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https://www.readbyqxmd.com/read/29053177/early-effect-of-medicare-shared-savings-program-accountable-care-organization-participation-on-prostate-cancer-care
#1
Tudor Borza, Samuel R Kaufman, Phyllis Yan, Lindsey A Herrel, Amy N Luckenbaugh, David C Miller, Ted A Skolarus, Bruce L Jacobs, John M Hollingsworth, Edward C Norton, Vahakn B Shahinian, Brent K Hollenbeck
BACKGROUND: Accountable care organizations (ACOs) can improve prostate cancer care by decreasing treatment variations (ie, avoidance of treatment in low-value settings). Herein, the authors performed a study to understand the effect of Medicare Shared Savings Program ACOs on prostate cancer care. METHODS: Using a 20% Medicare sample, the authors identified men with newly diagnosed prostate cancer from 2010 through 2013. Rates of treatment, potential overtreatment (ie, treatment in men with a ≥75% chance of 10-year mortality from competing risks), and Medicare payments were measured using regression models...
October 20, 2017: Cancer
https://www.readbyqxmd.com/read/29049050/an-update-on-noninvasive-follicular-thyroid-neoplasm-with-papillary-like-nuclear-features
#2
Danielle E Range, Xiaoyin S Jiang
PURPOSE OF REVIEW: Noninvasive encapsulated follicular variant of papillary thyroid carcinoma (PTC) has been established in the literature as a clinically indolent tumor. Despite this, it was traditionally treated like all other PTCs. In an attempt to reduce overtreatment of this entity, a panel of experts reclassified this entity as noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP). This reclassification has led to a flurry of literature elucidating the molecular, cytologic and clinical parameters of this 'new' entity and the implications for patient management...
October 18, 2017: Current Opinion in Oncology
https://www.readbyqxmd.com/read/29037312/rheumatoid-arthritis-seems-to-have-dmard-treatment-decision-influenced-by-fibromyalgia
#3
Rafael Mendonça da Silva Chakr, Claiton Brenol, Aline Ranzolin, Amanda Bernardes, Ana Paula Dalosto, Giovani Ferrari, Stephanie Scalco, Vanessa Olszewski, Charles Kohem, Odirlei Monticielo, João Carlos T Brenol, Ricardo M Xavier
OBJECTIVE: To compare DMARD use in patients with and without FM over time, including overtreatment and undertreatment rates in both groups. METHODS: A prospective cohort study with patients attending an RA outpatient clinic was conducted. Participants were consecutively recruited between March 2006 and June 2007 and were followed through December 2013. Data on DMARD use (prevalences, doses and escalation rates), DAS28, HAQ and radiographic progression were compared among RA patients with FM and without FM...
September 2017: Revista Brasileira de Reumatologia
https://www.readbyqxmd.com/read/29036559/the-brisk-standing-test-for-long-qt-syndrome-in-prepubertal-school-children-defining-normal
#4
L H P M Filippini, P G Postema, K Zoubin, B J M Hermans, N A Blom, T Delhaas, A A M Wilde
Aims: Long QT syndrome (LQTS) is associated with malignant arrhythmias and sudden death from birth to advanced age. Prolongation of the QT-interval, may however be concealed on standard electrocardiograms (ECG). The brisk-standing-test (BST) was developed to guide LQTS-diagnosis and treatment in adults. We hypothesized that the BST may be used in prepubertal children to identify LQTS subjects. Accordingly, reference values for the BST should be available to prevent incorrect diagnosis and treatment of LQTS...
October 3, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/29033816/verruciform-xanthoma-of-a-lower-lip-lesion-a-new-case-and-review-of-the-literature
#5
Filiz Cebeci, Ayşegül Verim, Adnan Somay, Emel Çalıkoğlu
A non-smoking man in his seventh decade presented with a lesion he had had for about 5 years on the right external surface of the lip 1 mm from the vermilion border. On physical examination, a yellowish-coloured, non-tender, verrucous mass of 0.5 × 0.7 cm was observed. A histopathological examination of the first 3-mm punch biopsy was non-diagnostic. The histopathological evaluation of a second, 5-mm-deep punch biopsy made by a pathology expert in oral lesions revealed a diagnosis of verruciform xanthoma. The key to the diagnosis of verruciform xanthoma is to recognize xanthoma cells...
