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https://www.readbyqxmd.com/read/28062326/the-impact-of-comorbidity-on-surgical-outcomes-in-older-adults-with-cancer
#1
REVIEW
Virginia Sun, Peggy S Burhenn, Lily Lai, Arti Hurria
OBJECTIVES: To provide an overview of the impact of comorbidity on surgical outcomes and postoperative geriatric events in older adults with cancer, and review key components of quality perioperative nursing care of older adults with cancer. DATA SOURCES: Journal articles, research reports, state of the science papers, position papers, and clinical guidelines from professional organizations. CONCLUSION: The high prevalence of multiple comorbidities and the associated burden of geriatric events in older adults after cancer surgery have a substantial impact on surgical outcomes, quality of life, and health care costs...
January 3, 2017: Seminars in Oncology Nursing
https://www.readbyqxmd.com/read/28056470/-anti-diabetic-medication-during-the-first-four-years-of-treatment-a-study-based-on-claims-data
#2
Veronika Lappe, Ingrid Köster, Ingrid Schubert
: Background Ever since the UKPDS study reassessed the usefulness of the substance metformin in 1998, it has been the first-line medication in anti-diabetic treatment. In addition, new classes and agents released on the market have given rise to new treatment options. The present study investigates prescription practice at the onset of treatment and in the years thereafter and measures it against German diabetes guidelines. Database and Methods Database: Statutory health insurance sample AOK/KV Hesse; Ages: 40 and over (N = 142514)...
January 2017: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/28028995/recommendations-for-optimizing-tuberculosis-treatment-therapeutic-drug-monitoring-pharmacogenetics-and-nutritional-status-considerations
#3
REVIEW
Rihwa Choi, Byeong Ho Jeong, Won Jung Koh, Soo Youn Lee
Although tuberculosis is largely a curable disease, it remains a major cause of morbidity and mortality worldwide. Although the standard 6-month treatment regimen is highly effective for drug-susceptible tuberculosis, the use of multiple drugs over long periods of time can cause frequent adverse drug reactions. In addition, some patients with drug-susceptible tuberculosis do not respond adequately to treatment and develop treatment failure and drug resistance. Response to tuberculosis treatment could be affected by multiple factors associated with the host-pathogen interaction including genetic factors and the nutritional status of the host...
March 2017: Annals of Laboratory Medicine
https://www.readbyqxmd.com/read/27999524/individual-and-co-occurring-snap-risk-factors-smoking-nutrition-alcohol-consumption-and-physical-activity-in-people-with-multiple-sclerosis
#4
Julia M Balto, Ipek Ensari, Elizabeth A Hubbard, Naiman Khan, Jennifer L Barnes, Robert W Motl
Background: Smoking, poor nutrition, excess alcohol consumption, and insufficient physical activity underlie most preventable causes of morbidity in the general population and may be associated with comorbidities and health outcomes in multiple sclerosis (MS). However, the frequency of co-occurrence of these risk factors in people with MS remains unclear. Methods: Sixty-nine individuals with MS completed self-report measures of smoking status, nutrition, alcohol use, physical activity levels, and sociodemographic and clinical characteristics...
November 2016: International Journal of MS Care
https://www.readbyqxmd.com/read/27998381/who-needs-oxygen-with-positive-airway-pressure-therapy
#5
Susmita Chowdhuri, Abdulghani Sankari, James A Rowley
The diagnosis and management of obstructive sleep apnea (OSA) are increasingly being performed in the home. In the home management pathway, patients with high pretest probability for OSA are first tested using home sleep apnea testing and if positive for OSA, are treated with automatic positive airway pressure (APAP). The home management pathway has been validated by multiple investigators1-3 and is considered an alternative pathway in guidelines for the evaluation and management of OSA.4 However, there are limitations to the routine use of this pathway...
December 16, 2016: Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine
https://www.readbyqxmd.com/read/27987248/understanding-and-overcoming-metformin-gastrointestinal-intolerance
#6
REVIEW
Fabrice Bonnet, André Scheen
Metformin is the most widely prescribed drug for patients with type 2 diabetes mellitus and the first-line pharmacologic option as supported by multiple international guidelines, yet a rather large proportion of patients cannot tolerate metformin in adequate amounts because of its associated gastrointestinal (GI) adverse events (AEs). GI AEs typically encountered with metformin therapy include diarrhoea, nausea, flatulence, indigestion, vomiting, and abdominal discomfort, with diarrhoea and nausea being the most common...
