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Using simulation and optimization approach to improve outcome through warfarin precision treatment

Chih-Lin Chi, Lu He, Kourosh Ravvaz, John Weissert, Peter J. Tonellato
2017 Biocomputing 2018  
Finally, we discuss the improved outcome of the precision treatment plan based on the sub-population optimized decision support rules.  ...  We apply a treatment simulation and optimization approach to develop decision support guidance for warfarin precision treatment plans.  ...  Acknowledgement We thank NIH-1R01LM011566-01 to support this work.  ... 
doi:10.1142/9789813235533_0038 fatcat:6sbxurph4bafhhk3c7g4t5bktu

The potential use of decision analysis to support shared decision making in the face of uncertainty: the example of atrial fibrillation and warfarin anticoagulation

A Robinson
2000 Quality in Health Care  
Viewpoint The potential use of decision analysis to support shared decision making in the face of uncertainty: the example of atrial fibrillation and warfarin anticoagulation A Robinson, R G Thomson, on  ...  This has led to attempts to develop decision support tools that enable patients and clinicians to make better decisions.  ...  , 4 to be more satisfied and less anxious, 5 6 and to have improved outcomes. 7-10 Furthermore, the "optimal" treatment decision for any individual may crucially depend on his or her preferences, particularly  ... 
doi:10.1136/qhc.9.4.238 pmid:11101709 pmcid:PMC1743538 fatcat:zzvftkwywrghtpkqkrsu3ghona

Improving Anticoagulant Treatment Strategies of Atrial Fibrillation Using Reinforcement Learning

Lei Zuo, Xin Du, Wei Zhao, Chao Jiang, Shijun Xia, Liu He, Rong Liu, Ribo Tang, Rong Bai, Jianzeng Dong, Xingzhi Sun, Gang Hu (+2 others)
2021 AMIA Annual Symposium Proceedings  
model in terms of short-term and long-term outcomes.  ...  In this paper, we developed a personalized anticoagulant treatment recommendation model for atrial fibrillation (AF) patients based on reinforcement learning (RL) and evaluated the effectiveness of the  ...  Acknowledgments We thank all the participants in this work for their support.  ... 
pmid:33936519 pmcid:PMC8075452 fatcat:e5zxzvoqojc6rms6lozfwcnq3u

Developing an Atrial Fibrillation Guideline Support Tool (AFGuST) for shared decision making

Mark H. Eckman, Ruth E. Wise, Katherine Naylor, Lora Arduser, Gregory Y.H. Lip, Brett Kissela, Matthew Flaherty, Dawn Kleindorfer, Faisal Khan, Daniel P. Schauer, John Kues, Alexandru Costea
2015 Current Medical Research and Opinion  
Results-Individual patient preferences for health-related outcomes may have greater or lesser impact on the choice of optimal antithrombotic therapy, depending upon the balance of patientspecific risks  ...  We developed a Markov decision analytic model as a computational "engine" to integrate patient-specific risk for stroke and hemorrhage and individual patient values for relevant outcomes in decisions about  ...  how those patient-specific values and preferences impact the optimal treatment decision.  ... 
doi:10.1185/03007995.2015.1019608 pmid:25690491 pmcid:PMC4708062 fatcat:sf3k5t73xfb5zox5moiqq6cu5m

An Automated Clinical Alert System for Newly-Diagnosed Atrial Fibrillation

David A. Cook, Felicity Enders, Pedro J. Caraballo, Rick A. Nishimura, Farrell J. Lloyd, Kevan L. Hartshorn
2015 PLoS ONE  
Objective Clinical decision support systems that notify providers of abnormal test results have produced mixed results.  ...  We sought to develop, implement, and evaluate the impact of a computer-based clinical alert system intended to improve atrial fibrillation stroke prophylaxis, and identify reasons providers do not implement  ...  [42] Others have used computer-based tools to increase warfarin use among patients in a nursing home, [43] to optimize the timing of follow-up, [44] and to inform provider-patient treatment discussions  ... 
doi:10.1371/journal.pone.0122153 pmid:25849969 pmcid:PMC4388495 fatcat:d3tsucyg3vbgxeecd4pvofgx5i

