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https://www.readbyqxmd.com/read/29656532/of-lamp-posts-keys-and-fabled-drunkards-a-perspectival-tale-of-4-guidelines
#1
Trisha Greenhalgh
BACKGROUND: Evidence-based medicine is the application of research findings to inform individual clinical decisions. There is a tension-both philosophical and practical-between the average result from a population study and the circumstances and needs of an individual patient. This personal account of "evidence-based" trauma care illustrates and explores this tension. THE CASE: The author, a keen athlete, describes her experience of a high-impact cycle accident that led to limb fractures (which were diagnosed and treated according to evidence-based guidelines) and also an occult injury to the cervical spine (which was not diagnosed at the time)...
April 15, 2018: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/29656511/neuropathic-pain-a-patient-centred-approach-to-measuring-outcomes
#2
Steve Hwang, Floortje van Nooten, Ted Wells, Aisling Ryan, Bruce Crawford, Christopher Evans, Marci English
BACKGROUND: Neuropathic pain (NP) is a complex, chronic pain state initiated by a primary lesion or dysfunction of the nervous system and presents as a variety of symptoms across multiple disease states. OBJECTIVE: To develop a patient-centred conceptual model of symptoms and impacts in subjects with diabetic peripheral neuropathy (DPN) or post-herpetic neuralgia (PHN) that can inform the measurement strategy in clinical trials. METHOD: Thirty subjects with DPN or PHN participated in in-person interviews which were performed until saturation was achieved...
April 15, 2018: Health Expectations: An International Journal of Public Participation in Health Care and Health Policy
https://www.readbyqxmd.com/read/29656064/a-prospective-study-of-patient-reported-pain-after-bulbar-urethroplasty
#3
Patrick Evans, Sorena Keihani, Benjamin N Breyer, Bradley A Erickson, James M Hotaling, Sara M Lenherr, Jeremy B Myers
PURPOSE: To understand the prevalence of chronic perineal pain, activity limitations, and patient satisfaction after urethroplasty. METHODS: From 2014-2016, we prospectively enrolled men undergoing urethroplasty for bulbar urethral strictures. Patients, before and after surgery, completed questions from the Core Lower Urinary Tract Symptom Score (CLSS) assessing pain frequency in the bladder and penis/urethra, as well as non-validated questions assessing perineal pain...
April 12, 2018: Urology
https://www.readbyqxmd.com/read/29655994/peripartum-anaesthetic-management-of-a-patient-with-brugada-syndrome-and-myoadenylate-deaminase-deficiency
#4
H Dawe, R Wendler, E Evans, S Hammond
Brugada syndrome is a rare electrophysiological cardiac disease which can result in serious arrhythmias and sudden cardiac death. Peripartum management is centred around avoiding arrhythmogenic drugs, including high doses of sodium channel blocking drugs such as bupivacaine. Myoadenylate deaminase deficiency, also known as adenosine monophosphate deaminase deficiency, is the commonest cause of myopathy in Caucasians. There is evidence that myoadenylate deaminase deficiency can predispose patients to developing malignant hyperthermia when exposed to specific anaesthetic agents...
March 2, 2018: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/29655666/environmental-considerations-in-the-selection-of-isolation-gowns-a-life-cycle-assessment-of-reusable-and-disposable-alternatives
#5
Eric Vozzola, Michael Overcash, Evan Griffing
BACKGROUND: Isolation gowns serve a critical role in infection control by protecting healthcare workers, visitors, and patients from the transfer of microorganisms and body fluids. The decision of whether to use a reusable or disposable garment system is a selection process based on factors including sustainability, barrier effectiveness, cost, and comfort. Environmental sustainability is increasingly being used in the decision-making process. Life cycle assessment is the most comprehensive and widely used tool used to evaluate environmental performance...
