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https://www.readbyqxmd.com/read/29449241/simplified-guideline-for-prescribing-medical-cannabinoids-in-primary-care
#1
G Michael Allan, Jamil Ramji, Danielle Perry, Joey Ton, Nathan P Beahm, Nicole Crisp, Beverly Dockrill, Ruth E Dubin, Ted Findlay, Jessica Kirkwood, Michael Fleming, Ken Makus, Xiaofu Zhu, Christina Korownyk, Michael R Kolber, James McCormack, Sharon Nickel, Guillermina Noël, Adrienne J Lindblad
OBJECTIVE: To develop a clinical practice guideline for a simplified approach to medical cannabinoid use in primary care; the focus was on primary care application, with a strong emphasis on best available evidence and a promotion of shared, informed decision making. METHODS: The Evidence Review Group performed a detailed systematic review of 4 clinical areas with the best evidence around cannabinoids: pain, nausea and vomiting, spasticity, and adverse events. Nine health professionals (2 generalist family physicians, 2 pain management-focused family physicians, 1 inner-city family physician, 1 neurologist, 1 oncologist, 1 nurse practitioner, and 1 pharmacist) and a patient representative comprised the Prescribing Guideline Committee (PGC), along with 2 nonvoting members (pharmacist project managers)...
February 2018: Canadian Family Physician Médecin de Famille Canadien
https://www.readbyqxmd.com/read/29448010/improved-outcomes-in-management-of-hypoplastic-left-heart-syndrome-associated-with-congenital-diaphragmatic-hernia-an-algorithmic-approach
#2
Kaitlin Balduf, T K Susheel Kumar, Umar Boston, Shyam Sathanandam, Marc V Lee, Tim Jancelewicz, Christopher J Knott-Craig
BACKGROUND: Hypoplastic left heart syndrome (HLHS) is the second most common congenital heart disease associated with congenital diaphragmatic hernia (CDH). The reported survival of neonates with CDH and HLHS is only 1-5%. We review our experience with CDH and HLHS and compare our outcomes to published literature. METHODS: Retrospective review of all neonates with CDH and HLHS at our institution over a 10 year period was performed. The morphology of cardiac and diaphragm defects, clinical course, treatment strategies and outcomes were reviewed and an algorithmic approach is proposed...
February 12, 2018: Seminars in Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29447356/barriers-to-the-availability-and-accessibility-of-controlled-medicines-for-chronic-pain-in-africa
#3
Elmang Nchako, Scottie Bussell, Carlos Nesbeth, Chisom Odoh
Africans endure a high burden of pain and suffering from HIV/AIDS and cancer, yet receive a meager amount of the world's pain medication. This tragedy occurs needlessly, given that inexpensive, effective and easily administered interventions are available. WHO has a 'three-step analgesic ladder' framework for managing cancer pain. This widely adopted clinical practice guideline is an integral part of palliative care programs and has also been applied to non-cancer pain. However, untreated pain is a major public health problem due to the discordance between scientific evidence and public policy...
February 13, 2018: International Health
https://www.readbyqxmd.com/read/29447116/amyloid-toxicity-in-alzheimer-s-disease
#4
REVIEW
Allison B Reiss, Hirra A Arain, Mark M Stecker, Nicolle M Siegart, Lora J Kasselman
A major feature of Alzheimer's disease (AD) pathology is the plaque composed of aggregated amyloid-β (Aβ) peptide. Although these plaques may have harmful properties, there is much evidence to implicate soluble oligomeric Aβ as the primary noxious form. Aβ oligomers can be generated both extracellularly and intracellularly. Aβ is toxic to neurons in a myriad of ways. It can cause pore formation resulting in the leakage of ions, disruption of cellular calcium balance, and loss of membrane potential. It can promote apoptosis, cause synaptic loss, and disrupt the cytoskeleton...
