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Clinical research challenge

Shannon Dorsey, Katie A McLaughlin, Suzanne E U Kerns, Julie P Harrison, Hilary K Lambert, Ernestine C Briggs, Julia Revillion Cox, Lisa Amaya-Jackson
Child and adolescent trauma exposure is prevalent, with trauma exposure-related symptoms, including posttraumatic stress, depressive, and anxiety symptoms often causing substantial impairment. This article updates the evidence base on psychosocial treatments for child and adolescent trauma exposure completed for this journal by Silverman et al. (2008). For this review, we focus on 37 studies conducted during the seven years since the last review. Treatments are grouped by overall treatment family (e.g., cognitive behavioral therapy), treatment modality (e...
October 19, 2016: Journal of Clinical Child and Adolescent Psychology
Dagmar Schmitz
Since cell-free DNA (cfDNA) fragments of placental origin can be isolated and analyzed from the blood of pregnant women. Applications of this finding have been developed and implemented in clinical care pathways worldwide at an unprecedented pace and manner. Implementation patterns, however, exhibit considerable insufficiencies. Different "motors" of implementation processes, like the market or various regulatory institutions, can be identified at a national level. Each "motor" entails characteristic ethical challenges which are exemplified impressively by a rising number of case reports...
2016: Advances in Experimental Medicine and Biology
Y H Kou, B G Jiang
Peripheral nerve defects are still a major challenge in clinical practice, and the most commonly used method of treatment for peripheral nerve defects is nerve transplantation, which has certain limitations and shortcomings, so new repair methods and techniques are needed. The peripheral nerve is elongated in limb lengthening surgery without injury, from which we got inspirations and proposed a new method to repair peripheral nerve defects: peripheral nerve elongation. The peripheral nerve could beelongated by a certain percent, but the physiological change and the maximum elongation range were still unknown...
October 18, 2016: Beijing da Xue Xue Bao. Yi Xue Ban, Journal of Peking University. Health Sciences
Laszlo Vutskits, Zhongcong Xie
General anaesthesia is usually considered to safely induce a reversible brain state allowing the performance of surgery under optimal conditions. An increasing number of clinical and experimental observations, however, suggest that anaesthetic drugs, especially when they are administered at the extremes of age, can trigger long-term morphological and functional alterations in the brain. Here, we review available mechanistic data linking general-anaesthesia exposure to impaired cognitive performance in both young and mature nervous systems...
October 18, 2016: Nature Reviews. Neuroscience
Juan Gea-Banacloche, Krishna Komanduri, Paul Carpenter, Sophie Paczesny, Stefanie Sarantopoulos, Jo-Anne Young, Nahed El Kassar, Robert Q Le, Kirk Schultz, Linda M Griffith, Bipin Savani, John R Wingard
Immune reconstitution following hematopoietic stem cell transplantation (HCT) beyond one year is not completely understood. Many transplant recipients who are free of graft versus host disease (GVHD) and not receiving any immunosuppression more than a year after transplant seem to be able to mount appropriate immune responses to common pathogens and respond adequately to immunizations. However, two large registry studies over the last two decades seem to indicate that infection is a significant cause of late mortality in some patients, even in the absence of concomitant GVHD...
October 14, 2016: Biology of Blood and Marrow Transplantation
Yehoshua Perl, James Geller, Michael Halper, Christopher Ochs, Ling Zheng, Joan Kapusnik-Uner
The purpose of the Big Data to Knowledge initiative is to develop methods for discovering new knowledge from large amounts of data. However, if the resulting knowledge is so large that it resists comprehension, referred to here as Big Knowledge (BK), how can it be used properly and creatively? We call this secondary challenge, Big Knowledge to Use. Without a high-level mental representation of the kinds of knowledge in a BK knowledgebase, effective or innovative use of the knowledge may be limited. We describe summarization and visualization techniques that capture the big picture of a BK knowledgebase, possibly created from Big Data...
October 17, 2016: Annals of the New York Academy of Sciences
Julia Jacobs, Emily M Spelbrink
Infants born prematurely are highly vulnerable to brain injury and susceptible to seizures in the first weeks of life. Many neonatal seizures occur without reliable clinical signs and are detectable only on electroencephalogram (EEG); understanding EEG findings in these neonates is crucial for providing appropriate care. This can be challenging, as EEG background activity and patterns vary considerably with gestational age. Some physiologic preterm EEG patterns, such as rhythmic temporal theta activity or delta brushes, may be sharply contoured and appear similar to epileptic EEG patterns later in life...