December 17, 2016: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/27984747/imaging-diagnostics-in-ovarian-cancer-magnetic-resonance-imaging-and-a-scoring-system-guiding-choice-of-primary-treatment
#7
Sigrid M Kasper, Margit Dueholm, Edvard Marinovskij, Jan Blaakær
OBJECTIVE: To analyze the ability of magnetic resonance imaging (MRI) and systematic evaluation at surgery to predict optimal cytoreduction in primary advanced ovarian cancer and to develop a preoperative scoring system for cancer staging. STUDY DESIGN: Preoperative MRI and standard laparotomy were performed in 99 women with either ovarian or primary peritoneal cancer. Using univariate and multivariate logistic regression analysis of a systematic description of the tumor in nine abdominal compartments obtained by MRI and during surgery plus clinical parameters, a scoring system was designed that predicted non-optimal cytoreduction...
October 29, 2016: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://www.readbyqxmd.com/read/27973934/patients-with-type-2-diabetes-anesthetic-management-in-the-ambulatory-setting-part-1-pathophysiology-and-associated-disease-states
#8
Bryant W Cornelius
The increasing prevalence of diabetes mellitus in the general population has many implications for the ambulatory anesthesia provider. Complications, particularly associated with poor glycemic control, can affect multiple organ systems and jeopardize the safety of any planned anesthetic. It is essential that anesthesiologists and sedation providers have in-depth knowledge of the pathophysiology of diabetes mellitus and the comorbid conditions that commonly accompany it. Anesthesiologists and sedation providers must also understand certain surgical and anesthetic considerations when planning an effective and safe anesthetic for diabetic patients...
2016: Anesthesia Progress
https://www.readbyqxmd.com/read/27965842/a-head-and-neck-cancer-intervention-for-use-in-survivorship-clinics-a-protocol-for-a-feasibility-study
#9
Talya Salz, Mary S McCabe, Kevin C Oeffinger, Stacie Corcoran, Andrew J Vickers, Andrew L Salner, Ellen Dornelas, Rebecca Schnall, Nirupa J Raghunathan, Elizabeth Fortier, Shrujal S Baxi
BACKGROUND: Head and neck cancer survivors commonly experience severe long-term toxicities, late-occurring symptoms, and significant risks of the second primary malignancy and comorbid illnesses. With multiple simultaneous health issues, these complex cancer survivors often do not receive comprehensive health care that addresses their needs. A tool is needed to streamline and standardize comprehensive care for this cohort. METHODS/DESIGN: We designed the Head and Neck Survivorship Tool: Assessment and Recommendations (HN-STAR) to address health care challenges for head and neck cancer survivors...
2016: Pilot and Feasibility Studies
https://www.readbyqxmd.com/read/27960204/community-acquired-pneumonia-a-global-perspective
#10
Grant W Waterer
Community-acquired pneumonia (CAP) is a global disease responsible for a large proportion of deaths and having significant economic cost. As diagnostic tools have increased in sensitivity, our understanding of the etiology of CAP has begun to change with a significant increase in confirmed viral infections and the recognition that multiple pathogens are frequently present. Empiric therapy remains the standard of care and guidelines are mostly based on published data from the United States or Europe. Blindly applying guidelines without any consideration of local etiological differences can lead to a risk of under or overtreatment...
December 2016: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27868437/can-we-address-depression-in-vision-rehabilitation-settings-professionals-perspectives-on-the-barriers-to-integrating-problem-solving-treatment
#11
Edith Holloway, Bonnie Sturrock, Ecosse Lamoureux, Jill Keeffe, Mark Hegel, Robin Casten, David Mellor, Gwyneth Rees
PURPOSE: Low vision rehabilitation (LVR) is a pertinent context for integrating early, evidence-based psychological interventions given the high prevalence of untreated depression in adults with vision impairment. This study aims to identify the perceived barriers and facilitators to staff-delivered telephone-based problem-solving treatment for primary care (PST-PC) offered as an integrated component of LVR. METHODS: Qualitative semi-structured interviews, developed using the theoretical domains framework (TDF) and Consolidated Framework for Implementation Research (CFIR), were conducted with 21 LVR professionals and a clinical psychologist involved in the delivery of PST-PC...
