Medical decision making : an international journal of the Society for Medical Decision Making
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Patients with hospital-acquired acute kidney injury (AKI) are at risk for increased mortality and further medical complications. Evaluating these patients with a prediction tool easily implemented within an electronic health record (EHR) would identify high-risk patients prior to the development of AKI and could prevent iatrogenically induced episodes of AKI and improve clinical management. ⋯ The authors generated risk prediction models for hospital-acquired AKI using only commonly available electronic data. The models identify patients at high risk for AKI who might benefit from early intervention or increased monitoring.
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Despite the huge cost of the program, the Centers for Medicare and Medicaid Services (CMS) has maintained a policy that cost-effectiveness is not considered in national coverage determinations (NCDs). ⋯ CMS is covering a number of interventions that do not appear to be cost-effective, suggesting that resources could be allocated more efficiently. Although the authors identified several instances where cost-effectiveness evidence was cited in NCDs, they found no clear evidence of an implicit threshold.
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Clinical decision rules can benefit clinicians, patients, and health systems, but they involve considerable up-front development costs and must be acceptable to the target audience. No existing instrument measures the acceptability of a rule. The current study validated such an instrument. ⋯ The OADRI is a simple, 12-item instrument that evaluates rule acceptability among clinicians. Potential uses include comparing multiple ''protorules'' during development, examining acceptability of a rule to a new audience prior to implementation, indicating barriers to rule use addressable by knowledge translation interventions, and potentially serving as a proxy measure for future rule use.
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Aircraft noise disturbs sleep and impairs recuperation. Authorities plan to expand Frankfurt airport. ⋯ According to the decision analysis, it is unlikely that the proposed curfew at Frankfurt Airport substantially benefits sleep structure. Extensions of the model could be used to evaluate or propose alternative air traffic regulation strategies for Frankfurt Airport.
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To test the hypothesis that nearest-neighbor analysis adds to logistic regression in the early diagnosis of late-onset neonatal sepsis. ⋯ The authors propose nearest-neighbor analysis in addition to regression in the early diagnosis of subacute, potentially catastrophic illnesses such as neonatal sepsis, and they recommend it as an approach to the general problem of predicting a clinical event from a multivariable data set.