October 2016: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
Jessica M Winfield, Geoffrey S Payne, Alex Weller, Nandita M deSouza
Multi-parametric magnetic resonance imaging (mpMRI) offers a unique insight into tumor biology by combining functional MRI techniques that inform on cellularity (diffusion-weighted MRI), vascular properties (dynamic contrast-enhanced MRI), and metabolites (magnetic resonance spectroscopy) and has scope to provide valuable information for prognostication and response assessment. Challenges in the application of mpMRI in the clinic include the technical considerations in acquiring good quality functional MRI data, development of robust techniques for analysis, and clinical interpretation of the results...
October 2016: Topics in Magnetic Resonance Imaging: TMRI
Cristina Varas-Lorenzo, Alejandro Arana, Catherine B Johannes, Lisa J McQuay, Kenneth J Rothman, Daniel Fife
BACKGROUND: The ascertainment of sudden cardiac death (SCD) in electronic health databases is challenging. OBJECTIVES: Our objective was to evaluate the applicability of the validated computer definition of SCD developed by Chung et al. in a retrospective study of SCD and domperidone exposure in the Clinical Practice Research Datalink (CPRD). METHODS: We assessed out-of-hospital SCD by applying the validated computer definition and linking data with Hospital Episode Statistics and death certificates...
September 2016: Drugs—Real World Outcomes
Bokai Cao, Xiangnan Kong, Philip S Yu
With rapid advances in neuroimaging techniques, the research on brain disorder identification has become an emerging area in the data mining community. Brain disorder data poses many unique challenges for data mining research. For example, the raw data generated by neuroimaging experiments is in tensor representations, with typical characteristics of high dimensionality, structural complexity, and nonlinear separability. Furthermore, brain connectivity networks can be constructed from the tensor data, embedding subtle interactions between brain regions...
December 2015: Brain Informatics
Maria Teresa Bardella, Luca Elli, Francesca Ferretti
PURPOSE OF REVIEW: A new syndrome responding to gluten-free diet and defined non-celiac gluten sensitivity entered the spectrum of gluten-related disorders, together with celiac disease and wheat allergy. However, its definition, prevalence, diagnosis, pathogenesis, treatment, and follow up are still controversial. The purpose of the review is to summarize the evidence and problems emerging from the current literature. RECENT FINDINGS: Direct implication of gluten in the onset of symptoms is often unproved as a low fermentable oligo-, di- and mono-saccharides and polyols diet or other components of cereals as wheat amylase trypsin inhibitor could be similarly involved...
December 2016: Current Gastroenterology Reports
Zhongheng Zhang, Nathan J Smischney, Haibo Zhang, Sven Van Poucke, Panagiotis Tsirigotis, Jordi Rello, Patrick M Honore, Win Sen Kuan, Juliet June Ray, Jiancang Zhou, You Shang, Yuetian Yu, Christian Jung, Chiara Robba, Fabio Silvio Taccone, Pietro Caironi, David Grimaldi, Stefan Hofer, George Dimopoulos, Marc Leone, Sang-Bum Hong, Mabrouk Bahloul, Laurent Argaud, Won Young Kim, Herbert D Spapen, Jose Rodolfo Rocco
Sepsis is a heterogeneous disease caused by an infection stimulus that triggers several complex local and systemic immuno-inflammatory reactions, which results in multiple organ dysfunction and significant morbidity and mortality. The diagnosis of sepsis is challenging because there is no gold standard for diagnosis. As a result, the clinical diagnosis of sepsis is ever changing to meet the clinical and research requirements. Moreover, although there are many novel biomarkers and screening tools for predicting the risk of sepsis, the diagnostic performance and effectiveness of these measures are less than satisfactory, and there is insufficient evidence to recommend clinical use of these new techniques...
