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Overtreatment

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https://www.readbyqxmd.com/read/28101226/evaluation-of-plasma-microrna-levels-to-predict-insensitivity-of-patients-with-advanced-lung-adenocarcinomas-to-pemetrexed-and-platinum
#1
Jinghua Zhu, Yuhua Qi, Jianzhong Wu, Meiqi Shi, Jifeng Feng, Longbang Chen
Pemetrexed combined with platinum is a first-line therapy used to treat patients with advanced non-small cell lung cancer (NSCLC) that exhibit negative or unknown epidermal growth factor receptor (EGFR) mutational status or anaplastic lymphoma kinase (ALK) rearrangements. Lung adenocarcinoma (LAC) is the primary type of NSCLC. In order to prevent overtreatment, it is necessary to identify patients with LAC who may not benefit from certain chemotherapies. Patients recruited in the present study (n=129) were diagnosed with advanced LAC and received first-line pemetrexed and platinum-based chemotherapy...
December 2016: Oncology Letters
https://www.readbyqxmd.com/read/28097633/meropenem-dosing-based-on-a-population-pharmacokinetic-pharmacodynamic-model-in-elderly-patients-with-infection-of-the-lower-respiratory-tract
#2
Qing-Tao Zhou, Bei He, Ning Shen, Ying Liang, Li-Na Sun
BACKGROUND: Meropenem is used for the treatment of severe lower respiratory tract infections (LRTIs) caused by multidrug-resistant Gram-negative bacilli. OBJECTIVE: We evaluated the clinical benefits of a strategy of meropenem dosing based on a population pharmacokinetics/pharmacodynamics (PK/PD) model in elderly patients with an LRTI. METHODS: In this prospective single-center open-label randomized controlled trial, 79 elderly patients with an LRTI caused by Gram-negative bacilli were randomized to a study group (SG) or a control group (CG)...
January 17, 2017: Drugs & Aging
https://www.readbyqxmd.com/read/28092924/evaluation-of-the-use-of-rotational-thromboelastometry-in-the-assessment-of-fxi-deficency
#3
G N Pike, A M Cumming, J Thachil, C R M Hay, P H B Bolton-Maggs, J Burthem
INTRODUCTION: The absence of a reliable clinical test to predict bleeding tendency leaves factor XI (FXI)-deficient individuals at risk of overtreatment or under treatment. AIM: To assess whether rotational thromboelastometry has value in detection of FXI deficiency and identification of bleeding tendency. METHODS: Thromboelastometry was measured in whole blood and platelet-rich plasma (PRP) samples containing corn trypsin inhibitor (CTI) from controls (n = 50) and FXI-deficient individuals (n = 93) at tissue factor (TF) 0...
January 16, 2017: Haemophilia: the Official Journal of the World Federation of Hemophilia
https://www.readbyqxmd.com/read/28081533/eeg-monitoring-technique-influences-the-management-of-hypoxic-ischemic-seizures-in-neonates-undergoing-therapeutic-hypothermia
#4
Saber Jan, Frances J Northington, Charlamaine M Parkinson, Carl E Stafstrom
Electroencephalogram (EEG) monitoring techniques for neonatal hypoxia-ischemia (HI) are evolving over time, and the specific type of EEG utilized could influence seizure diagnosis and management. We examined whether the type of EEG performed affected seizure treatment decisions (e.g., the choice and number of antiseizure drugs [ASDs]) in therapeutic hypothermia-treated neonates with HI from 2007 to 2015 in the Johns Hopkins Hospital Neonatal Intensive Care Unit. During this period, 3 different EEG monitoring protocols were utilized: Period 1 (2007-2009), single, brief conventional EEG (1 h duration) at a variable time during therapeutic hypothermia treatment, i...
January 17, 2017: Developmental Neuroscience
https://www.readbyqxmd.com/read/28077178/ptsd-or-not-ptsd-comparing-the-proposed-icd-11-and-the-dsm-5-ptsd-criteria-among-young-survivors-of-the-2011-norway-attacks-and-their-parents
#5
G S Hafstad, S Thoresen, T Wentzel-Larsen, A Maercker, G Dyb
BACKGROUND: The conceptualization of post-traumatic stress disorder (PTSD) in the upcoming International Classification of Diseases (ICD)-11 differs in many respects from the diagnostic criteria in the Diagnostic and Statistical Manual for Mental Disorders, fifth edition (DSM-5). The consequences of these differences for individuals and for estimation of prevalence rates are largely unknown. This study investigated the concordance of the two diagnostic systems in two separate samples at two separate waves...