May 2017: Case Reports in Dermatology
https://www.readbyqxmd.com/read/29033057/clinical-inertia-versus-overtreatment-in-glycaemic-management
#6
Kamlesh Khunti, Melanie J Davies
No abstract text is available yet for this article.
October 9, 2017: Lancet Diabetes & Endocrinology
https://www.readbyqxmd.com/read/29032296/most-gleason-8-biopsies-are-downgraded-on-prostatectomy-does-4-4-7
#7
Ted Gansler, Stacey Fedewa, Robert Qi, Chun Chieh Lin, Ahmedin Jemal, Judd W Moul
PURPOSE: Non-representative biopsy sampling of prostate cancers with a biopsy Gleason score of 8 can adversely influence decisions regarding androgen deprivation among men receiving primary radiation therapy. The frequency of and factors associated with downgrading of Gleason 8 biopsies at prostatectomy are not well known. MATERIALS AND METHODS: Records from the National Cancer Database (a hospital-based registry in the United States) of 72,556 men with prostate cancer diagnosed 2010-2013, including 5,474 with Gleason 8 biopsies and no other high progression-risk criteria (per National Comprehensive Cancer Network guidelines)...
October 11, 2017: Journal of Urology
https://www.readbyqxmd.com/read/29031353/regulation-of-acid-base-balance-in-chronic-kidney-disease
#8
REVIEW
Glenn T Nagami, L Lee Hamm
The kidneys play a major role in the regulation of acid-base balance by reabsorbing bicarbonate filtered by the glomeruli and excreting titratable acids and ammonia into the urine. In CKD, with declining kidney function, acid retention and metabolic acidosis occur, but the extent of acid retention depends not only on the degree of kidney impairment but also on the dietary acid load. Acid retention can occur even when the serum bicarbonate level is apparently normal. With reduced kidney function, acid transport processes in the surviving nephrons are augmented but as disease progresses ammonia excretion and, in some individuals, the ability to reabsorb bicarbonate falls, whereas titratable acid excretion is preserved until kidney function is severely impaired...
September 2017: Advances in Chronic Kidney Disease
https://www.readbyqxmd.com/read/29023685/summary-statement-on-screening-for-prostate-cancer-in-europe
#9
Eveline A M Heijnsdijk, Chris H Bangma, Josep M Borràs, Tiago M de Carvalho, Xavier Castells, Martin Eklund, Josep A Espinàs, Markus Graefen, Henrik Grönberg, Iris Lansdorp-Vogelaar, Pim J van Leeuwen, Vera Nelen, Franz Recker, Monique J Roobol, Pieter Vandenbulcke, Harry J de Koning
The European Randomised Study of Screening for Prostate Cancer (ERSPC) showed that Prostate-Specific Antigen (PSA) based screening results in a significant prostate cancer mortality reduction. Although there are concerns on overdiagnosis and overtreatment, it has been shown that the benefits can outweigh the harms if screening is stopped in older ages to prevent overdiagnosis. A limited screening program (for example screening at ages 55-59 years), including active surveillance for men with low-risk tumors, can even be cost-saving, compared with testing in an opportunistic setting in the wrong ages, as currently in Europe...
October 12, 2017: International Journal of Cancer. Journal International du Cancer
https://www.readbyqxmd.com/read/29019331/clinical-and-pathological-characteristics-of-triple-positive-breast-cancer-among-iraqi-patients
#10
Nada A S Alwan, Faisal H Mualla, Munawar Al Naqash, Saad Kathum, Furat N Tawfiq, Sana Nadhir
BACKGROUND: Breast cancer is the most common malignancy affecting the Iraqi population and the leading cause of cancer related mortality among Iraqi women. It has been well documented that prognosis of patients depends largely upon the hormone receptor contents and HER-2 over expression of their neoplasm. Recent studies suggest that Triple Positive (TP) tumors, bearing the three markers, tend to exhibit a relatively favorable clinical behavior in which overtreatment is not recommended...