April 11, 2018: American Journal of Infection Control
https://www.readbyqxmd.com/read/29655620/identification-of-men-with-low-risk-biopsy-confirmed-prostate-cancer-as-candidates-for-active-surveillance
#6
Daniel W Lin, E David Crawford, Thomas Keane, Brent Evans, Julia Reid, Saradha Rajamani, Krystal Brown, Alexander Gutin, Jonathan Tward, Peter Scardino, Michael Brawer, Steven Stone, Jack Cuzick
BACKGROUND: A combined clinical cell-cycle risk (CCR) score that incorporates prognostic molecular and clinical information has been recently developed and validated to improve prostate cancer mortality (PCM) risk stratification over clinical features alone. As clinical features are currently used to select men for active surveillance (AS), we developed and validated a CCR score threshold to improve the identification of men with low-risk disease who are appropriate for AS. METHODS: The score threshold was selected based on the 90th percentile of CCR scores among men who might typically be considered for AS based on NCCN low/favorable-intermediate risk criteria (CCR = 0...
April 11, 2018: Urologic Oncology
https://www.readbyqxmd.com/read/29655587/short-term-quality-of-life-after-subthalamic-stimulation-depends-on-non-motor-symptoms-in-parkinson-s-disease
#7
Haidar Salimi Dafsari, Luisa Weiß, Monty Silverdale, Alexandra Rizos, Prashanth Reddy, Keyoumars Ashkan, Julian Evans, Paul Reker, Jan Niklas Petry-Schmelzer, Michael Samuel, Veerle Visser-Vandewalle, Angelo Antonini, Pablo Martinez-Martin, K Ray-Chaudhuri, Lars Timmermann
BACKGROUND: Subthalamic nucleus (STN) deep brain stimulation (DBS) improves quality of life (QoL), motor, and non-motor symptoms (NMS) in advanced Parkinson's disease (PD). However, considerable inter-individual variability has been observed for QoL outcome. HYPOTHESIS: We hypothesized that demographic and preoperative NMS characteristics can predict postoperative QoL outcome. METHODS: In this ongoing, prospective, multicenter study (Cologne, Manchester, London) including 88 patients, we collected the following scales preoperatively and on follow-up 6 months postoperatively: PDQuestionnaire-8 (PDQ-8), NMSScale (NMSS), NMSQuestionnaire (NMSQ), Scales for Outcomes in PD (SCOPA)-motor examination, -complications, and -activities of daily living, levodopa equivalent daily dose...
February 24, 2018: Brain Stimulation
https://www.readbyqxmd.com/read/29655586/non-motor-outcomes-of-subthalamic-stimulation-in-parkinson-s-disease-depend-on-location-of-active-contacts
#8
Haidar Salimi Dafsari, Jan Niklas Petry-Schmelzer, K Ray-Chaudhuri, Keyoumars Ashkan, Luca Weis, Till A Dembek, Michael Samuel, Alexandra Rizos, Monty Silverdale, Michael T Barbe, Gereon R Fink, Julian Evans, Pablo Martinez-Martin, Angelo Antonini, Veerle Visser-Vandewalle, Lars Timmermann
BACKGROUND: Subthalamic nucleus (STN) deep brain stimulation (DBS) improves quality of life (QoL), motor, and non-motor symptoms (NMS) in Parkinson's disease (PD). Few studies have investigated the influence of the location of neurostimulation on NMS. OBJECTIVE: To investigate the impact of active contact location on NMS in STN-DBS in PD. METHODS: In this prospective, open-label, multicenter study including 50 PD patients undergoing bilateral STN-DBS, we collected NMSScale (NMSS), NMSQuestionnaire (NMSQ), Hospital Anxiety and Depression Scale (anxiety/depression, HADS-A/-D), PDQuestionnaire-8 (PDQ-8), Scales for Outcomes in PD-motor examination, motor complications, activities of daily living (ADL), and levodopa equivalent daily dose (LEDD) preoperatively and at 6 months follow-up...