February 15, 2018: Reviews in the Neurosciences
https://www.readbyqxmd.com/read/29441510/translating-the-combination-of-gene-therapy-and-tissue-engineering-for-treating-recessive-dystrophic-epidermolysis-bullosa
#5
A Dakiw Piaceski, D Larouche, K Ghani, F Bisson, S Cortez Ghio, S Larochelle, M J Moulin, M Caruso, L Germain
The combination of gene therapy and tissue engineering is one of the most promising strategies for the treatment of recessive dystrophic epidermolysis bullosa (RDEB). RDEB is a rare genetic disease characterised by mutations in the COL7A1 gene, encoding type VII collagen (COLVII), which forms anchoring fibrils at the dermal-epidermal junction of the skin. This disease causes severe blistering and only palliative treatments are offered. In this study, the base of a strategy combining gene therapy and a tissue-engineered skin substitute (TES), which would be suitable for the permanent closure of skin wounds, was set-up...
February 14, 2018: European Cells & Materials
https://www.readbyqxmd.com/read/29440831/prognostic-value-of-troponin-in-infants-with-hypoplastic-left-heart-syndrome-between-stage-i-and-ii-of-palliation
#6
Martin Christmann, Emanuela R Valsangiacomo Büchel, Hitendu Dave, Dietrich Klauwer, Anna Cavigelli-Brunner
Background: The period between stage I and II procedure for treatment of hypoplastic left heart syndrome (HLHS) bears high mortality and morbidity. Methods: We sought to analyze the prognostic value of Troponin T/I (Trop), a well-recognized marker for myocardial damage and heart failure, for predicting outcome in a retrospective analysis of 70 infants with HLHS at our institution between March 2001 and October 2014. Results: Stage I procedure consisted of Norwood I operation in 35 (50%) and Hybrid-approach in 22 (31%) patients...
January 2018: Annals of Pediatric Cardiology
https://www.readbyqxmd.com/read/29440798/rural-palliative-care-in-north-india-rapid-evaluation-of-a-program-using-a-realist-mixed-method-approach
#7
Daniel F Munday, Erna Haraldsdottir, Manju Manak, Ann Thyle, Cathy M Ratcliff
Context: Palliative care has not developed widely in rural North India. Since 2010, the Emmanuel Hospitals Association (EHA) has been developing a model of palliative care appropriate for this setting, based on teams undertaking home visits with the backup of outpatient and inpatient services. A project to further develop the model operated from 2012 to 2015 supported by funding from the UK. Aims: This study aims to evaluate the EHA palliative care project. Settings and Design: Rapid evaluation method using a mixed method realist approach at the five project hospital sites...
January 2018: Indian Journal of Palliative Care
https://www.readbyqxmd.com/read/29440127/ethics-and-patient-and-public-involvement-with-children-and-young-people
#8
Sarah Jane Mitchell, Anne-Marie Slowther, Jane Coad, Shazaan Akhtar, Elizabeth Hyde, Dena Khan, Jeremy Dale
Patient and public involvement (PPI) is important both in research and in quality improvement activities related to healthcare services . While PPI activities do not require formal ethical approval, they can raise a number of ethical concerns, through the introduction of complex technical medical concepts, challenging language or sensitive subject areas. There is very little published literature to guide ethical practice in this area. We have been conducting PPI with children and young people throughout a research study in paediatric palliative care...
February 9, 2018: Archives of Disease in Childhood. Education and Practice Edition
https://www.readbyqxmd.com/read/29436432/passing-the-baton-of-trust
#9
Catherine Millington-Sanders
Proactive, shared decision making between key professionals and sensitive communication with patients, and those important to them, can never be overestimated. Projected annual deaths in England and Wales are set to rise, highlighting the increasing need for high quality palliative and end-of-life care. The Royal College of General Practitioners and Marie Curie have worked in partnership to develop the Daffodil Standards, an evidenced-based, structured approach for practices using quality improvement methodology to help improve care for patients at an advanced stage of serious illness or approaching end of life...