September 2017: Gulf Journal of Oncology
https://www.readbyqxmd.com/read/29017160/role-of-molecular-biology-in-diagnosis-and-characterization-of-vulvo-vaginitis-in-clinical-practice
#11
Gilbert G G Donders, Jacques Ravel, Beatrice Vitali, Mihai G Netea, Andres Salumets, Magnus Unemo
The diagnosis of vulvo-vaginal complaints has always been enigmatic in obstetrics and gynecology. Patients with clear, pathognomonic symptoms end up with a proper diagnosis and treatment most of the time, but unfortunately we are now living in a world where women reach out to the Internet and readily get all information as to which disease their symptoms correspond to and also find the appropriate treatment "over-the-counter." Because of this trend, we as specialists are increasingly confronted with patients with complex and combined conditions...
October 10, 2017: Gynecologic and Obstetric Investigation
https://www.readbyqxmd.com/read/28992842/-overtreatment-and-undertreatment-of-depression
#12
Janne-Elin Yttri, Poul Videbech
The aim of this study was to examine what we know about the general practitioners' ability to diagnose and treat depression. Some studies suggest that clinicians might have considerable difficulty identifying depressions correctly, but that diagnostics become more accurate with increased severity of the disease. Several studies suggest that patients diagnosed with depression are undertreated, and some studies suggest that patients might receive antidepressants, even though they do not fulfil the International Classification of Diseases 10 criterion for depression...
October 9, 2017: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/28991651/lung-cancer-in-the-older-patient
#13
REVIEW
Julie A Barta, Ralph G Zinner, Michael Unger
Cancers of the lung and bronchus are the leading cause of cancer deaths in men and women in the United States, and two-thirds of new lung cancer cases are diagnosed in patients over age 65. There are few dedicated clinical trials in the elderly, leading to both undertreatment and overtreatment biases. Even fit older adults experience age-related decline in physiologic reserve, and additional issues of polypharmacy, geriatric syndromes, and inadequate social support are not uncommon, leading to disparities in treatment and survival...
November 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/28990929/multiparametric-magnetic-resonance-imaging-for-active-surveillance-of-prostate-cancer
#14
Julie Y An, Abhinav Sidana, Peter L Choyke, Bradford Wood, Peter A Pinto, İsmail Barış Türkbey
Active surveillance has gained popularity as an acceptable management option for men with low-risk prostate cancer. Successful utilization of this strategy can delay or prevent unnecessary interventions - thereby reducing morbidity associated with overtreatment. The usefulness of active surveillance primarily depends on correct identification of patients with low-risk disease. However, current population-wide algorithms and tools do not adequately exclude high-risk disease, thereby limiting the confidence of clinicians and patients to go on active surveillance...
September 29, 2017: Balkan Medical Journal
https://www.readbyqxmd.com/read/28988728/vertical-locking-of-the-metacarpophalangeal-joint-of-the-little-finger-a-case-report
#15
Yasuhiro Seki
Locking of the metacarpophalangeal (MCP) joint is commonly caused by hyperextension of the thumb or moderate flexion of the index or middle finger. We report a rare case of vertical locking of the MCP joint of the little finger in a 16-year old female after blunt trauma to the little finger. The MCP joint was locked when positioned at approximately 90-degree-flexion and could not extend actively or passively. A manual reduction was easily achieved and no immobilization was applied. Vertical locking of the MCP joint can be easily reduced, and immobilization is unnecessary after reduction...
September 22, 2017: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
https://www.readbyqxmd.com/read/28984518/validation-of-the-unruptured-intracranial-aneurysm-treatment-score-comparison-with-real-world-cerebrovascular-practice
#16
Vijay M Ravindra, Adam de Havenon, Timothy C Gooldy, Jonathan Scoville, Jian Guan, William T Couldwell, Philipp Taussky, Joel D MacDonald, Richard H Schmidt, Min S Park
OBJECTIVE The purpose of this study was to compare the unruptured intracranial aneurysm treatment score (UIATS) recommendations with the real-world experience in a quaternary academic medical center with a high volume of patients with unruptured intracranial aneurysms (UIAs). METHODS All patients with UIAs evaluated during a 3-year period were included. All factors included in the UIATS were abstracted, and patients were scored using the UIATS. Patients were categorized in a contingency table assessing UIATS recommendation versus real-world treatment decision...