January 12, 2017: Psychological Medicine
https://www.readbyqxmd.com/read/28075651/imaging-characteristics-of-prostate-cancer-patients-who-discontinued-active-surveillance-on-3-t-multiparametric-prostate-mri
#6
David J Habibian, Corinne C Liu, Alex Dao, Kaitlin E Kosinski, Aaron E Katz
OBJECTIVE: Early-stage prostate cancer may be followed with active surveillance to avoid overtreatment. Our institution's active surveillance regimen uses annual MRI in place of serial biopsies, and biopsies are performed only when clinically necessary. The objective of our study was to report the multiparametric MRI characteristics of prostate cancer patients who discontinued active surveillance at our institution after repeat imaging revealed possible evidence of tumor upgrading. MATERIALS AND METHODS: The Department of Urology at Winthrop University Hospital prospectively maintains a database of prostate cancer patients who are monitored with active surveillance...
January 11, 2017: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/28073203/testicular-sparing-surgery-in-small-testis-masses-a-multinstitutional-experience
#7
Andrea B Galosi, Paola Fulvi, Andrea Fabiani, Lucilla Servi, Alessandra Filosa, Luca Leone, Angelo Marronaro, Enrico Caraceni, Rodolfo Montironi
INTRODUCTION: The incidence of benign testicular tumors is increasing in particular in small lesion incidentally found at scrotal ultrasonography. Primary aim of this study was to perform radical surgery in malignant tumor. Secondary aim was to verify the efficacy of the diagnostic-therapeutic pathway recently adopted in management of small masses with testis sparing surgery in benign lesions. MATERIALS AND METHODS: In this multicenter study, we reviewed all patients with single testis lesion less than 15 mm at ultrasound as main diameter...
December 30, 2016: Archivio Italiano di Urologia, Andrologia
https://www.readbyqxmd.com/read/28073194/verruciform-xanthoma-of-the-penis-a-rare-benign-lesion-that-simulates-carcinoma
#8
Aldo Franco De Rose, Mattia Tosi, Guglielmo Mantica, Nataniele Piol, Carlo Toncini, Carlo Terrone
Verruciform xanthoma is a rare and benign condition predominantly affecting the oral cavity, but also skin and female anogenital mucosa. It can be flat, papular-warty or crateriform-cystic. Furthermore it can simulate HPV viral lesion such as condyloma and malignant neoplasia such as verrucous squamous cell carcinoma. An accurate diagnosis is important to avoid overtreatment, considering it is a benign lesion that does not require any radical treatment. We present an extremely rare case of a 64 year-old man with a small, slighty raised, gray reddish-dotted lesion on the left portion of the ventral side of his glans...
December 30, 2016: Archivio Italiano di Urologia, Andrologia
https://www.readbyqxmd.com/read/28069712/an-evidence-based-medicine-approach-to-antihyperglycemic-therapy-in-diabetes-mellitus-to-overcome-overtreatment
#9
Anil N Makam, Oanh K Nguyen
Overtreatment is pervasive in medicine and leads to potential patient harms and excessive costs in health care. Although evidence-based medicine is often derided as practice by rote algorithmic medicine, the appropriate application of key evidence-based medicine principles in clinical decision making is fundamental to preventing overtreatment and promoting high-value, individualized patient-centered care. Specifically, this article discusses the importance of (1) using absolute rather than relative estimates of benefits to inform treatment decisions; (2) considering the time horizon to benefit of treatments; (3) balancing potential harms and benefits; and (4) using shared decision making by physicians to incorporate the patient's values and preferences into treatment decisions...
