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https://www.readbyqxmd.com/read/27924735/-clinical-medication-reviews-in-elderly-patients-with-polypharmacy-a-cross-sectional-study-in-dutch-community-pharmacies
#1
S H Chau, A P D Jansen, P M van de Ven, P Hoogland, P J M Elders, J G Hugtenburg
OBJECTIVE: To investigate the nature and prevalence of drug related problems (DRPs) in older patients with polypharmacy identified by community pharmacists in daily practice through means of a clinical medication review (CMR) and assess the implementation rate of proposed interventions to solve DRPs. DESIGN: A cross-sectional study METHOD: We analysed the CMR data of 3,807 older patients (≥ 65 years) with polypharmacy (≥ 5 drugs) completed in January-August 2012...
2016: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/27923247/patterns-of-empiric-antibiotic-administration-for-presumed-early-onset-neonatal-sepsis-in-neonatal-intensive-care-units-in-the-united-states
#2
Emily A Oliver, Patricia B Reagan, Jonathan L Slaughter, Catalin S Buhimschi, Irina A Buhimschi
Objective To evaluate current patterns in empiric antibiotic use for early-onset neonatal sepsis (EONS). Study Design Retrospective population-based cohort study of newborns admitted on postnatal day 0 to 1 and discharged from NICUs participating in the Pediatric Health Information System (PHIS 2006-2013). Analyses included frequency of antibiotic initiation within 3 days of birth, duration of first course, and variation among hospitals. Results Of 158,907 newborns, 118,624 (74.7%) received antibiotics on or before postnatal day 3...
December 6, 2016: American Journal of Perinatology
https://www.readbyqxmd.com/read/27916292/cancer-prognosis-defined-by-the-combined-analysis-of-8q-pten-and-erg
#3
Maria P Silva, João D Barros-Silva, Elin Ersvær, Wanja Kildal, Tarjei Sveinsgjerd Hveem, Manohar Pradhan, Joana Vieira, Manuel R Teixeira, Håvard E Danielsen
Overtreatment is a major concern in men diagnosed with prostate cancer. The aim of this study was to evaluate the combined prognostic role of three frequent molecular alterations in prostate cancer, namely relative 8q gain, ERG overexpression, and loss of PTEN expression, in a series of 136 patients with prostate cancer treated with prostatectomy and with a long follow-up. Fluorescent in situ hybridization was used to detect the relative copy number of 8q and immunohistochemistry was used for quantitative assessment of ERG and PTEN expression...
December 2016: Translational Oncology
https://www.readbyqxmd.com/read/27913491/prognostic-factors-in-follicular-lymphoma-new-tools-to-personalize-risk
#4
Carla Casulo
Follicular lymphoma (FL) is the most common indolent lymphoma, and it has a long median overall survival (OS). However, the recent discovery of clinical and biological prognostic biomarkers in FL is shedding light on FL heterogeneity and the need for a precise and risk-stratified individual approach at diagnosis and relapse. Many FL patients who are asymptomatic with indolent disease can be vulnerable to the toxicity, emotional distress, and financial burden of overtreatment. Yet a subset of FL patients develop chemoresistance to standard chemoimmunotherapy, experience transformation to aggressive lymphoma and rapid progression, and represent the population most in need of novel therapies and curative approaches...
December 2, 2016: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/27909535/search-for-the-ideal-antithrombotic-drug-utopian-task-likely-is-implemented-already
#5
REVIEW
Petras Stirbys Md PhD
Atrial fibrillation is the most prevalent cardiac arrhythmia with a high risk of ischemic stroke. Thromboprophylaxis plays a key role in prevention of cardioembolic and non-cardioembolic events. Oral antithrombotic drugs are most often used to reduce hypercoagulable state. Patients may suffer from both under- and overtreatment compromising the outcomes. Medication peculiarities at large are well-known and widely debated. Non-adherence to antithrombotic drug regimen poses a significant risk of stroke. There is a pressing need for more detailed delineation of risk factors, namely by incorporation of the letter "N" (meaning "Non-adherence to drug therapy") into the well-known risk score alphanumeric display: CHA2DS2N-VASc...