October 6, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28982039/whorling-sclerosing-meningioma-a-review-on-the-histological-features-of-a-rare-tumor-including-an-illustrative-case
#17
REVIEW
İlhan Elmaci, Meric Adil Altinoz, Aydin Sav, Fatih Han Bolükbaşı, Mustafa Önöz, Özdil Başkan, Ramazan Sari
Whorling-Sclerosing variant of meningioma (WSM) is a very rare variant of meningioma and only 28 cases were previously reported in the English medical literature. The term "whorling" describes different morphological features including psammoma bodies formed by precipitated calcium or by layered whorling sheets of tumor cells in meningothelial meningiomas. In WSM, the sclerosing structures are formed by typical paucicellular or acellular collagen whorls which form the majority of tumor volume. Hence, diagnosis of these tumors is based more often on morphological and histochemical features rather than on immunohistochemical findings...
September 28, 2017: Clinical Neurology and Neurosurgery
https://www.readbyqxmd.com/read/28978135/preoperative-imaging-markers-and-pdz-binding-kinase-tissue-expression-predict-low-risk-disease-in-endometrial-hyperplasias-and-low-grade-cancers
#18
Anna Berg, Ankush Gulati, Sigmund Ytre-Hauge, Kristine E Fasmer, Karen K Mauland, Erling A Hoivik, Jenny A Husby, Ingvild L Tangen, Jone Trovik, Mari K Halle, Ingunn Stefansson, Lars A Akslen, Kathrine Woie, Line Bjørge, Helga B Salvesen, Øyvind O Salvesen, Henrica M J Werner, Ingfrid S Haldorsen, Camilla Krakstad
PURPOSE: Distinguishing complex atypical hyperplasia (CAH) from grade 1 endometrioid endometrial cancer (EECG1) preoperatively may be valuable in order to prevent surgical overtreatment, particularly in patients wishing preserved fertility or in patients carrying increased risk of perioperative complications. MATERIAL AND METHODS: Preoperative histological diagnosis and radiological findings were compared to final histological diagnosis in patients diagnosed with CAH and EECG1...
September 15, 2017: Oncotarget
https://www.readbyqxmd.com/read/28971492/drug-related-problems-identified-during-medication-review-before-and-after-the-introduction-of-a-clinical-decision-support-system
#19
S Verdoorn, H F Kwint, P Hoogland, J Gussekloo, M L Bouvy
WHAT IS KNOWN AND OBJECTIVE: To facilitate the identification of drug-related problems (DRPs) during medication review, several tools have been developed. Explicit criteria, like Beers criteria or STOPP (Screening Tool of Older Peoples' Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment) criteria, can easily be integrated into a clinical decision support system (CDSS). The aim of this study was to investigate the effect of adding a CDSS to medication review software on identifying and solving DRPs in daily pharmacy practice...
October 2, 2017: Journal of Clinical Pharmacy and Therapeutics
https://www.readbyqxmd.com/read/28969408/evaluation-of-per-operative-cough-stress-test-during-transobturator-mid-urethral-sling-surgery
#20
Abdulmuttalip Simsek, Sinan Levent Kirecci, Goksel Bayar, Kaya Horasanli, Faruk Ozgor, Zafer Gokhan Gurbuz
PURPOSE: Currently, it is unclear how the mesh tension should be adjusted on the transobturator tape surgery (TOT) for improving continence. The aim of this study was to evaluate the effects of per-operative cough stress test on TOT. MATERIALS AND METHODS: Between March 2007 and December 2011, 206 women with SUI were enrolled in this study. Patients were randomly categorized to treatment with TOT (96) or TOT with cough stress test (110). The IIQ-7 and the UDI-6 were used to identify satisfaction level...
October 3, 2017: Archivio Italiano di Urologia, Andrologia
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