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https://www.readbyqxmd.com/read/28411872/induction-therapy-with-the-selective-interleukin-23-inhibitor-risankizumab-in-patients-with-moderate-to-severe-crohn-s-disease-a-randomised-double-blind-placebo-controlled-phase-2-study
#1
Brian G Feagan, William J Sandborn, Geert D'Haens, Julián Panés, Arthur Kaser, Marc Ferrante, Edouard Louis, Denis Franchimont, Olivier Dewit, Ursula Seidler, Kyung-Jo Kim, Markus F Neurath, Stefan Schreiber, Paul Scholl, Chandrasena Pamulapati, Bojan Lalovic, Sudha Visvanathan, Steven J Padula, Ivona Herichova, Adina Soaita, David B Hall, Wulf O Böcher
BACKGROUND: The interleukin-23 pathway is implicated genetically and biologically in the pathogenesis of Crohn's disease. We aimed to assess the efficacy and safety of risankizumab (BI 655066, Boehringer Ingelheim, Ingelheim, Germany), a humanised monoclonal antibody targeting the p19 subunit of interleukin-23, in patients with moderately-to-severely active Crohn's disease. METHODS: In this randomised, double-blind, placebo-controlled phase 2 study, we enrolled patients at 36 referral sites in North America, Europe, and southeast Asia...
April 12, 2017: Lancet
https://www.readbyqxmd.com/read/28410647/disease-trajectories-before-esrd-implications-for-clinical-management
#2
REVIEW
Keiichi Sumida, Csaba P Kovesdy
One of the biggest challenges nephrologists face is to predict complex clinical pathways of kidney disease progression that do not follow a steady linear decline. This unpredictability often becomes a barrier to timely shared decision making between patients and physicians and could lead to adverse patient outcomes. By using numerous analytic approaches to characterize the longitudinal changes in kidney function, emerging evidence has disclosed the heterogeneous trajectories of kidney disease progression, particularly in late-stage chronic kidney disease (CKD) nearing end-stage renal disease (ESRD), and showed their independent associations with various clinical outcomes...
March 2017: Seminars in Nephrology
https://www.readbyqxmd.com/read/28407748/the-role-of-ethnicity-in-pathways-to-emergency-psychiatric-services-for-clients-with-psychosis
#3
Martin Rotenberg, Andrew Tuck, Rachel Ptashny, Kwame McKenzie
BACKGROUND: This study investigates the role of ethnicity in pathways to emergency mental health care in Toronto for clients with psychosis, while taking into account neighborhood factors. Previous literature has focused on Afro-Caribbean clients, reporting an increased risk of accessing mental health care through negative pathways. METHODS: A retrospective chart review for clients from 6 different ethnic origin groups presenting with psychosis - East Asian, South Asian, Black African, Black Caribbean, White European, and White North American - was undertaken in a psychiatric emergency department (ED)...
April 13, 2017: BMC Psychiatry
https://www.readbyqxmd.com/read/28406341/outcomes-of-haematuria-referrals-two-year-data-from-a-single-large-university-hospital-in-denmark
#4
Muhammad Elmussareh, Matthew Young, Maria Ordell Sundelin, Camilla Brinkmann Bak-Ipsen, Ole Graumann, Jørgen Bjerggaard Jensen
OBJECTIVE: The aim of this study was to review haematuria referrals to a large university hospital in Denmark, based on the previous Danish guidelines for haematuria referral (before January 2016), to evaluate the pattern of referrals and the cancer detection rates and compare these with the current guidelines. MATERIALS AND METHODS: A retrospective study was undertaken of all patients referred from primary care for the evaluation of haematuria from January 2013 to December 2014...
April 13, 2017: Scandinavian Journal of Urology
https://www.readbyqxmd.com/read/28403839/transfer-between-hospitals-as-a-predictor-of-delay-in-diagnosis-and-treatment-of-patients-with-non-small-cell-lung-cancer-a-register-based-cohort-study
#5
Maria Iachina, Erik Jakobsen, Anne Kudsk Fallesen, Anders Green
BACKGROUND: Lung cancer is the second most frequent cancer diagnosis in Denmark. Although improved during the last decade, the prognosis of lung cancer is still poor with an overall 5-year survival rate of approximately 12%. Delay in diagnosis and treatment of lung cancer has been suggested as a potential cause of the poor prognosis and as consequence, fast track cancer care pathways were implemented describing maximum acceptable time thresholds from referral to treatment. In Denmark, patients with lung cancer are often transferred between hospitals with diagnostic facilities to hospitals with treatment facilities during the care pathway...