February 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/29436279/integrated-palliative-care-is-about-professional-networking-rather-than-standardisation-of-care-a-qualitative-study-with-healthcare-professionals-in-19-integrated-palliative-care-initiatives-in-five-european-countries
#10
Marlieke den Herder-van der Eerden, Jeroen van Wijngaarden, Sheila Payne, Nancy Preston, Lisa Linge-Dahl, Lukas Radbruch, Karen Van Beek, Johan Menten, Csilla Busa, Agnes Csikos, Kris Vissers, Jelle van Gurp, Jeroen Hasselaar
BACKGROUND: Integrated palliative care aims at improving coordination of palliative care services around patients' anticipated needs. However, international comparisons of how integrated palliative care is implemented across four key domains of integrated care (content of care, patient flow, information logistics and availability of (human) resources and material) are lacking. AIM: To examine how integrated palliative care takes shape in practice across abovementioned key domains within several integrated palliative care initiatives in Europe...
February 1, 2018: Palliative Medicine
https://www.readbyqxmd.com/read/29435712/antimicrobial-therapy-in-palliative-care-an-overview
#11
REVIEW
Filipa Macedo, Catarina Nunes, Katia Ladeira, Filipa Pinho, Nadine Saraiva, Nuno Bonito, Luísa Pinto, Francisco Gonçalves
In the advanced stages of illness, patients often face challenging decisions regarding their treatment and overall medical care. Terminal ill patients are commonly affected by infections. However, in palliative care, the use of antimicrobials can be an ethical dilemma. Deciding whether to treat, withhold, or withdraw the antimicrobial treatment for an infection can be difficult. Antimicrobial administration can lead to adverse outcomes but the two main benefits, longer survival and symptom relief, are the main reasons why physicians prescribe antimicrobial when treating terminally ill patients...
February 12, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/29434048/hospital-end-of-life-care-in-haematological-malignancies
#12
Yvan Beaussant, Etienne Daguindau, Adrien Chauchet, Philippe Rochigneux, Christophe Tournigand, Régis Aubry, Lucas Morin
OBJECTIVE: To investigate patterns of care during the last months of life of hospitalised patients who died from different haematological malignancies. METHODS: Nationwide register-based study, including all hospitalised adults ≥20 years who died from haematological malignancies in France in 2010-2013. Outcomes included use of invasive cancer treatments and referral to palliative care. Percentages are adjusted for sex and age using direct standardisation. RESULTS: Of 46 629 inpatients who died with haematological malignancies, 24...
February 6, 2018: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/29433576/barriers-and-facilitators-to-the-implementation-of-a-paediatric-palliative-care-team
#13
Lisa M Verberne, Marijke C Kars, Sasja A Schepers, Antoinette Y N Schouten-van Meeteren, Martha A Grootenhuis, Johannes J M van Delden
BACKGROUND: Over the last decade, paediatric palliative care teams (PPCTs) have been introduced to support children with life-limiting diseases and their families and to ensure continuity, coordination and quality of paediatric palliative care (PPC). However, implementing a PPCT into an organisation is a challenge. The objective of this study was to identify barriers and facilitators reported by healthcare professionals (HCPs) in primary, secondary or tertiary care for implementing a newly initiated multidisciplinary PPCT to bridge the gap between hospital and home...
February 12, 2018: BMC Palliative Care
https://www.readbyqxmd.com/read/29433497/a-painful-experience-of-limited-understanding-healthcare-professionals-experiences-with-palliative-care-of-people-with-severe-dementia-in-norwegian-nursing-homes
#14
May Helen Midtbust, Rigmor Einang Alnes, Eva Gjengedal, Else Lykkeslet
BACKGROUND: People dying with dementia have significant healthcare needs, and palliative care, with its focus on comfort and quality of life, should be made available to these patients. The aim of this study was to explore and increase knowledge of healthcare professionals' experiences with palliative care to people with severe dementia in nursing homes. METHODS: To describe the phenomenon under investigation, we used a phenomenological research approach grounded in the philosophy of Husserl...
February 13, 2018: BMC Palliative Care
https://www.readbyqxmd.com/read/29432564/management-of-metastatic-retroperitoneal-sarcoma-a-consensus-approach-from-the-transatlantic-retroperitoneal-sarcoma-working-group-tarpswg
#15
A J MacNeill, W J Van Houdt, C J Swallow, A Gronchi
Introduction: Retroperitoneal sarcoma (RPS) is a rare disease accounting for 0.1-0.2% of all malignancies. Management of RPS is complex and requires multidisciplinary, tailored treatment strategies at all stages, but especially in the context of metastatic or multifocal recurrent disease. Due to the rarity and heterogeneity of this family of diseases, the literature to guide management is limited. Methods: The Trans-Atlantic Retroperitoneal Sarcoma Working Group (TARPSWG) is an international collaboration of sarcoma experts from all disciplines convened in an effort to overcome these limitations...