Integrated precision medicine: the role of electronic health records in delivering personalized treatment

Amy Sitapati, Hyeoneui Kim, Barbara Berkovich, Rebecca Marmor, Siddharth Singh, Robert El-Kareh, Brian Clay, Lucila Ohno-Machado
2017 Wiley Interdisciplinary Reviews: Systems Biology and Medicine  
, we face an acute need to develop systems that will integrate disparate data sources, provide real-time decision support, and enhance our ability to positively impact patient outcomes.  ...  We briefly review different types of clinical decision support (CDS) and present the current state of CDS, which is already improving the care patients receive with genetic profilebased tailored recommendations  ...  SS and RM are supported by T15LM011271 from NIH.  ... 
doi:10.1002/wsbm.1378 pmid:28207198 pmcid:PMC5400726 fatcat:wilz23fjzbccja62hvwxg7rduy

Personalized Medicine and Genomics: Challenges and Opportunities in Assessing Effectiveness, Cost-Effectiveness, and Future Research Priorities

Rena Conti, David L. Veenstra, Katrina Armstrong, Lawrence J. Lesko, Scott D. Grosse
2010 Medical decision making  
Personalized medicine is health care that tailors interventions to individual variation in risk and treatment response.  ...  A symposium at the annual meeting of the Society for Medical Decision Making on 23 October 2007 highlighted the challenges and opportunities posed in translating advances in molecular medicine into clinical  ...  Acknowledgments The symposium was supported by conference grant R13 HS017305 from the Agency for Healthcare Research and Quality.  ... 
doi:10.1177/0272989x09347014 pmid:20086232 pmcid:PMC4598076 fatcat:i4rpdnjrerfitd2uxdwvtkc6em

Cardiovascular Pharmacogenomics: Current Status and Future Directions—Report of a National Heart, Lung, and Blood Institute Working Group

Kiran Musunuru, Dan M. Roden, Robin Boineau, Michael R. Bristow, Timothy A. McCaffrey, Christopher Newton‐Cheh, Dina N. Paltoo, Yves Rosenberg, Jay G. Wohlgemuth, Issam Zineh, Ahmed A. K. Hasan
2012 Journal of the American Heart Association : Cardiovascular and Cerebrovascular Disease  
The conference brought together leaders from academia, industry, and government to (1) discuss personalized medicine's current and potential impact on cardiovascular patient outcomes; (2) review emerging  ...  generation that are needed for adoption and improved quality of cardiovascular patient care.  ...  Unlike with warfarin, there have not yet been any trials assessing whether clinical decision-making informed by knowledge of CYP2C19 genotypes improves clinical outcomes.  ... 
doi:10.1161/jaha.111.000554 pmid:23130127 pmcid:PMC3487365 fatcat:b67sxx5ryvbtzbum6wsxyg3k5e

Guidance for the practical management of warfarin therapy in the treatment of venous thromboembolism

Daniel M. Witt, Nathan P. Clark, Scott Kaatz, Terri Schnurr, Jack E. Ansell
2016 Journal of Thrombosis and Thrombolysis  
In an effort to provide practical and implementable information about VTE and its treatment, guidance statements pertaining to choosing good candidates for warfarin therapy, warfarin initiation, optimizing  ...  optimal outcomes for their patients with VTE Pivotal practical questions pertaining to this topic were developed by consensus of the authors and were derived from evidence-based consensus statements whenever  ...  Acknowledgments We wish to acknowledge the support provided by Myelin and Associates with the preparation of this manuscript for submission.  ... 
doi:10.1007/s11239-015-1319-y pmid:26780746 pmcid:PMC4715850 fatcat:ntwhdt5tm5h7dfkidhwlamr4iy

Can computerised decision support systems deliver improved quality in primary care?