April 12, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28397649/support-and-assessment-for-fall-emergency-referrals-safer-2-a-cluster-randomised-trial-and-systematic-review-of-clinical-effectiveness-and-cost-effectiveness-of-new-protocols-for-emergency-ambulance-paramedics-to-assess-older-people-following-a-fall-with-referral
#6
Helen A Snooks, Rebecca Anthony, Robin Chatters, Jeremy Dale, Rachael Fothergill, Sarah Gaze, Mary Halter, Ioan Humphreys, Marina Koniotou, Phillipa Logan, Ronan Lyons, Suzanne Mason, Jon Nicholl, Julie Peconi, Ceri Phillips, Judith Phillips, Alison Porter, A Niroshan Siriwardena, Graham Smith, Alun Toghill, Mushtaq Wani, Alan Watkins, Richard Whitfield, Lynsey Wilson, Ian T Russell
BACKGROUND: Emergency calls are frequently made to ambulance services for older people who have fallen, but ambulance crews often leave patients at the scene without any ongoing care. We evaluated a new clinical protocol which allowed paramedics to assess older people who had fallen and, if appropriate, refer them to community-based falls services. OBJECTIVES: To compare outcomes, processes and costs of care between intervention and control groups; and to understand factors which facilitate or hinder use...
March 2017: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/28387548/review-of-vestibular-and-oculomotor-screening-and-concussion-rehabilitation
#7
Anthony P Kontos, Jamie McAllister Deitrick, Michael W Collins, Anne Mucha
Vestibular and oculomotor impairment and symptoms may be associated with worse outcomes after sport-related concussion (SRC), including prolonged recovery. In this review, we evaluate current findings on vestibular and oculomotor impairments as well as treatment approaches after SRC, and we highlight areas in which investigation is needed. Clinical researchers have intimated that recovery from SRC may follow certain clinical profiles that affect the vestibular and oculomotor pathways. Identifying clinical profiles may help to inform better treatment and earlier intervention to reduce recovery time after SRC...
March 2017: Journal of Athletic Training
https://www.readbyqxmd.com/read/28384241/mental-ill-health-in-structural-pathways-to-women-s-experiences-of-intimate-partner-violence
#8
Mercilene T Machisa, Nicola Christofides, Rachel Jewkes
BACKGROUND: Depression, post-traumatic stress disorder (PTSD), and binge drinking are among mental health effects of child abuse and intimate partner violence (IPV) experiences among women. Emerging data show the potential mediating role of mental ill health in the relationship of child abuse and IPV. There is evidence that PTSD, depression and alcohol abuse are comorbid common mental disorders and that a bidirectional relationship exists between depression and IPV in some settings. Furthermore, the temporal direction in the relationship of alcohol abuse and women's IPV experiences from different studies is unclear...
2017: PloS One
https://www.readbyqxmd.com/read/28376789/high-pre-diagnosis-attrition-among-patients-with-presumptive-mdr-tb-an-operational-research-from-bhopal-district-india
#9
Deepak Shewade, Arun M Kokane, Akash Ranjan Singh, Manoj Verma, Malik Parmar, Ashish Chauhan, Sanjay Singh Chahar, Manoj Tiwari, Sheeba Naz Khan, Vivek Gupta, Jaya Prasad Tripathy, Mukesh Nagar, Sanjai Kumar Singh, Pradeep Kumar Mehra, Ajay Mv Kumar
BACKGROUND: Pre-diagnosis attrition needs to be addressed urgently if we are to make progress in improving MDR-TB case detection and achieve universal access to MDR-TB care. We report the pre-diagnosis attrition, along with factors associated, and turnaround times related to the diagnostic pathway among patient with presumptive MDR-TB in Bhopal district, central India (2014). METHODS: Study was conducted under the Revised National Tuberculosis Control Programme setting...
April 4, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28370206/adjuvant-psychological-therapy-in-long-term-endocrine-conditions
#10
J Daniels, J M Turner-Cobb
Consideration of psychological distress in long term endocrine conditions is of vital importance given the prevalence of anxiety and depression in such disorders. Poor mental health can lead to compromised self-care, higher utilisation of health services, lower rates of adherence, reduced quality of life and ultimately poorer outcomes. Adjuvant psychological therapy offers an effective resource to reduce distress in endocrinological disorders. While the vast majority of work in this area has focused on psychological screening and intervention in diabetes, identification and recognition of psychological distress is equally important in other endocrinological conditions, with supportive evidence in Polycystic Ovary Syndrome and Addison's disease...