November 20, 2016: Disability and Rehabilitation
https://www.readbyqxmd.com/read/27867460/percutaneous-dual-valve-intervention-in-a-high-risk-patient-with-severe-aortic-and-mitral-stenosis
#12
Blaz Mrevlje, Mohamad Aboukura, Christoph A Nienaber
Aortic stenosis is the most frequent and mitral stenosis is the least frequent native single-sided valve disease in Europe. Patients with the combination of severe symptomatic degenerative aortic and mitral stenosis are very rare. Guidelines for the treatment of heart valve diseases are clear for single-valve situations. However, there is no common agreement or recommendation for the best treatment strategy in patients with multiple valve disease and severe concomitant comorbidities. A 76-year-old female patient with the combination of severe degenerative symptomatic aortic and mitral stenosis and several comorbidities including severe obesity, who was found unsuitable surgical candidate by the heart team and unsuitable for two-time general anesthesia in the case of two-step single-valve percutaneous approach by anesthesiologists, underwent successful percutaneous dual-valve single-intervention (transcatheter aortic valve implantation and percutaneous mitral balloon commissurotomy)...
July 2016: Heart Views: the Official Journal of the Gulf Heart Association
https://www.readbyqxmd.com/read/27861373/physician-perspectives-on-de-intensifying-diabetes-medications
#13
Natalia Genere, Robert M Sargis, Christopher M Masi, Aviva G Nathan, Michael T Quinn, Elbert S Huang, Neda Laiteerapong
Guidelines for diabetes care recommend that physicians select individualized glycemic goals based on life expectancy, diabetes duration, comorbidity, and resources/support. When patients have stable hemoglobin A1C (HbA1C) levels, guidelines lack recommendations on when diabetes medications should be de-intensified.To understand physicians' perspectives on de-intensifying diabetes medications in patients with type 2 diabetes.Cross-sectional survey, (February-June, 2015).Academic medical center and suburban integrated health system...
November 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27849494/inpatient-trauma-focused-treatment-for-veterans-implementation-and-evaluation-of-patient-perceptions-and-outcomes-of-an-integrated-evidence-based-treatment-approach
#14
Deleene S Menefee, Wendy S Leopoulos, Jana K Tran, Ellen Teng, Jill Wanner, Elisabeth Wilde, Stephen McCauley, Susan X Day
BACKGROUND: Practice guidelines for post-traumatic stress disorder (PTSD) treatment suggest that inpatient care may be warranted when the severity of the clinical presentation is marred with significant concerns about suicidality and psychiatric comorbidity. Yet, limited guidance exists on conducting trauma-focused treatment in acute hospital settings beyond the traditional medical or stabilization model. OBJECTIVE: The purpose of this current article is to describe and evaluate the integration of evidence-based treatments (EBTs) for PTSD implemented in two gender-specific, Veterans Affairs inpatient programs...
November 2016: Military Medicine
https://www.readbyqxmd.com/read/27825371/effective-and-safe-proton-pump-inhibitor-therapy-in-acid-related-diseases-a-position-paper-addressing-benefits-and-potential-harms-of-acid-suppression
#15
EDITORIAL
Carmelo Scarpignato, Luigi Gatta, Angelo Zullo, Corrado Blandizzi
BACKGROUND: The introduction of proton pump inhibitors (PPIs) into clinical practice has revolutionized the management of acid-related diseases. Studies in primary care and emergency settings suggest that PPIs are frequently prescribed for inappropriate indications or for indications where their use offers little benefit. Inappropriate PPI use is a matter of great concern, especially in the elderly, who are often affected by multiple comorbidities and are taking multiple medications, and are thus at an increased risk of long-term PPI-related adverse outcomes as well as drug-to-drug interactions...
