JAMA network open
-
Multicenter Study
Development and Performance of the Pulmonary Embolism Result Forecast Model (PERFORM) for Computed Tomography Clinical Decision Support.
Pulmonary embolism (PE) is a life-threatening clinical problem, and computed tomographic imaging is the standard for diagnosis. Clinical decision support rules based on PE risk-scoring models have been developed to compute pretest probability but are underused and tend to underperform in practice, leading to persistent overuse of CT imaging for PE. ⋯ The machine learning model, PERFORM, may consider multitudes of applicable patient-specific risk factors and dependencies to arrive at a PE risk prediction that generalizes to new population distributions. This approach might be used as an automated clinical decision-support tool for patients referred for CT PE imaging to improve CT use.
-
Randomized Controlled Trial Clinical Trial
Effect of Sequential or Active Choice for Colorectal Cancer Screening Outreach: A Randomized Clinical Trial.
Colonoscopy and fecal immunochemical testing (FIT) are considered top-tier tests for colorectal cancer (CRC) screening. Behavioral economic insights about "choice architecture" suggest that participation could be influenced by how people are presented test options. ⋯ There was no significant increase in CRC screening when offering sequential or active choice, but there was a lower rate of colonoscopy in the choice arms than in the colonoscopy-only arm. Subtle changes in sequencing or defaults can alter patient decision making related to preventive health.
-
Multicenter Study
Long-term Host Immune Response Trajectories Among Hospitalized Patients With Sepsis.
Long-term immune sequelae after sepsis are poorly understood. ⋯ In this study, persistent elevation of inflammation and immunosuppression biomarkers occurred in two-thirds of patients who survived a hospitalization for sepsis and was associated with worse long-term outcomes.
-
Meta Analysis
Global Incidence of Frailty and Prefrailty Among Community-Dwelling Older Adults: A Systematic Review and Meta-analysis.
Frailty is a common geriatric syndrome of significant public health importance, yet there is limited understanding of the risk of frailty development at a population level. ⋯ Results of this study suggest that community-dwelling older adults are prone to developing frailty. Increased awareness of the factors that confer high risk of frailty in this population subgroup is vital to inform the design of interventions to prevent frailty and to minimize its consequences.
-
Randomized Controlled Trial
Effect of First-line S-1 Plus Oxaliplatin With or Without Ramucirumab Followed by Paclitaxel Plus Ramucirumab on Advanced Gastric Cancer in East Asia: The Phase 2 RAINSTORM Randomized Clinical Trial.
Ramucirumab, a human IgG 1 antibody against vascular endothelial growth factor receptor 2, has been shown to improve progression-free survival and overall survival in patients with advanced gastric cancer in the second-line setting. ⋯ In this randomized clinical trial, the addition of ramucirumab to first-line S-1 and oxaliplatin treatment did not prolong progression-free survival or overall survival compared with S-1 and oxaliplatin alone among East Asian patients with advanced gastric cancer; no new safety signals for ramucirumab were identified.