Browsing by Subject "Decision Support Techniques"
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Item Application of the Caprini Risk Assessment Model in Evaluation of Non-Venous Thromboembolism Complications in Plastic and Reconstructive Surgery Patients(2014-02-04) Jeong, Haneol S.; Miller, Travis J.; Davis, Kathryn; Matthew, Anoop; Lysikowski, Jerzy; Lazcano, Eric; Reed, Gary; Kenkel, Jeffrey M.GOALS/PURPOSE: The Caprini Risk Assessment Model (RAM) is an ordinal scoring tool used to quantify and categorize a patient's risk for venous thromboembolism in the post-surgery setting. However, there has been no similar exploration into predictive associations of this score with the other potential complications of surgical procedures. This is surprising because the full list of variables that comprise an individual Caprini score involve a host of systemic factors that involve multiple organ systems. This study investigates whether Caprini scores can be applied to non-VTE complications. METHODS/TECHNIQUE: Authors undertook a retrospective chart review of 1598 encounters for a series of complex reconstructive and body-contouring operations at an academic medical institution. Input variables included Caprini score components, patient co-morbidities, and prophylactic use. Output variables were postoperative complications. Tests for proportions were performed on percentile data. Non-percentile data was treated with comparison of means (t-test). Odds ratios for complications were calculated for stratified risk groups and compared. RESULTS/COMPLICATIONS: The overall complication rate was 28.03%. DVT incidence was 1.50%. In comparing complication vs. complication-free patients, age, BMI, operation time, hypertension, diabetes, renal disease, and cancer were statistically significant. For DVT versus DVT-free patients, sex, BMI, operation time, smoking status, diabetes, hypertension, and prior DVT were significant. Increasing Caprini scores are associated with increasing odds ratios (OR) for dehiscence (1.73, p = 0.028), infection (2.04, p = 0.0003), seroma (1.52, p = .045), hematoma (2.12, p = 0.050), and necrosis (2.83, p = 0.0004) with a corresponding overall OR increase of 1.69 (p < 0.0001). These odds ratios parallel similar increases in the baseline occurrence rates for the noted complications. CONCLUSIONS: The data demonstrates that Caprini scores can be applied preoperatively to categorize a patient's risk of developing multiple non-VTE complications. Patients in the higher risk categories will be at an increased risk of suffering from wound dehiscence, infection, seroma, hematoma, and necrosis. Considering these potential complications as a single group, a high-risk patient has a 69% increased odds of suffering at least one problem compared with low-risk individuals. Unfortunately, few preoperative steps can be taken to directly address the complications that the Caprini model is predictive for. However, these results can help physicians better understand which complications to keep watch for most rigorously during postoperative monitoring. In addition, the data can guide conservations with patients during initial preoperative consultations.Item Clinical Parameters Are More Predictive of Mortality in Alcoholic Hepatitis than Histopathologic Severity(2017-03-24) Yeluru, Apurva; Cuthbert, Jennifer; Thiele, Dwain L.; Lee, William M.BACKGROUND: Alcoholic hepatitis (AH) is primarily diagnosed by clinical parameters, but is often misdiagnosed due to nonspecific symptoms, leading to high mortality rates. While histology aids definitive diagnosis, the role of the liver biopsy in its workup is still controversial. Currently, there is no widely accepted grading histologic grading system for AH. The relationship between biopsy findings and clinical course is also yet unknown. The Alcoholic Hepatitis Histologic Score (AHHS) was recently developed to define patient prognosis by histologic criteria. OBJECTIVE: The purpose of this study was to compare histologic severity defined by the AHHS with clinical severity of AH, as seen with symptoms, laboratory markers, and patient survival. METHODS: We conducted a retrospective case series of 56 patients with biopsy-proven AH from two hospitals in Dallas, TX, USA. Clinical and demographic data were collected from electronic medical records. Two trained pathologists blinded to patients' outcomes graded liver biopsies using the AHHS criteria. Relationships between clinical symptoms and complications, laboratory investigations, patient outcomes, individual histologic features, and the AHHS were analyzed. RESULTS: No hematologic or biochemical laboratory markers significantly correlated with the AHHS. Higher AST correlated with a greater degree of steatosis on biopsy (p<0.0019). Severe neutrophil infiltration on biopsy correlated with higher serum bilirubin, INR, MELD, and DF (p=0.034). Survival analysis by Kaplan-Meier curves and log-rank tests showed no significant correlation between AHHS and 90-day survival (p=0.09), while multiple clinical scoring systems accurately stratified prognosis (p<0.018 for all). Severe neutrophil infiltration on biopsy also correlated significantly with death (p=0.0001). CONCLUSION: Retrospective analysis in a diverse U.S. urban cohort did not confirm the validity of AHHS to predict survival in AH. In contrast, clinical parameters were better predictors of survival. Our results suggest that clinical deterioration, rather than histopathologic severity, is more informative in determining prognosis in AH. The relationship between neutrophil infiltration and mortality deserves further study.Item Surrogate decision making in the internet age(2018-02-13) Berg, Jessica W.[Note: The slides are not available from this event.] The technology revolution has had an enormous effect on all aspects of the practice of medicine, from record-keeping to scheduling to billing to treatments to research. But although there have been efforts to create online decision-aids to facilitate informed consent, little thought has been given to the role of social media in surrogate decision making. Many people have been using various outlets for years, and left significant electronic documentation of their preferences. As social media users age, questions of how and whether to use social media to assist surrogate decision making will become more prevalent. This presentation considers the ethical and legal issues involved in the use of social media -- such as Facebook and Twitter -- in determining medical treatment preferences for surrogate decision making.Item Using biomarkers to add precision to cardiovascular medicine, prevention and population health: hype or hope?(2021-07-30) de Lemos, James