January 10, 2017: Circulation
https://www.readbyqxmd.com/read/28052017/rhcg-and-tcaf1-promoter-hypermethylation-predicts-biochemical-recurrence-in-prostate-cancer-patients-treated-by-radical-prostatectomy
#10
Siri H Strand, Michal Switnicki, Mia Moller, Christa Haldrup, Tine M Storebjerg, Jakob Hedegaard, Iver Nordentoft, Soren Hoyer, Michael Borre, Jakob S Pedersen, Peter J Wild, Jong Y Park, Torben F Orntoft, Karina D Sorensen
PURPOSE: The lack of biomarkers that can distinguish aggressive from indolent prostate cancer has caused substantial overtreatment of clinically insignificant disease. Here, by genome-wide DNA methylome profiling, we sought to identify new biomarkers to improve the accuracy of prostate cancer diagnosis and prognosis. EXPERIMENTAL DESIGN: Eight novel candidate markers, COL4A6, CYBA, TCAF1 (FAM115A), HLF, LINC01341 (LOC149134), LRRC4, PROM1, and RHCG, were selected from Illumina Infinium HumanMethylation450 BeadChip analysis of 21 tumor (T) and 21 non-malignant (NM) prostate specimens...
December 30, 2016: Oncotarget
https://www.readbyqxmd.com/read/28049113/update-on-pediatric-overuse
#11
Eric R Coon, Paul C Young, Ricardo A Quinonez, Daniel J Morgan, Sanket S Dhruva, Alan R Schroeder
As concerns over health care-related harms and costs continue to mount, efforts to identify and combat medical overuse are needed. Although much of the recent attention has focused on health care for adults, children are also harmed by overuse. Using a structured PubMed search and manual tables of contents review, we identified important articles on pediatric overuse published in 2015. These articles were evaluated according to the quality of the methods, the magnitude of clinical effect, and the number of patients potentially affected and were categorized into overdiagnosis, overtreatment, and overutilization...
January 3, 2017: Pediatrics
https://www.readbyqxmd.com/read/28048472/tu-h-campus-jep3-04-factors-predicting-a-need-for-treatment-replanning-with-proton-radiotherapy-for-lung-cancer
#12
C Teng, G Janssens, C Ainsley, B Teo, G Valdes, B Burgdorf, A Berman, W Levin, Y Xiao, L Lin, P Gabriel, C Simone, T Solberg
PURPOSE: Proton dose distribution is sensitive to tumor regression and tissue and normal anatomy changes. Replanning is sometimes necessary during treatment to ensure continue tumor coverage or avoid overtreatment of organs at risk (OARs). We investigated action thresholds for replanning and identified both dosimetric and non-dosimetric metrics that would predict a need for replan. METHODS: All consecutive lung cancer patients (n = 188) who received definitive proton radiotherapy and had more than two evaluation CT scans at the Roberts Proton Therapy Center (Philadelphia, USA) from 2011 to 2015 were included in this study...
June 2016: Medical Physics
https://www.readbyqxmd.com/read/28046017/development-and-external-validation-of-the-korean-prostate-cancer-risk-calculator-for-high-grade-prostate-cancer-comparison-with-two-western-risk-calculators-in-an-asian-cohort
#13
Jae Young Park, Sungroh Yoon, Man Sik Park, Hoon Choi, Jae Hyun Bae, Du Geon Moon, Sung Kyu Hong, Sang Eun Lee, Chanwang Park, Seok-Soo Byun
PURPOSE: We developed the Korean Prostate Cancer Risk Calculator for High-Grade Prostate Cancer (KPCRC-HG) that predicts the probability of prostate cancer (PC) of Gleason score 7 or higher at the initial prostate biopsy in a Korean cohort (http://acl.snu.ac.kr/PCRC/RISC/). In addition, KPCRC-HG was validated and compared with internet-based Western risk calculators in a validation cohort. MATERIALS AND METHODS: Using a logistic regression model, KPCRC-HG was developed based on the data from 602 previously unscreened Korean men who underwent initial prostate biopsies...
2017: PloS One
https://www.readbyqxmd.com/read/28045715/oncologic-procedures-amenable-to-fluorescence-guided-surgery
#14
Kiranya E Tipirneni, Jason M Warram, Lindsay S Moore, Andrew C Prince, Esther de Boer, Aditi H Jani, Irene L Wapnir, Joseph C Liao, Michael Bouvet, Nicole K Behnke, Mary T Hawn, George A Poultsides, Alexander L Vahrmeijer, William R Carroll, Kurt R Zinn, Eben Rosenthal
OBJECTIVE: Although fluorescence imaging is being applied to a wide range of cancers, it remains unclear which disease populations will benefit greatest. Therefore, we review the potential of this technology to improve outcomes in surgical oncology with attention to the various surgical procedures while exploring trial endpoints that may be optimal for each tumor type. BACKGROUND: For many tumors, primary treatment is surgical resection with negative margins, which corresponds to improved survival and a reduction in subsequent adjuvant therapies...