August 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27905473/carcinogenic-human-papillomavirus-infection
#6
Mark Schiffman, John Doorbar, Nicolas Wentzensen, Silvia de Sanjosé, Carole Fakhry, Bradley J Monk, Margaret A Stanley, Silvia Franceschi
Infections with human papillomavirus (HPV) are common and transmitted by direct contact. Although the great majority of infections resolve within 2 years, 13 phylogenetically related, sexually transmitted HPV genotypes, notably HPV16, cause - if not controlled immunologically or by screening - virtually all cervical cancers worldwide, a large fraction of other anogenital cancers and an increasing proportion of oropharyngeal cancers. The carcinogenicity of these HPV types results primarily from the activity of the oncoproteins E6 and E7, which impair growth regulatory pathways...
December 1, 2016: Nature Reviews. Disease Primers
https://www.readbyqxmd.com/read/27898099/clinical-and-molecular-rationale-to-retain-the-cancer-descriptor-for-gleason-score-6-disease
#7
REVIEW
Chad A Reichard, Eric A Klein
Treatment choices for men with indolent prostate cancer include active surveillance or definitive local therapy. Overtreatment of these patients is an important current problem. Treatment decisions are often made jointly by the clinician and the patient, partly based on the tumour's Gleason score. To reduce the burden of overtreatment, the clinical significance of Gleason score 3 + 3 = 6 prostate cancer has been questioned and some have advocated that Gleason pattern 3 should be stripped of its cancer status...
November 29, 2016: Nature Reviews. Urology
https://www.readbyqxmd.com/read/27893934/surveillance-versus-adjuvant-radiotherapy-for-patients-with-high-risk-stage-i-seminoma
#8
Mette S Mortensen, Mikkel Bandak, Maria Gg Kier, Jakob Lauritsen, Mads Agerbaek, Niels V Holm, Hans von der Maase, Gedske Daugaard
BACKGROUND: The optimal treatment strategy for patients with clinical stage I (CS-1) seminoma is controversial. The objective of the current study was to evaluate the outcomes for patients considered to be at high risk of disease recurrence with a tumor size ≥6 cm. Patients were treated with either adjuvant radiotherapy (RT) or followed with surveillance. METHODS: From the Danish Testicular Cancer database, the authors identified 473 patients with CS-1 seminoma with a tumor size ≥6 cm...
November 28, 2016: Cancer
https://www.readbyqxmd.com/read/27886816/pretreatment-with-antiplatelet-agents-in-the-setting-of-percutaneous-coronary-intervention-when-and-which-drugs
#9
REVIEW
Davide Capodanno, Dominick J Angiolillo
Administering antiplatelet agents before coronary angiography to patients referred to elective or urgent percutaneous coronary intervention (PCI) requires a careful evaluation of advantages and disadvantages associated with platelet inhibition to avoid overtreatment on one side and undertreatment on the other. The delicate balance between ischemic protection and bleeding demands the ability to undertake risk stratification and individualized decisions, which is particularly challenging in the setting of ad hoc PCI and urgent procedures...
January 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/27881048/accuracy-of-pre-treatment-locoregional-rectal-cancer-staging-in-a-national-improvement-project
#10
Bart Op de Beeck, Peter Smeets, Freddy Penninckx, Piet Pattyn, Geert Silversmit, Elizabeth Van Eycken
BACKGROUND: The aim of this study was to assess the accuracy, particularly the predictive value, of locoregional clinical rectal cancer staging (cTN) and its variability in a national improvement project. METHODS: cTN stages and the distance between tumour and mesorectal fascia (MRF) were compared with histopathological findings in 1168 patients who underwent radical resection without neoadjuvant treatment. Data were registered prospectively from 2006 to 2014. RESULTS: Agreement between clinical and histopathological TN stages was 50%, independent of tumour location...
November 24, 2016: Acta Chirurgica Belgica
https://www.readbyqxmd.com/read/27879545/epstein-barr-virus-associated-mucocutaneous-ulcer-in-a-patient-with-t-cell-acute-lymphoblastic-leukemia-importance-of-accurate-diagnosis-and-conservative-management
#11
Anant Vatsayan, Ashish Gupta, Sanjay Ahuja, Rachel Egler, Rose C Beck, Yousif Matloub
Epstein-Barr virus-associated mucocutaneous ulcer (EBV-MCU) is a recently characterized entity that falls under the spectrum of EBV-lymphoproliferative disorders. First described in 2010 by Dojcinov et al, it is an EBV-driven localized proliferation of B cells, occurring in mucocutaneous tissues including the skin, the oropharynx, and the gastrointestinal tract of immunosuppressed patients in the absence of an intact T-cell repertoire. Typically, it has been described in elderly patients with age-related immunosenescence and patients who are on immunosuppressive therapy...
