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clinical questions

Dagmara Rusinek, Ewa Chmielik, Jolanta Krajewska, Michal Jarzab, Malgorzata Oczko-Wojciechowska, Agnieszka Czarniecka, Barbara Jarzab
A rising incidence of thyroid cancers (TCs) mainly small tumors, observed during recent years, lead to many controversies regarding treatment strategies. TCs represent a distinct molecular background and clinical outcome. Although in most cases TCs are characterized by a good prognosis, there are some aggressive forms, which do not respond to standard treatment. There are still some questions, which have to be resolved to avoid dangerous simplifications in the clinical management. In this article, we focused on the current advantages in preoperative molecular diagnostic tests and histopathological examination including noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)...
August 22, 2017: International Journal of Molecular Sciences
Paul A Arbisi
A reflection on the exchange between Larrabee et al. (2017) and Nichols (2017) is provided by a clinical psychologist who co-authored an early critique questioning the validity of the FBS as a measure of over reporting and who, based on subsequent studies demonstrating the effectiveness of the FBS in identifying non-credible report of somatic and cognitive complaints, changed his opinion regarding the utility of the FBS/FBS-r as a symptom validity measure. Given the accumulated evidence demonstrating the effectiveness of the FBS/FBS-r as a symptom validity measure, reasons for the continued debate over the validity and utility of the FBS/FBS-r are discussed...
August 22, 2017: Clinical Neuropsychologist
Roy Fleischmann
Tofacitinib is a pan JAK inhibitor with specificity for JAK3 over JAK1 over JAK2, which is approved in many countries for the treatment of rheumatoid arthritis (RA), including the United States and the European Union, either as monotherapy or in combination with conventional synthetic disease modifying anti-arthritis drugs (csDMARDs). Phase 2, 3 and 4 clinical trials have investigated the efficacy and safety of tofacitinib given either as monotherapy or in combination with csDMARDs. Areas Covered: This review reports the safety, clinical, functional, and radiographic efficacy, of tofacitinib used as monotherapy in the treatment of adult patients with RA reported in the prospective, double-blind, controlled randomized trials reported to date...
August 22, 2017: Expert Opinion on Pharmacotherapy
Deepa V Cherla, Maya L Moses, Cristina P Viso, Julie L Holihan, Juan R Flores-Gonzalez, Lillian S Kao, Tien C Ko, Mike K Liang
BACKGROUND: The modified Activities Assessment Scale (AAS) is a 13-question abdominal wall quality of life (AW-QOL) survey validated in patients undergoing ventral hernia repair (VHR). No studies have assessed AW-QOL among individuals without abdominal wall pathology. The minimal clinically important difference (MCID) of the modified AAS and its implications for the threshold at which VHR should be offered also remain unknown. Our objectives were to (1) establish the AW-QOL of patients with a clinical abdominal wall hernia versus those with no hernia, (2) determine the MCID of the modified AAS, and (3) identify the baseline quality of life (QOL) score at which patients derive little clinical benefit from VHR...
August 21, 2017: World Journal of Surgery
Matthias Aurich, Gunther Olaf Hofmann, Bernd Rolauffs
PURPOSE: The aim was to analyse the biological characteristics of chondrocytes from the two biopsy sites notch vs. trochlea of human knee joints. The question was whether tissue engineering-relevant characteristics such as viability and mRNA expression profile would be comparable ex vivo and after monolayer expansion, as these are parts of routine autologous chondrocyte implantation (ACI). METHODS: Biopsies from the intercondylar notch and the lateral aspect of the trochlea from 20 patients with ICRS grades 3 and 4 cartilage defects were harvested during arthroscopy...
August 21, 2017: International Orthopaedics
Peter Doshi, Peter Hur, Mark Jones, Husam Albarmawi, Tom Jefferson, Daniel J Morgan, Patricia A Spears, John H Powers
Importance: Potential research participants may assume that randomized trials comparing new interventions with older interventions always hypothesize greater efficacy for the new intervention, as in superiority trials. However, antibiotic trials frequently use "noninferiority" hypotheses allowing a degree of inferior efficacy deemed "clinically acceptable" compared with an older effective drug, in exchange for nonefficacy benefits (eg, decreased adverse effects). Considering these different benefit-harm trade-offs, proper informed consent necessitates supplying different information on the purposes of superiority and noninferiority trials...
