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International Journal of Clinical Practice

Ayasa Fujibayashi, Takashi Niwa, Mayumi Tsuchiya, Syuri Takeichi, Keiko Suzuki, Hirotoshi Ohta, Jun Yonetamari, Ayumi Niwa, Masayo Yamamoto, Daijiro Hatakeyama, Hisashi Baba, Akio Suzuki, Nobuo Murakami
BACKGROUND: The standard duration of administration of antimicrobial prophylaxis in surgery and non-surgical invasive therapy was shortened according to the promotion of appropriate use. Here, we conducted an intervention to optimize antimicrobial prophylaxis by revising all relevant clinical pathways based on the most recent guidelines. METHODS: We conducted a single-center, prospective cohort study in patients who received antimicrobial prophylaxis to evaluate outcomes following revision of the clinical pathways for antimicrobial prophylaxis...
November 10, 2018: International Journal of Clinical Practice
Heather Payne, Rhona McMenemin, Amit Bahl, Damian Greene, John Staffurth
AIM: To explore the practice and attitudes of uro-oncologists in the UK regarding monitoring testosterone levels and the use of testosterone replacement therapy (TRT) in their prostate cancer patients treated with androgen deprivation therapy (ADT). METHODS: An expert-devised online questionnaire was completed by members of the British Uro-oncology Group (BUG). RESULTS: Of 160 uro-oncologists invited, 84 completed the questionnaire. Before initiating ADT in patients with non-metastatic prostate cancer, only 45% of respondents measured testosterone levels and 61% did not measure testosterone at all during ADT in the adjuvant or neoadjuvant setting...
November 10, 2018: International Journal of Clinical Practice
A J Larner
Overdiagnosis appears to be an umbrella term, or an overarching category with various components, such as overdetection, overdefinition, or overselling.2 How these qualitative elements map on to the quantitative categories (true positives and negatives, false positives and negatives) as defined in screening test accuracy studies is not clear to me. Whilst on face value overdetection might seem to be equivalent to false positives, Brodersen and his colleagues are explicit that overdiagnosis is not a false positive result...
October 31, 2018: International Journal of Clinical Practice
John Brodersen
It is with great interest I have read Larner et al.'s paper "Evaluating cognitive screening instruments with the "likelihood to be diagnosed or misdiagnosed" measure".[1] As indicated in the title of their paper "misdiagnosis" is of concern. However, I wonder how much overdiagnosis[2] these instruments the authors have scrutinised create? If overdiagnosis does occur when using cognitive screening instruments the numbers of misdiagnosis reported in Larner et al.'s paper can be biased...
October 30, 2018: International Journal of Clinical Practice
María Ruiz-Ruigómez, Carlos Dueñas, Cristina Hernandez, David Vinuesa, Nieves M Coronado-Álvarez, Vera Portillo-Tuñón, Cristina Cardozo, Leopoldo Muñoz-Medina, Rebeca Cabo-Magadán, Juan D Luna, Josep Mensa, Jorge Parra-Ruiz
INTRODUCTION: Candida species are the leading cause of invasive fungal infections in hospitalised patients and are the fourth most common isolates recovered from patients with bloodstream infection. Few data exist on risk factors for candidemia in non-ICU patients. We performed a population-based case-control study to evaluate the main predictors for candidemia in non-ICU patients. METHODS AND FINDINGS: We included all non-neutropenic, non-critically ill and non-surgical adult patients with candidemia between January 2010 and June 2014...
October 30, 2018: International Journal of Clinical Practice
Alyssa Zupon, Craig Rothenberg, Katherine Couturier, Ting-Xu Tan, Gina Siddiqui, Matthew James, Dan Savage, Edward R Melnick, Arjun K Venkatesh
BACKGROUND: Clinical practice guidelines (CPGs) have been published by the American College of Emergency Physicians (ACEP) since 1990 to advance evidence-based emergency care. ACEP clinical policies have drawn anecdotal criticism for bias, yet the overall quality of these guidelines has not previously been quantified. We sought to examine ACEP clinical policies using a recognized, validated appraisal instrument: Appraisal of Guideline for Research & Evaluation (AGREE II). METHODS: Systematic assessment of current ACEP clinical policies using the AGREE II instrument, which contains 23 appraisal items (scored on a 1-7 scale) in six domains and two overall assessments...
October 29, 2018: International Journal of Clinical Practice
Melanie Yee Lee Siaw, Joyce Yu-Chia Lee
BACKGROUND: Diabetes is a chronic and complex disease that requires a multidisciplinary collaborative care approach. OBJECTIVE: The primary objective was to evaluate the clinical outcomes of patients with uncontrolled diabetes within a multidisciplinary collaborative care model. The secondary objective was to evaluate the humanistic and economic outcomes of this model of care. METHODS: A search using PubMed, SCOPUS, and CINAHL from 2007 to 2017 was conducted...