November 9, 2016: BMC Medicine
https://www.readbyqxmd.com/read/27799842/variations-in-the-management-of-fibromyalgia-by-physician-specialty-rheumatology-versus-primary-care
#16
Stephen L Able, Rebecca L Robinson, Kurt Kroenke, Philip Mease, David A Williams, Yi Chen, Madelaine Wohlreich, Bill H McCarberg
PURPOSE: To evaluate the effect of physician specialty regarding diagnosis and treatment of fibromyalgia (FM) and assess the clinical status of patients initiating new treatment for FM using data from Real-World Examination of Fibromyalgia: Longitudinal Evaluation of Costs and Treatments. PATIENTS AND METHODS: Outpatients from 58 sites in the United States were enrolled. Data were collected via in-office surveys and telephone interviews. Pairwise comparisons by specialty were made using chi-square, Fisher's exact tests, and Student's t-tests...
2016: Pragmat Obs Res
https://www.readbyqxmd.com/read/27778533/quality-of-life-clinical-outcome-personality-and-coping-in-chronic-hemodialysis-patients
#17
Giuseppina D'Onofrio, Mariadelina Simeoni, Paolo Rizza, Mariarita Caroleo, Maria Capria, Giovanni Mazzitello, Tiziana Sacco, Elena Mazzuca, Maria Teresa Panzino, Annamaria Cerantonio, Cristina Segura-Garcia, Michele Andreucci, Pasquale De Fazio, Giorgio Fuiano
RATIONAL: Our aim was to investigate the quality of life (QoL) in 103 patients undergoing chronic hemodialysis (HD) in an integrated assessment of clinical, personological, and adaptation parameters, also in a non-urban context. OBJECTIVES: We collected data from all chronic HD patients attending four HD units. Clinical status was assessed by Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines and by Age-adjusted Charlson Comorbidity Index (ACCI). Patients completed the following questionnaires: Kidney Disease Quality of Life Short Form (KDQOL-SF), Pittsburgh Sleep Quality Index (PSQI)...
October 25, 2016: Renal Failure
https://www.readbyqxmd.com/read/27768569/refractory-depression-fatigue-irritable-bowel-syndrome-and-chronic-pain-a-functional-medicine-case-report
#18
Gregory Plotnikoff, Melissa Barber
INTRODUCTION: Single-disorder or single-organ-system clinical practice guidelines are often of limited usefulness in guiding effective management of patients with chronic multidimensional signs and symptoms. The presence of multiple long-standing medical problems in a given patient despite intensive medical effort suggests that addressing systemic core imbalances could complement more narrowly focused approaches. CASE PRESENTATION: A 72-year-old man experiencing longstanding depression, fatigue, irritable bowel syndrome, and chronic pain in the context of additional refractory illnesses was assessed and treated, guided by a system-oriented approach to underlying core imbalances termed functional medicine...
2016: Permanente Journal
https://www.readbyqxmd.com/read/27759337/management-practices-in-indian-patients-with-uncontrolled-hypertension
#19
Rajkumar Bharatia, Manoj Chitale, Ganesh Narain Saxena, Raman Ganesh Kumar, Chikkalingaiah, Abhijit Trailokya, Kalpesh Dalvi, Suhas Talele
INTRODUCTION: Hypertension (HTN), being a major risk factor for cardiovascular diseases (CVDs), is an important issue of medical and public health. High blood pressure (BP) is ranked as the third most important risk factor for attributable burden of disease in south Asia (2010). Hypertension (HTN) exerts a substantial public health burden on cardiovascular health status and healthcare systems in India. Uncontrolled hypertension among adults with hypertension is associated with increased mortality...
July 2016: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/27754289/br-08-1-high-sodium-intake-reduction-in-diabetes-with-hypertension
#20
Zhiming Zhu
Management of hypertension in diabetes is critical for reducing cardiovascular mortality and morbidity. Dietary approaches for controlling high blood pressure have historically focused on sodium. Thus, many guidelines recommend that patients with type 2 diabetes reduce high sodium intake. Nonetheless, the potential benefits of sodium reduction are debatable. The kidney has a crucial role in glucose filtration and reabsorption in addition to its regulation of fluid and electrolyte homeostasis. A key factor linking sodium uptake and glucose transport is the sodium-glucose cotransporter 2 (SGLT2) in renal proximal tubular cells...
September 2016: Journal of Hypertension
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