December 30, 2016: Annals of Surgery
https://www.readbyqxmd.com/read/28045352/antidepressant-prescribing-in-primary-care-to-older-adults-without-major-depression
#15
Donovan T Maust, Jo Anne Sirey, Helen C Kales
OBJECTIVE: The study compared distress levels among two groups of older adults who had been newly prescribed an antidepressant by their primary care physician, those with major depressive disorder (MDD) and those without MDD. METHODS: This analysis used a convenience sample of participants (N=231) who had been newly prescribed an antidepressant in a randomized controlled trial of a program to improve antidepressant adherence and depression outcomes among older adults (≥55)...
January 3, 2017: Psychiatric Services: a Journal of the American Psychiatric Association
https://www.readbyqxmd.com/read/28040332/rheumatoid-arthritis-seems-to-have-dmard-treatment-decision-influenced-by-fibromyalgia
#16
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...
December 18, 2016: Revista Brasileira de Reumatologia
https://www.readbyqxmd.com/read/28038381/extent-of-undertreatment-and-overtreatment-with-cholesterol-lowering-therapy-according-to-european-guidelines-in-92-348-danes-without-ischemic-cardiovascular-disease-and-diabetes-in-2004-2014
#17
Anne Langsted, Jacob J Freiberg, Børge G Nordestgaard
BACKGROUND AND AIMS: We estimated the extent of undertreatment and overtreatment with cholesterol-lowering therapy according to European guidelines in individuals in the Danish general population without ischemic cardiovascular disease and diabetes. METHODS: We examined 92,348 such individuals aged 35-100 years recruited from 2004 through 2014 in the Copenhagen General Population Study. Each individual was assigned their 10-year risk of fatal cardiovascular disease according to the European SCORE chart based on age, sex, smoking, total cholesterol, and systolic blood pressure...
November 24, 2016: Atherosclerosis
https://www.readbyqxmd.com/read/28038345/a-bayesian-model-for-estimating-multi-state-disease-progression
#18
Shiwen Shen, Simon X Han, Panayiotis Petousis, Robert E Weiss, Frank Meng, Alex A T Bui, William Hsu
A growing number of individuals who are considered at high risk of cancer are now routinely undergoing population screening. However, noted harms such as radiation exposure, overdiagnosis, and overtreatment underscore the need for better temporal models that predict who should be screened and at what frequency. The mean sojourn time (MST), an average duration period when a tumor can be detected by imaging but with no observable clinical symptoms, is a critical variable for formulating screening policy. Estimation of MST has been long studied using continuous Markov model (CMM) with Maximum likelihood estimation (MLE)...
December 22, 2016: Computers in Biology and Medicine
https://www.readbyqxmd.com/read/28034073/cost-effectiveness-of-skin-surveillance-through-a-specialized-clinic-for-patients-at-high-risk-of-melanoma
#19
Caroline G Watts, Anne E Cust, Scott W Menzies, Graham J Mann, Rachael L Morton
Purpose Clinical guidelines recommend that people at high risk of melanoma receive regular surveillance to improve survival through early detection. A specialized High Risk Clinic in Sydney, Australia was found to be effective for this purpose; however, wider implementation of this clinical service requires evidence of cost-effectiveness and data addressing potential overtreatment of suspicious skin lesions. Patients and Methods A decision-analytic model was built to compare the costs and benefits of specialized surveillance compared with standard care over a 10-year period, from a health system perspective...
January 2017: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28029492/overdiagnosis-in-breast-imaging
#20
Andy Evans, Sarah Vinnicombe
The main harm of overdiagnosis is overtreatment. However a form of overdiagnosis also occurs when foci of cancer are found by imaging in addition to the symptomatic lesion when this leads to additional treatment which does not benefit the patient. Even if overtreatment is avoided, knowledge of the diagnosis can still cause psychological harm. Overdiagnosis is an inevitable effect of mammographic screening as the benefit comes from diagnosing breast cancer prior to clinical detectability. Estimates of the rate of overdiagnosis at screening are around 10%...
October 28, 2016: Breast: Official Journal of the European Society of Mastology
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