for use during telestroke encounters to differentiate stroke mimics from ischemic cerebrovascular disease derived and validated in the Partners TeleStroke Network. Using data from 3 distinct US and European telestroke

2018 EvidenceUpdates

180. Performance of pre-hospital evaluations in ruling out invasive chest stab wounds. Full Text available with Trip Pro

Performance of pre-hospital evaluations in ruling out invasive chest stab wounds. Some guidelines advocate for managing patients with penetrating thoracic wounds in trauma centres with cardiothoracic surgery. This systematic approach is questionable. Only 15% of these patients require surgery. It is known that clinical examination fails to detect hemopneumothorax in penetrating trauma. However, no studies have evaluated the combined diagnostic performance of vital signs and the clinical (...) evaluation of wounds. The clinical characteristics of wounds have not been investigated. We aimed to evaluate the ability of combinations of pre-hospital signs to rule out invasive chest stab trauma.This was a prospective observational study. All consecutive adult patients hospitalized in the perioperative acute care unit of a tertiary university hospital were included. Injury diagnoses were provided by exploratory surgery and imaging tests. Patients with a final diagnosis of invasive wounds (IWs

2020 Scandinavian journal of trauma, resuscitation and emergency medicine

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