October 27, 2018: International Journal of Clinical Practice
Nagaraj Malipatil, Mark Lunt, Ram Prakash Narayanan, Kirk Siddals, Gabriela Y Cortés Moreno, Martin J Gibson, Harvest F Gu, Adrian H Heald, Rachelle P Donn
INTRODUCTION: Recent studies have indicated that methylation of the LINE-1 elements is associated with an increased risk of worsening carbohydrate metabolism. It has been shown that overall DNA methylation of LINE-1 elements could be considered as a risk factor for T2DM and its complications, independent of other established risk factors. METHODS: A total of 794 T2DM individuals from Salford, UK were included in this study (60% men n = 470). All patients had clinical and metabolic variables measured in 2002 (baseline outcomes) and annually through to 2016...
October 21, 2018: International Journal of Clinical Practice
Yannick Erard, Rosaria Del Giorno, Anna Zasa, Simone De Gottardi, Roberto Della Bruna, Franco Keller, Luca Clivio, Angela Greco, Olivier Giannini, Luca Gabutti
BACKGROUND: Reducing unnecessary laboratory blood testing in the hospital setting represents a challenge to improve the adequacy of healthcare and a tricky task for teaching hospitals. Our hospital network, actively participates in the Choosing Wisely Campaign and is engaged in avoiding unnecessary low value interventions and investigations. We aimed to study whether a multi-level approach combining educational and web-system based interventions, could be effective in reducing laboratory testing and related costs...
October 19, 2018: International Journal of Clinical Practice
Isabella Berardelli, Daniele Belvisi, Valentina Corigliano, Matteo Costanzo, Marco Innamorati, Giovanni Fabbrini, Alfredo Berardelli, Maurizio Pompili
BACKGROUND: Previous studies investigating the risk of suicide in patients with Parkinson's disease (PD) have reported conflicting results. This study evaluated suicide risk in PD and investigated the relationship between suicide risk and perceived disability, hopelessness and affective temperaments in PD. METHODS: One-hundred and twenty PD patients were consecutively enrolled. The diagnosis of PD was based on clinical criteria. All patients underwent a psychiatric evaluation that included the administration of the Columbia-Suicide Severity Rating Scale, the Italian Perceived Disability Scale, the Beck Hopelessness Inventory and the TEMPS-A questionnaire...
October 19, 2018: International Journal of Clinical Practice
Gregory Y H Lip
AIM: Four non-vitamin K oral anticoagulants (NOACs) have been evaluated in clinical trials for the prevention of stroke in patients with atrial fibrillation (AF). Although each of the NOACs have been shown to be at least non-inferior to warfarin for efficacy and safety outcomes, controversy remains over the relative safety of each NOAC in patient subgroups. This narrative review provides an overview of phase III data on NOAC trials for the prevention of stroke in AF, with a focus on reporting the safety of each agent in key patient subgroups based on age, gender, accumulated risk factors, and primary or secondary prevention of stroke...
October 17, 2018: International Journal of Clinical Practice
Jürgen Palm, Katharina Fuchs, Holger Stammer, Anne Schumacher-Stimpfl, Jens Milde
OBJECTIVE: The aim of this multi-centre, randomised, double-blind, placebo-controlled trial was to compare the efficacy and safety of the fixed combination of 0.5 mg tyrothricin, 1.0 mg benzalkonium chloride, and 1.5 mg benzocaine (study drug marketed as Dorithricin® ) in repeat dosing for 3 days to match placebo lozenges in the treatment of acute pharyngitis in adults. METHODS: Patients (pts, aged ≥18 years) with acute pharyngitis, ie, non-streptococcal sore throat and moderate-to-severe pain (intensity NRS ≥ 7; VAS ≥ 50) were assigned to study drug (n = 160) or matching placebo (n = 161)...
October 17, 2018: International Journal of Clinical Practice
Leslie Citrome
Every month I am tasked with selecting articles to receive the label of "Editor's Choice" (EC), ensuring that the article is free to access forever. The goal is to highlight material that may not be easily available elsewhere or that provides an update to a hot topic.1 In some cases these EC choices are accompanied by an editorial. Does this mean greater attention will be paid to EC articles as measured in terms of downloads?. This article is protected by copyright. All rights reserved.