March 30, 2017: Clinical Endocrinology
https://www.readbyqxmd.com/read/28368789/design-and-implementation-of-a-physician-coaching-pilot-to-promote-value-based-referrals-to-specialty-care
#11
Leah Tuzzio, Evette J Ludman, Eva Chang, Lorella Palazzo, Travis Abbott, Edward H Wagner, Robert J Reid
INTRODUCTION: Referral rates to specialty care from primary care physicians vary widely. To address this variability, we developed and pilot tested a peer-to-peer coaching program for primary care physicians. OBJECTIVES: To assess the feasibility and acceptability of the coaching program, which gave physicians access to their individual-level referral data, strategies, and a forum to discuss referral decisions. METHODS: The team designed the program using physician input and a synthesis of the literature on the determinants of referral...
2017: Permanente Journal
https://www.readbyqxmd.com/read/28365537/suicide-attempters-examined-in-a-parisian-emergency-department-contrasting-characteristics-associated-with-multiple-suicide-attempts-or-with-the-motive-to-die
#12
Florence Perquier, David Duroy, Camille Oudinet, Alya Maamar, Christophe Choquet, Enrique Casalino, Michel Lejoyeux
Among patients examined after a suicide attempt in a Parisian emergency department, we aimed to compare individual characteristics of i) first time and multiple suicide attempters, ii) attempters whose principal motive was "to die" and attempters who had any other motive. Information regarding sociodemographics, clinical characteristics, prior mental health care and outgoing referral was collected in 168 suicide attempters using a standardized form. Associations of these variables with suicide attempt repetition (yes or no) and with the motive underlying the attempt (to die or not) were examined using descriptive statistics and multivariable logistic regression models...
March 22, 2017: Psychiatry Research
https://www.readbyqxmd.com/read/28359079/evaluating-wait-times-from-screening-to-breast-cancer-diagnosis-among-women-undergoing-organised-assessment-vs-usual-care
#13
Anna M Chiarelli, Derek Muradali, Kristina M Blackmore, Courtney R Smith, Lucia Mirea, Vicky Majpruz, Frances P O'Malley, May Lynn Quan, Claire Mb Holloway
BACKGROUND: Timely coordinated diagnostic assessment following an abnormal screening mammogram reduces patient anxiety and may optimise breast cancer prognosis. Since 1998, the Ontario Breast Screening Program (OBSP) has offered organised assessment through Breast Assessment Centres (BACs). For OBSP women seen at a BAC, an abnormal mammogram is followed by coordinated referrals through the use of navigators for further imaging, biopsy, and surgical consultation as indicated. For OBSP women seen through usual care (UC), further diagnostic imaging is arranged directly from the screening centre and/or through their physician; results must be communicated to the physician who is then responsible for arranging any necessary biopsy and/or surgical consultation...
March 30, 2017: British Journal of Cancer
https://www.readbyqxmd.com/read/28359011/diagnostic-triage-for-low-back-pain-a-practical-approach-for-primary-care
#14
REVIEW
Lynn D Bardin, Peter King, Chris G Maher
Diagnostic triage is an essential guideline recommendation for low back pain (LBP), which is the most frequent musculoskeletal condition that general practitioners encounter in Australia. Clinical diagnosis of LBP - informed by a focused history and clinical examination - is the key initial step for GPs, and determines subsequent diagnostic workup and allied health and medical specialist referral. The goal of diagnostic triage of LBP is to exclude non-spinal causes and to allocate patients to one of three broad categories: specific spinal pathology (< 1% of cases), radicular syndrome (∼ 5-10% of cases) or non-specific LBP (NSLBP), which represents 90-95% of cases and is diagnosed by exclusion of the first two categories...
April 3, 2017: Medical Journal of Australia
https://www.readbyqxmd.com/read/28356923/the-guy-s-and-st-thomas-s-nhs-foundation-trust-home-service-an-overview-of-a-new-service
#15
Geraldine A Lee, Karen Titchener
Hospital in the home is a relatively new concept within the UK healthcare system. The Guy's and St Thomas's NHS Foundation Trust (GSTT) @home service 'Bringing hospital care to your home' was commissioned by Lambeth and Southwark CCG in 2014 to provide acute care in the patients' place of residence by facilitating rapid discharge from hospital. The service is designed for 260-280 referrals each month from local hospitals, London Ambulance Service, GPs, district nurses and palliative care services. The GSTT@home provides intensive care for a short episode through multidisciplinary team work with the aim of returning the patient to their prior health status following an acute episode of ill health...