March 16, 2018: Brain Stimulation
https://www.readbyqxmd.com/read/29653297/the-efficacy-of-transcranial-random-noise-stimulation-trns-on-mood-may-depend-on-individual-differences-including-age-and-trait-mood
#9
Carys Evans, Michael J Banissy, Rebecca A Charlton
OBJECTIVES: To assess whether changes in brain microstructures associated with ageing and presence of cardiovascular risk factors (CVRF) reduce the efficacy of transcranial electrical stimulation (tES) improving mood in euthymic older adults. METHODS: Using excitatory high-frequency transcranial random noise stimulation (tRNS) over bilateral dorsolateral prefrontal cortex, the effect on mood was assessed in euthymic young adults (YA), older adults (HOA) and older adults with CVRF (OVR)...
March 31, 2018: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
https://www.readbyqxmd.com/read/29652752/practice-change-from-intermittent-medication-boluses-to-bolusing-from-a-continuous-infusion-in-pediatric-critical-care-a-quality-improvement-project
#10
Jessica L Hochstetler, A Jill Thompson, Natalie M Ball, Melissa C Evans, Shaun C Frame, A Lauren Haney, Amelia K Little, Jaime L O'Donnell, Bryna M Rickett, Elizabeth H Mack
OBJECTIVES: To determine whether implementing a guideline to bolus medications from continuous infusions in PICUs affects nursing satisfaction, patient safety, central line entries, medication utilization, or cost. DESIGN: This is a pre- and postimplementation quality improvement study. SETTING: An 11-bed ICU and 14-bed cardiac ICU in a university-affiliated children's hospital. PATIENTS: Patients less than 18 years old admitted to the PICU or pediatric cardiac ICU receiving a continuous infusion of dexmedetomidine, midazolam, fentanyl, morphine, vecuronium, or cisatracurium from May 2015 to May 2016, excluding November 2015 (washout period), were eligible for inclusion...
April 12, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29652246/metformin-in-non-diabetic-hyperglycaemia-the-glint-feasibility-rct
#11
Simon J Griffin, M Angelyn Bethel, Rury R Holman, Kamlesh Khunti, Nicholas Wareham, Gwen Brierley, Melanie Davies, Andrew Dymond, Rose Eichenberger, Philip Evans, Alastair Gray, Colin Greaves, Kyla Harrington, Graham Hitman, Greg Irving, Sarah Lessels, Ann Millward, John R Petrie, Martin Rutter, Mike Sampson, Naveed Sattar, Stephen Sharp
BACKGROUND: The treatment of people with diabetes with metformin can reduce cardiovascular disease (CVD) and may reduce the risk of cancer. However, it is unknown whether or not metformin can reduce the risk of these outcomes in people with elevated blood glucose levels below the threshold for diabetes [i.e. non-diabetic hyperglycaemia (NDH)]. OBJECTIVE: To assess the feasibility of the Glucose Lowering In Non-diabetic hyperglycaemia Trial (GLINT) and to estimate the key parameters to inform the design of the full trial...
April 2018: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/29652199/the-role-and-mechanism-of-borneol-to-open-the-blood-brain-barrier
#12
Tao Wu, Aiqin Zhang, Hongyang Lu, Qiaoyuan Cheng
BACKGROUND: The blood-brain barrier (BBB) is the greatest challenge in the treatment of intracranial malignant tumors. OBJECTIVE: The aim of this study is to determine the role of borneol in opening the BBB and elucidate the underlying mechanisms. MATERIALS AND METHODS: Twenty Sprague-Dawley (SD) rats were randomized into borneol group intragastrically administered with 10% borneol corn oil (2 mL/kg) and control group. After 30 minutes, 2% Evans blue (4 mL/kg) was injected...
April 1, 2018: Integrative Cancer Therapies
https://www.readbyqxmd.com/read/29652140/intra-versus-intermolecular-carbon-to-carbon-proton-transfers-in-the-reactions-of-arynes-with-nitrogen-nucleophiles-a-dft-study
#13
Yi Wang, Zhi-Xiang Yu
Carbon-to-carbon proton transfer (PT) is an elementary reaction in organic chemistry. Herein we report a systematic DFT study on the carbon-tocarbon proton transfers in the reactions of arynes with nitrogen nucleophiles, including tertiary amines, aziridines, imines, and N-heteroarenes. DFT calculations indicated that the Gibbs energies of activation for the 1,4- and 1,5-proton transfers involved are lower than 20 kcal/mol in most cases. We also found that the Bell-Evans-Polanyi principle applies to the 1,4-proton transfers, indicating that the more exergonic an intramolecular proton transfer is (the more stable a carbanion is generated), the faster it will be...