August 21, 2017: JAMA Internal Medicine
Flaminia Bardanzellu, Paola Neroni, Angelica Dessì, Vassilios Fanos
In preterm infants, failure or delay in spontaneous closure of Ductus Arteriosus (DA), resulting in the condition of Patent Ductus Arteriosus (PDA), represents a significant issue. A prolonged situation of PDA can be associated with several short- and long-term complications. Despite years of researches and clinical experience on PDA management, unresolved questions about the treatment and heterogeneity of clinical practices in different centers still remain, in particular regarding timing and modality of intervention...
2017: BioMed Research International
Hayley E Mableson, Sarah Martindale, Michelle C Stanton, Charles Mackenzie, Louise A Kelly-Hope
BACKGROUND: Lymphatic filariasis (LF) is a neglected tropical disease (NTD) targeted for global elimination by 2020. Currently there is considerable international effort to scale-up morbidity management activities in endemic countries, however there remains a need for rapid, cost-effective methods and adaptable tools for obtaining estimates of people presenting with clinical manifestations of LF, namely lymphoedema and hydrocele. The mHealth tool 'MeasureSMS-Morbidity' allows health workers in endemic areas to use their own mobile phones to send clinical information in a simple format using short message service (SMS)...
2017: MHealth
Parvati B Patel, Tejas K Patel, Snehal Anturlikar, Sahila Khatun, Prakash Bhabhor, Manoj Kumar Saurabh
BACKGROUND: An important challenge to spontaneous reporting system is underreporting. The sensitization and involvement of undergraduate medical students can reduce underreporting in pharmacovigilance program. OBJECTIVE: To analyze the clinical characteristics and reporting quality of adverse drug reactions (ADRs) by undergraduate medical students in comparison with physicians' reporting. METHODS: We sensitized the second professional year undergraduate medical students about pharmacovigilance and asked them to submit reports of ADR observed during their clinical posting from January to December 2015...
July 2017: Perspectives in Clinical Research
Netanel Ofer, Orit Shefi, Gur Yaari
Computational modeling of signal propagation in neurons is critical to our understanding of basic principles underlying brain organization and activity. Exploring these models is used to address basic neuroscience questions as well as to gain insights for clinical applications. The seminal Hodgkin Huxley model is a common theoretical framework to study brain activity. It was mainly used to investigate the electrochemical and physical properties of neurons. The influence of neuronal structure on activity patterns was explored, however, the rich dynamics observed in neurons with different morphologies is not yet fully understood...
August 21, 2017: Scientific Reports
Julien Santi-Rocca, Fernando Fernandez-Cortes, Carlos Chillón-Marinas, María-Luisa González-Rubio, David Martin, Núria Gironès, Manuel Fresno
The extreme genetic diversity of the protozoan Trypanosoma cruzi has been proposed to be associated with the clinical outcomes of the disease it provokes: Chagas disease (CD). To address this question, we analysed the similarities and differences in the CD pathophysiogenesis caused by different parasite strains. Using syngeneic mice infected acutely or chronically with 6 distant parasite strains, we integrated simultaneously 66 parameters: parasite tropism (7 parameters), organ and immune responses (local and systemic; 57 parameters), and clinical presentations of CD (2 parameters)...
August 21, 2017: Scientific Reports
E Taskesen, A Mishra, S van der Sluis, R Ferrari, J H Veldink, M A van Es, A B Smit, D Posthuma, Y Pijnenburg
Frontotemporal dementia (FTD) is a neurodegenerative disorder predominantly affecting the frontal and temporal lobes. Genome-wide association studies (GWAS) on FTD identified only a few risk loci. One of the possible explanations is that FTD is clinically, pathologically, and genetically heterogeneous. An important open question is to what extent epigenetic factors contribute to FTD and whether these factors vary between FTD clinical subgroup. We compared the DNA-methylation levels of FTD cases (n = 128), and of FTD cases with Amyotrophic Lateral Sclerosis (FTD-ALS; n = 7) to those of unaffected controls (n = 193), which resulted in 14 and 224 candidate genes, respectively...
August 21, 2017: Scientific Reports
Karen L Tang, Kelsey Lucyk, Hude Quan
BACKGROUND: Professional coding specialists ("coders") are experts at translating patient chart information into alphanumerical codes, which are then widely used in research and health policy decision-making. Coders rely solely on documentation by health care providers to complete this task. We aimed to explore physician-related barriers to coding that results in high-quality administrative data. METHODS: In a qualitative study conducted from December 2015 to March 2016, we recruited 28 coders who worked in health care facilities in Alberta using purposive and snowball sampling...