March 2017: London Journal of Primary Care
https://www.readbyqxmd.com/read/28347354/equipoise-across-the-patient-population-optimising-recruitment-to-a-randomised-controlled-trial
#16
Paul Whybrow, Robert Pickard, Susan Hrisos, Tim Rapley
BACKGROUND: This paper proposes a novel perspective on the value of qualitative research for improving trial design and optimising recruitment. We report findings from a qualitative study set within the OPEN trial, a surgical randomised controlled trial (RCT) comparing two interventions for recurrent bulbar urethral stricture, a common cause of urinary problems in men. METHODS: Interviews were conducted with men meeting trial eligibility criteria (n = 19) to explore reasons for accepting or declining participation and with operating urologists (n = 15) to explore trial acceptability...
March 27, 2017: Trials
https://www.readbyqxmd.com/read/28342189/straight-to-test-colonoscopy-for-two-week-wait-referrals-improves-time-to-diagnosis-of-colorectal-cancer-and-is-feasible-in-a-high-volume-unit
#17
A Banerjea, J Voll, A Chowdhury, A Siddika, S Thomson, R Briggs, D J Humes
AIM: We have introduced "straight-to-test" (STT) colonoscopy as part of our two-week wait (2WW) pathway to address increasing numbers of urgent referrals for colorectal cancer (CRC) with in the National Health Service. In this study we evaluated the ability of this initiative to shorten the time to diagnosis of CRC. METHODS: We amended our 2WW referral form to include performance status and comorbidities. General practitioners were asked to provide data on estimated glomerular filtration rate and full blood count/ferritin...
March 25, 2017: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
https://www.readbyqxmd.com/read/28339402/outcomes-of-hospitalised-muscular-dystrophy-patients
#18
Ghilas Boussaid, Hélène Prigent, Gilbert Caranhac, Djillali Annane, Christian Devaux, David Orlikowski, Frédéric Lofaso
BACKGROUND: In France, referral centres in teaching hospitals were created 10 years ago to provide MD patients with treatments and follow-up designed to prevent complications and improve outcomes. Respiratory failure is a major cause of death among subjects with MD, and its prevention and treatment can serve as a touchstone for assessing the effectiveness of MD care pathways. OBJECTIVE: We report data from a preliminary study of admissions of MD patients in France and of factors associated with mortality, with special emphasis on respiratory failure [RF]...
March 20, 2017: Journal of Neuromuscular Diseases
https://www.readbyqxmd.com/read/28335084/identification-of-new-bmp6-pro-peptide-mutations-in-patients-with-iron-overload
#19
Chiara Piubelli, Annalisa Castagna, Giacomo Marchi, Monica Rizzi, Fabiana Busti, Sadaf Badar, Monia Marchetti, Marco De Gobbi, Antonella Roetto, Luciano Xumerle, Eda Suku, Alejandro Giorgetti, Massimo Delledonne, Oliviero Olivieri, Domenico Girelli
Hereditary Hemochromatosis (HH) is a genetically heterogeneous disorder caused by mutations in at least 5 different genes (HFE, HJV, TFR2, SLC40A1, HAMP) involved in the production or activity of the liver hormone hepcidin, a key regulator of systemic iron homeostasis. Nevertheless, patients with an HH-like phenotype that remains completely/partially unexplained despite extensive sequencing of known genes are not infrequently seen at referral centers, suggesting a role of still unknown genetic factors. A compelling candidate is Bone Morphogenetic Protein 6 (BMP6), which acts as a major activator of the BMP-SMAD signaling pathway, ultimately leading to the upregulation of hepcidin gene transcription...
March 23, 2017: American Journal of Hematology
https://www.readbyqxmd.com/read/28334728/does-emergency-presentation-of-cancer-represent-poor-performance-in-primary-care-insights-from-a-novel-analysis-of-linked-primary-and-secondary-care-data
#20
Peter Murchie, Sarah M Smith, Michael S Yule, Rosalind Adam, Melanie E Turner, Amanda J Lee, Shona Fielding
BACKGROUND: People diagnosed with cancer following emergency presentation have poorer short-term survival. To what extent this signifies a missed opportunity for earlier diagnosis in primary care remains unclear as little detailed data exist on the patient/general practitioner interaction beforehand. METHODS: Analysis of primary care and regional data for 1802 cancer patients from Northeast Scotland. Adjusted odds ratios (OR) and 95% confidence intervals (CIs) for patient and GP practice predictors of emergency presentation...
March 23, 2017: British Journal of Cancer
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