April 13, 2018: Journal of Organic Chemistry
https://www.readbyqxmd.com/read/29650485/providing-transthoracic-echocardiography-training-for-intensive-care-unit-trainees-an-educational-improvement-initiative
#14
Catherine M Kuza, M Tariq Hanifi, Melissa Koç, Matthias Stopfkuchen-Evans
OBJECTIVE: Transthoracic echocardiography (TTE) is important in the management of critically ill patients, yet it has not been incorporated into many residency programs' curricula. Our objective is to determine if trainees undergoing a 60-minute training session on TTE have improved knowledge, ultrasound skills, and increases the utilization of TTE during their rotation in the intensive care unit (ICU). We will also compare the results of participants with prior TTE exposure to TTE-naïve trainees...
April 9, 2018: Journal of Surgical Education
https://www.readbyqxmd.com/read/29650424/implications-of-insecticide-resistance-for-malaria-vector-control-with-long-lasting-insecticidal-nets-a-who-coordinated-prospective-international-observational-cohort-study
#15
Immo Kleinschmidt, John Bradley, Tessa Bellamy Knox, Abraham Peter Mnzava, Hmooda Toto Kafy, Charles Mbogo, Bashir Adam Ismail, Jude D Bigoga, Alioun Adechoubou, Kamaraju Raghavendra, Jackie Cook, Elfatih M Malik, Zinga José Nkuni, Michael Macdonald, Nabie Bayoh, Eric Ochomo, Etienne Fondjo, Herman Parfait Awono-Ambene, Josiane Etang, Martin Akogbeto, Rajendra M Bhatt, Mehul Kumar Chourasia, Dipak K Swain, Teresa Kinyari, Krishanthi Subramaniam, Achille Massougbodji, Mariam Okê-Sopoh, Aurore Ogouyemi-Hounto, Celestin Kouambeng, Mujahid Sheikhedin Abdin, Philippa West, Khalid Elmardi, Sylvie Cornelie, Vincent Corbel, Neena Valecha, Evan Mathenge, Luna Kamau, Jonathan Lines, Martin James Donnelly
BACKGROUND: Scale-up of insecticide-based interventions has averted more than 500 million malaria cases since 2000. Increasing insecticide resistance could herald a rebound in disease and mortality. We aimed to investigate whether insecticide resistance was associated with loss of effectiveness of long-lasting insecticidal nets and increased malaria disease burden. METHODS: This WHO-coordinated, prospective, observational cohort study was done at 279 clusters (villages or groups of villages in which phenotypic resistance was measurable) in Benin, Cameroon, India, Kenya, and Sudan...
April 9, 2018: Lancet Infectious Diseases
https://www.readbyqxmd.com/read/29650015/inclusion-and-exclusion-criteria-used-in-non-specific-low-back-pain-trials-a-review-of-randomised-controlled-trials-published-between-2006-and-2012
#16
Pål André Amundsen, David W Evans, Dévan Rajendran, Philip Bright, Tom Bjørkli, Sandra Eldridge, Rachelle Buchbinder, Martin Underwood, Robert Froud
BACKGROUND: Low back pain is a common health complaint resulting in substantial economic burden. Each year, upwards of 20 randomised controlled trials (RCTs) evaluating interventions for non-specific low back pain are published. Use of the term non-specific low back pain has been criticised on the grounds of encouraging heterogeneity and hampering interpretation of findings due to possible heterogeneous causes, challenging meta-analyses. We explored selection criteria used in trials of treatments for nsLBP...