August 15, 2017: CMAJ Open
Joel Wilson, Jerry Baskerville, Sahar Zarabi
A shortcut review was carried out to establish whether serum procalcitonin levels can be used to identify serious bacterial infection in ED patients with undifferentiated SIRS. 14 papers presented the best evidence to answer the clinical question. The review concludes that raised procalcitonin levels are associated with bacteraemia; however, there are no clinical management studies addressing this question in ED patients with SIRS.
September 2017: Emergency Medicine Journal: EMJ
Joel Wilson, Sahar Zarabi
A shortcut review was carried out to establish whether the presence of systemic inflammatory response criteria in emergency department patients with pancreatitis is predictive of the risk of death. Eight papers presented the best evidence to answer the clinical question. The review concludes that the presence of SIRS in emergency department patients with pancreatitis is associated with a higher risk of mortality.
September 2017: Emergency Medicine Journal: EMJ
Andrew Cook, Elke Streit, Gill Davage
OBJECTIVES: The objective of this study was to explore whether reducing the material supplied to external experts during peer review and decreasing the burden of response would maintain review quality into prioritising research questions for a major research funder. METHODS AND ANALYSIS: Clinical experts who agreed to review documents outlining research for potential commissioning were screened for eligibility and randomised in a factorial design to two types of review materials (long document versus short document) and response modes (structured review form versus free text email response)...
August 21, 2017: BMJ Open
Julia Chisnell, Tom Marshall, Chris Hyde, Zhivko Zhelev, Lora E Fleming
OBJECTIVE: This study reviewed the news media coverage of statins, seeking to identify specific trends or differences in viewpoint between media outlets and examine common themes. DESIGN: The study is a content analysis of the frequency and content of the reporting of statins in a selection of the British newsprint media. It involved an assessment of the number, timing and thematic content of articles followed by a discourse analysis examining the underlying narratives...
August 21, 2017: BMJ Open
Nobuaki Matsubara, Yoko Yamada, Ken-Ichi Tabata, Takefumi Satoh, Naoto Kamiya, Hiroyoshi Suzuki, Takashi Kawahara, Hiroji Uemura, Akihiro Yano, Satoru Kawakami, Masafumi Otsuka, Satoshi Fukasawa
BACKGROUND: An important clinical question of great interest to clinicians is how to best sequence androgen receptor targeted agents (ARTAs) and chemotherapy for metastatic castration-resistant prostate cancer (mCRPC), but the answer is still unclear. MATERIALS AND METHODS: To evaluate and compare the clinical outcomes of ARTA and docetaxel (DTX) as second-line treatment in the post first-line ARTA, we conducted a retrospective analysis of chemotherapy-naive mCRPC patients who had received sequential treatment with ARTA followed by another ARTA (ARTA-ARTA) or ARTA followed by DTX (ARTA-DTX)...
July 26, 2017: Clinical Genitourinary Cancer
Anthony R Mato, Meghan C Thompson, Chadi Nabhan, Jakub Svoboda, Stephen J Schuster
The treatment landscape for chronic lymphocytic leukemia (CLL) is changing rapidly. Novel targeted agents such as ibrutinib, venetoclax, and idelalisib have had a significant effect on first-line, relapsed/refractory, and high-risk disease. Despite these advances, there are continuous needs for new treatment options, especially for patients in whom these novel therapies fail or those who cannot tolerate these novel therapies. In 2011, Porter et al reported the first successful use of autologous chimeric antigen receptor T cells (CARTs) directed against cluster of differentiation (CD)19 in 3 refractory CLL patients...
July 21, 2017: Clinical Lymphoma, Myeloma & Leukemia
Lara Keuck
Alois Alzheimer (1864-1915) was a German physician who specialized in psychiatry, and who is today known for the first description of a-in his own words-peculiar ailment (eigenartige Erkrankung), which was named after him. In his time, however, he was foremost recognized for his work in refining histopathological techniques and thereby contributing to the methodological arsenal for differential diagnosis in clinical psychiatry. In his laboratory that was based at the renowned Munich Psychiatric University Clinic led by Emil Kraepelin (1856-1926), Alzheimer, his assistants, and students conserved, prepared, and studied slices of deceased patients' brains under the microscope...
2017: Progress in Brain Research
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