October 16, 2018: International Journal of Clinical Practice
José M de Miguel-Yanes, Rodrigo Jiménez-García, Javier de Miguel-Díez, Valentín Hernández-Barrera, Manuel Méndez-Bailón, Nuria Muñoz-Rivas, Ana López-de-Andrés
AIMS: To describe trends and outcomes during admission for solid organ transplant in people with or without type 2 diabetes in Spain, 2001-2015. METHODS: We used national hospital discharge data to select all hospital admissions for kidney, lung, heart and liver transplant. We estimated admission rates stratified by type 2 diabetes status. We built Poisson regression models to compare the adjusted time trends in admission rates. We tested in-hospital mortality (IHM) in logistic regression analyses...
October 13, 2018: International Journal of Clinical Practice
Raymond C Rosen, Claus G Roehrborn, Michael J Manyak, Juan Manuel Palacios-Moreno, Timothy H Wilson, Zrinka Lulic, Francois Giuliano
AIMS: Five-α reductase inhibitor (5ARI) therapy has been associated with sexual dysfunction in some patients. This study assessed the impact of a fixed-dose combination of the 5ARI dutasteride 0.5 mg and the α1 -adrenoceptor antagonist tamsulosin 0.4 mg (DUT-TAM FDC) on Men's Sexual Health Questionnaire (MSHQ) domain scores in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH). METHODS: This was a post hoc analysis of a double-blind, randomized, placebo-controlled, parallel-group, multicenter study in sexually active patients, aged ≥50 years, with a confirmed clinical diagnosis of BPH...
October 13, 2018: International Journal of Clinical Practice
Dirk Müller-Wieland, Martin Merkel, Andreas Hamann, Erhard Siegel, Bertram Ottillinger, Rainer Woker, Kristian Fresenius
OBJECTIVES: The objective of this survey was to estimate the prevalence of type 2 diabetes mellitus (T2DM) in hospitalised patients ≥55 years based on routine HbA1c measurement upon admission, using the diagnosis algorithm according to the German National Diabetes Care Guideline. DESIGN: Non-interventional survey. SETTING: Four German maximum care hospitals. POPULATION: Consecutive patients ≥55 years of age admitted to hospital...
October 8, 2018: International Journal of Clinical Practice
Marko Skelin, Eugen Javor, Marko Lucijanić, Tomo Lucijanić, Lejsa Jakupović, Dario Rahelić
AIM: Type 2 diabetes (T2D) is one of the major public health issues worldwide. The main cause of mortality and morbidity among T2D patients are cardiovascular (CV) causes. Various antidiabetics are used in T2D treatment, but until recently they lacked clear evidence of the reduction in CV mortality and all-cause mortality as independent study end-points. The aim of this article was to present and critically evaluate potential mechanisms behind the remarkable results documented in trials with new antidiabetics for the treatment of T2D...
October 8, 2018: International Journal of Clinical Practice
Valeria Caramello, Giulia Marulli, Giuseppe Reimondo, Fausto Fanto', Adriana Boccuzzi
BACKGROUND: Reverse triage (RT) identifies patients eligible for discharge and have been proposed to cope with daily surge. Nevertheless, early discharge could increase the rate of readmission. Our aim is to test the effectiveness and safety of RT alone and with readmission screening tools (Identification Senior At Risk [ISAR], HOSPITAL, and Groeningen Frailty Index [GFI] scores) to predict appropriate discharge. MATERIAL AND METHODS: We prospectively assessed every 4 days (t0 ) inpatients of medical divisions (High Dependency Unit (HDU), Internal Medicine (IM), and Geriatrics (Ger)) of an Italian Hospital...
October 4, 2018: International Journal of Clinical Practice
Joseph Habboushe, Caroline Altman, Gregory Y H Lip
BACKGROUND: The impact of the utilisation of such e-health approaches, including mHealth (use of mobile phones and other wireless technology in the delivery of medical care) assessments of health parameters, or the use of decision aids and online risk calculators over time have not been previously described. The objective of this analysis is to assess the time trends in use of the CHADS2 and CHA2 DS2 VASc scores in e-health, and the geographical and specialty uptake of these scores, using data gleaned from a popular online clinical decision tool and medical reference, MDCalc...
October 3, 2018: International Journal of Clinical Practice
Zhiyao Chen, Guoming Wen, Xuelian Cao, Shunming Li, Xiaolin Wang, Zhenjiang Yao, Chuan'an Wu, Xiaohua Ye
BACKGROUND: Group B streptococcus (GBS), which asymptomatically colonises the vaginal and rectal areas of women, is a leading cause of neonatal mortality and morbidity. This study aimed to determine the prevalence and factors associated with GBS colonisation among pregnant women in Shenzhen, China. METHODS: A hospital-based cross-sectional survey was conducted, using a multistage sampling method. Pregnant women at ≥28 weeks' gestation completed a questionnaire and vaginal swabs were obtained for GBS analysis...
October 1, 2018: International Journal of Clinical Practice
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