B. C Delaney, D. A Fitzmaurice, A. Riaz, F D R. Hobbs
1999 BMJ (Clinical Research Edition)  
The question examined by this review is how may computerised decision support systems contribute to improving quality in primary care?  ...  Improvement of quality by a reduction of the variation in primary care practice is a key component of UK national health policy. 3 Computerised decision support systems have potential to drive reminders  ...  of monitoring and preventive tasks in the management of chronic disease Computerised dosing systems for warfarin improve the control of anticoagulation Computerised diagnostic decision support has not  ... 
doi:10.1136/bmj.319.7220.1281 pmid:10559035 pmcid:PMC1129060 fatcat:jrfgfkynfbgmxpit7kdlgz44oa

Semantically enabling pharmacogenomic data for the realization of personalized medicine

Matthias Samwald, Adrien Coulet, Iker Huerga, Robert L Powers, Joanne S Luciano, Robert R Freimuth, Frederick Whipple, Elgar Pichler, Eric Prud'hommeaux, Michel Dumontier, M Scott Marshall
2012 Pharmacogenomics (London)  
optimize future treatment decisions in a wide variety of unanticipated ways.  ...  (established clinical rules that can be implemented in decision support systems).  ... 
doi:10.2217/pgs.11.179 pmid:22256869 pmcid:PMC3957334 fatcat:q7o2vfijn5hmlasoaskcjjopkq

Cost-Effectiveness of Preference-Based Antithrombotic Therapy for Patients With Nonvalvular Atrial Fibrillation

B. F. Gage, A. B. Cardinalli, D. K. Owens
1998 Stroke  
We compared 10-year projections of quality-adjusted survival and medical expenditure associated with two atrial fibrillation treatment strategies: warfarin-for-all therapy versus preference-based therapy  ...  Preference-based treatment should improve quality-adjusted survival and reduce medical expenditure in patients who have nonvalvular atrial fibrillation and not more than one additional risk factor for  ...  Dr Owens is supported by a Career Development Award from the Veterans Affairs Health Services Research and Development Service.  ... 
doi:10.1161/01.str.29.6.1083 pmid:9626276 fatcat:sfdeqgqzy5dplf7c2puhtb3tta

Reinforcement Learning in Neurocritical and Neurosurgical Care: Principles and Possible Applications

Ying Liu, Nidan Qiao, Yuksel Altinel, Waqas Haider Bangyal
2021 Computational and Mathematical Methods in Medicine  
Reinforcement learning (RL) algorithm is a computational method to find sequential optimal decisions among multiple suboptimal options.  ...  Dynamic decision-making was essential in the clinical care of surgical patients.  ...  Acknowledgments This study is supported by grant 17YF1426700 from the Shanghai Committee of Science and Technology of China and the National Natural Science Foundation No. 82073640.  ... 
doi:10.1155/2021/6657119 pmid:33680069 pmcid:PMC7925047 fatcat:org7olsiofbgpgswdgikgjdraq

Stroke prevention: age alone does not rule out warfarin

Sarah-Anne Schumann, Bernard Ewigman
2007 Journal of Family Practice  
z INR testing systems Several randomized trials support the use of monitoring systems such as a pharmacist managed anticoagulation service or decision support software, both of which can improve the percentage  ...  z Meticulous monitoring, patient education • managing warfarin therapy requires meticulous care to avoid complications and optimize treatment effect. • Patients may be reluctant to take warfarin because  ... 
pmid:17976336 pmcid:PMC3183830 fatcat:rbctzzevifccndifpiuw2h7flm

Breaks in continuity of care and the rural senior transferred for medical care under regionalisation

H. Jay Biem, H. Hadjistavropoulos, Debra Morgan, Henry B. Biem, Raymond W. Pong
2003 International Journal of Integrated Care  
Optimal continuity of care is characterised not only by regular contact with the providers who establish collaboration with patients and their caregivers, but also by communication, co-ordination, contingency  ...  quality, safety and ease of warfarin anticoagulation. [92][93] Some clinics are staffed by pharmacists [94][95] and some by nurses using computerised decision support and point-of-care testing. [96  ...  This definition goes beyond personal contact and assumes integration of the health care system over time and place. Second, the characteristics of optimal continuity of care are interrelated.  ... 
doi:10.5334/ijic.85 fatcat:mnq6nxhazvdgnbtmd2jmlm5bhm
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