February 7, 2018: Annals of Oncology: Official Journal of the European Society for Medical Oncology
https://www.readbyqxmd.com/read/29432361/single-port-thoracoscopic-pericardial-window-under-local-anesthesia
#16
Chang Y Park, Niall C McGonigle
There are numerous surgical approaches for the treatment of pericardial effusions but no clear consensus of best management. We present a 44-year-old woman with metastatic breast cancer presenting with a new 2-cm pericardial effusion on ultrasound. In light of the patient's palliative condition and the urgent need for chemotherapy, careful consideration was made for her surgical drainage of the pericardial effusion. Because of the patient's medical comorbidities, a general anesthetic was deemed not to be in the patient's best interest...
February 9, 2018: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/29432353/practices-in-human-dignity-in-palliative-care-a-qualitative-study
#17
Esra Akin Korhan, Çağatay Üstün, Derya Uzelli Yilmaz
Respecting and valuing an individual's existential dignity forms the basis of nursing and medical practice and of nursing care. The objective of the study was to determine the approach to human dignity that nurses and physicians have while providing palliative care. This qualitative study was performed using a phenomenological research design. In-depth semistructured interviews were conducted in 9 nurses and 5 physicians with human dignity approach in palliative care. Following the qualitative Colaizzi method of analyzing the data, the statements made by the nurses and physicians during the interviews were grouped under 8 categories...
March 2018: Holistic Nursing Practice
https://www.readbyqxmd.com/read/29429005/new-frontier-cancer-pain-management-clinical-fellowship
#18
Uri Hochberg, Jordi Perez, Manuel Borod
Cancer pain is a multi-dimensional experience, varies from person to person both physically and psycho-socially, and impacts all aspects of the patients' quality of life. Majority of patients with an advanced or metastatic cancer will experience pain. It is estimated that as many as half of cancer patients are under-treated and as many as 20% experience pain refractory to the conventional WHO ladder of pain management. The McGill University Health Centre (MUHC) Cancer Pain Clinic (CPC) was created to meet the needs of those patients with a diagnosis of cancer whose pain had become a main symptom and those who failed to respond to conventional treatment...
February 10, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/29428188/-i-m-not-a-spiritual-person-how-hope-might-facilitate-conversations-about-spirituality-among-teens-and-young-adults-with-cancer
#19
Krysta S Barton, Tyler Tate, Nancy Lau, Karen B Taliesin, Elisha D Waldman, Abby R Rosenberg
CONTEXT: Supporting patients' spiritual needs is central to palliative care. Adolescents and Young Adults (AYAs) may be developing their spiritual identities; it is unclear how to navigate conversations concerning their spiritual needs. OBJECTIVES: To (1) describe spiritual narratives among AYAs based on their self-identification as religious, spiritual, both, or neither; and, (2) identify language to support AYA spiritual needs in keeping with their self-identities...
February 8, 2018: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/29427101/spinocerebellar-ataxia-type-1-molecular-mechanisms-of-neurodegeneration-and-preclinical-studies
#20
Judit M Pérez Ortiz, Harry T Orr
Spinocerebellar ataxia type 1 (SCA1) is an adult-onset, inherited disease that leads to degeneration of Purkinje cells of the cerebellum and culminates in death 10-30 years after disease onset. SCA1 is caused by a CAG repeat mutation in the ATXN1 gene, encoding the ATXN1 protein with an abnormally expanded polyglutamine tract. As neurodegeneration progresses, other brain regions become involved and contribute to cognitive deficits as well as problems with speech, swallowing, and control of breathing. The fundamental basis of pathology is an aberration in the normal function of Purkinje cells affecting regulation of gene transcription and RNA splicing...
2018: Advances in Experimental Medicine and Biology
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