April 12, 2018: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/29649900/in-vitro-comparison-of-a-novel-single-probe-dual-energy-lithotripter-to-current-devices
#17
Evan Clayton Carlos, Daniel A Wollin, Brenton B Winship, Ruiyang Jiang, Daniela Radvak, Ben H Chew, Michael R Gustafson, W Neal Simmons, Pei Zhong, Glenn M Preminger, Michael Eric Lipkin
PURPOSE: The LithoClast Trilogy is a novel single probe, dual-energy lithotripter with ultrasonic vibration and electromagnetic impact forces. ShockPulse and LithoClast Select are existing lithotripters that also use a combination of ultrasonic and mechanical impact energies. We compared the efficacy and tip motion of these devices in an in vitro setting. MATERIALS AND METHODS: 15:3 Begostones were used in all trials. Test groups were Trilogy, ShockPulse, Select ultrasound only (Select-US) and Select ultrasound with pneumatic (Select-USP)...
April 13, 2018: Journal of Endourology
https://www.readbyqxmd.com/read/29649307/bilateral-carotid-artery-stenosis-causes-unexpected-early-changes-in-brain-extracellular-matrix-and-blood-brain-barrier-integrity-in-mice
#18
Jill M Roberts, Michael E Maniskas, Gregory J Bix
Bilateral carotid artery stenosis (BCAS) is one experimental model of vascular dementia thought to preferentially impact brain white matter. Indeed, few studies report hippocampal and cortical pathology prior to 30 days post-stenosis; though it is unclear whether those studies examined regions outside the white matter. Since changes in the blood-brain barrier (BBB) permeability precede more overt brain pathology in various diseases, we hypothesized that changes within the BBB and/or BBB-associated extracellular matrix (ECM) could occur earlier after BCAS in the hippocampus, cortex and striatum and be a precursor of longer term pathology...
2018: PloS One
https://www.readbyqxmd.com/read/29648979/long-term-functional-and-structural-consequences-of-primary-blast-overpressure-to-the-eye
#19
Rachael Allen, Cara T Motz, Andrew Feola, Kyle Chesler, Raza Haider, Sringanesh Ramachandra Rao, Lara Skelton, Steven Fliesler, Machelle T Pardue
Acoustic blast overpressure (ABO) injury in military personnel and civilians is often accompanied by delayed visual deficits. However, most animal model studies dealing with blast-induced visual defects have focused on short-term (≤1 month) changes. Here, we evaluated long-term (≤8 months) retinal structure and function deficits in rats with ABO injury. Adult male Long Evans rats were subjected to ABO from a single blast (∼ 190 dB SPL, ∼ 63 kPa, @80 psi), generated by a shock tube device. Retinal function (electroretinography), visual function (optokinetic tracking), retinal thickness (spectral domain-optical coherence tomography), and spatial cognition/exploratory motor behavior (Y-maze) were measured at 2, 4, 6, and 8 months post-blast...
March 6, 2018: Journal of Neurotrauma
https://www.readbyqxmd.com/read/29648971/anti-inflammatory-effects-of-a-mixture-of-lactic-acid-bacteria-and-sodium-butyrate-in-atopic-dermatitis-murine-model
#20
Jeong A Kim, Sung-Hak Kim, In Sung Kim, Da Yoon Yu, Sung Chan Kim, Seung Ho Lee, Sang Suk Lee, Cheol-Heui Yun, In Soon Choi, Kwang Keun Cho
Atopic dermatitis is a chronic and recurrent inflammatory skin disease. Recently, probiotics have been shown to suppress allergic symptoms through immunomodulatory responses. In the present study, combinatorial effects on allergic symptoms were identified in BALB/c mice fed with a mixture of four species of probiotics, Bifidobacterium lactis, Lactobacillus casei, Lactobacillus rhamnosus, and Lactobacillus plantarum, and sodium butyrate. Following sensitization with whey protein, the mice were challenged and divided into two groups: (1) mice administered with phosphate-buffered saline as a control and (2) mice administered with the probiotic mixture and sodium butyrate...
March 20, 2018: Journal of Medicinal Food
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