September 2016: Journal of Thoracic Disease
José E Belizário, Beatriz A Sangiuliano, Marcela Perez-Sosa, Jennifer M Neyra, Dayson F Moreira
With multiple omics strategies being applied to several cancer genomics projects, researchers have the opportunity to develop a rational planning of targeted cancer therapy. The investigation of such numerous and diverse pharmacogenomic datasets is a complex task. It requires biological knowledge and skills on a set of tools to accurately predict signaling network and clinical outcomes. Herein, we describe Web-based in silico approaches user friendly for exploring integrative studies on cancer biology and pharmacogenomics...
2016: Frontiers in Pharmacology
Nariman A Nawar, Phyllis R Sawyer
BACKGROUND Segmental absence of intestinal musculature is a well described entity in premature infants. It presents with peritonitis, bowel perforation, and obstruction. The diagnosis is based on pathologic observation of absence of intestinal musculature. Researchers hypothesized that this entity is a result of a vascular accident during embryogenesis. However, segmental absence of intestinal musculature is no longer limited to the pediatric population. Recently, a few cases have been described in adults with and without significant vascular diseases...
October 17, 2016: American Journal of Case Reports
Carla J Rash, Maxine Stitzer, Jeremiah Weinstock
This article introduces the special issue on contingency management (CM), an efficacious intervention for the treatment of substance use disorders with low uptake in clinical settings that is not commensurate with evidence for efficacy. In this special issue of the Journal of Substance Abuse Treatment, we present 16 articles representing the latest research in efficacy, implementation, and technological advances related to CM. Combined, this collection of articles highlights the diverse populations, settings, and applications of CM in the treatment of substance use disorders...
September 28, 2016: Journal of Substance Abuse Treatment
Elizabeth Murray, Eric B Hekler, Gerhard Andersson, Linda M Collins, Aiden Doherty, Chris Hollis, Daniel E Rivera, Robert West, Jeremy C Wyatt
Digital health interventions have enormous potential as scalable tools to improve health and healthcare delivery by improving effectiveness, efficiency, accessibility, safety, and personalization. Achieving these improvements requires a cumulative knowledge base to inform development and deployment of digital health interventions. However, evaluations of digital health interventions present special challenges. This paper aims to examine these challenges and outline an evaluation strategy in terms of the research questions needed to appraise such interventions...
November 2016: American Journal of Preventive Medicine
Paula D N Dworatzek, Joanne Stier
PURPOSE: Peer education (PE) has been used effectively in nutrition; however, research examining dietitians' attitudes regarding PE is lacking. METHODS: An online survey was sent to a random sample of 1198 Dietitians of Canada members to assess attitudes regarding PE by practice area. RESULTS: A representative sample of dietitians by practice area and location was obtained (n = 229; 19%). Their total attitude score (TAS) was 226 ± 26 (mean ± SD) out of 295 (maximum)...
July 19, 2016: Canadian Journal of Dietetic Practice and Research
Natalie K Bradford, Liam J Caffery, Anthony C Smith
INTRODUCTION: With the escalating costs of health care, issues with recruitment and retention of health practitioners in rural areas, and poor economies of scale, the question of delivering people to services or services to people is a dilemma for health authorities around the world. People living in rural areas have poorer health outcomes compared to their urban counterparts, and the problem of how to provide health care and deliver services in rural locations is an ongoing challenge...
October 2016: Rural and Remote Health
K N Anderson, J J Connor, A F Koerner, M A Rueter
STUDY QUESTION: Compared to families with IVF singletons, what are parental depressive, parent-adolescent interaction and adolescent adjustment outcomes in families with 11-17-year-old IVF twins? SUMMARY ANSWER: No differences were detected for any measured outcome between families with 11-17-year-old IVF twins and those with IVF singletons, despite high statistical power. WHAT IS KNOWN ALREADY: When IVF twins are younger than 5-years-old, parents tend to have more mental health difficulties and poorer parent-child interactions relative to IVF singletons...
October 15, 2016: Human Reproduction
Brett K Beaulieu-Jones, Casey S Greene
Patient interactions with health care providers result in entries to electronic health records (EHRs). EHRs were built for clinical and billing purposes but contain many data points about an individual. Mining these records provides opportunities to extract electronic phenotypes, which can be paired with genetic data to identify genes underlying common human diseases. This task remains challenging: high quality phenotyping is costly and requires physician review; many fields in the records are sparsely filled; and our definitions of diseases are continuing to improve over time...
October 12, 2016: Journal of Biomedical Informatics
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