November 22, 2016: Journal of Pediatric Hematology/oncology
https://www.readbyqxmd.com/read/27878797/choosing-wisely-at-the-end-of-life-the-crucial-role-of-medical-indication
#12
Gian Domenico Borasio, Ralf J Jox
At the end of life, several treatments are administered routinely that lack medical indication and may cause significant harm to patients. Examples include artificial hydration and oxygen therapy in the dying phase, as well as enteral nutrition in advanced dementia. Medical indication is defined as the appropriateness of a therapeutic or diagnostic measure in the patient's concrete clinical situation, in light of the best available evidence. The decision about the absence or presence of a medical indication is a core competence of physicians...
2016: Swiss Medical Weekly
https://www.readbyqxmd.com/read/27876036/diabetes-screening-intervals-based-on-risk-stratification
#13
Sachiko Ohde, Emily McFadden, Gautam A Deshpande, Hiroshi Yokomichi, Osamu Takahashi, Tsuguya Fukui, Rafael Perera, Zentaro Yamagata
BACKGROUND: Guidelines for frequency of Type 2 diabetes mellitus (DM) screening remain unclear, with proposed screening intervals typically based on expert opinion. This study aims to demonstrate that HbA1c screening intervals may differ substantially when considering individual risk for diabetes. METHODS: This was a multi-institutional retrospective open cohort study. Data were collected between April 1999 to March 2014 from one urban and one rural cohort in Japan...
November 22, 2016: BMC Endocrine Disorders
https://www.readbyqxmd.com/read/27873054/expectant-management-may-reduce-overtreatment-in-women-affected-by-unexplained-infertility-confirmed-by-diagnostic-laparoscopy
#14
S De Cicco, Valeria Tagliaferri, L Selvaggi, D Romualdi, C Di Florio, V Immediata, A Lanzone, M Guido
PURPOSE: To determine whether the mini-invasive surgery still play a role in the diagnostic workup and in the management of the couples affected by unexplained infertility. METHODS: 170 infertile women (age range 25-38 years) with documented normal ovarian, tubal and uterine function underwent combined hysteroscopic and laparoscopic surgery; 100 women refused surgery or ART treatment (control group) choosing expectant management. A retrospective assessment questionnaire was proposed to enrolled women to collect the rate of spontaneous or ART-induced pregnancies...
November 21, 2016: Archives of Gynecology and Obstetrics
https://www.readbyqxmd.com/read/27870649/the-reliability-of-disease-activity-score-in-28-joints-c-reactive-protein-might-be-overestimated-in-a-subgroup-of-rheumatoid-arthritis-patients-when-the-score-is-solely-based-on-subjective-parameters-a-cross-sectional-exploratory-study
#15
Inger Marie Jensen Hansen, Rikke Asmussen Andreasen, Mark Nam van Bui Hansen, Amir Emamifar
BACKGROUND: Disease Activity Score in 28 Joints (DAS28) is a scoring system to evaluate disease activity and treatment response in rheumatoid arthritis (RA). A DAS28 score of greater than 3.2 is a well-described limit for treatment intensification; however, the reliability of DAS28 might be overestimated. OBJECTIVE: The aim of this study was to evaluate the reliability of DAS28 in RA, especially focusing on a subgroup of patients with a DAS28 score of greater than 3...
November 19, 2016: Journal of Clinical Rheumatology: Practical Reports on Rheumatic & Musculoskeletal Diseases
https://www.readbyqxmd.com/read/27868389/monitoring-of-human-uterus-transplantation-with-cervical-biopsies-a-provisional-scoring-system-for-rejection
#16
J Mölne, V Broecker, J Ekberg, O Nilsson, P Dahm-Kähler, M Brännström
Until now, absolute uterine factor infertility has been the major untreatable form of female infertility. Recently, uterus transplantation has proven to be the first successful treatment for absolute uterine factor infertility, with demonstration of live births. Here, live donation uterus transplantation was performed in nine women. 163 cervical biopsies (149 protocol, 14 follow-up) were taken to detect histopathological signs of rejection. Based on experience from animal experiments, we used a three-grade scoring system to evaluate biopsies systematically...
November 21, 2016: American Journal of Transplantation
https://www.readbyqxmd.com/read/27866835/over-using-chemotherapy-in-the-adjuvant-setting
#17
Giuseppe Curigliano, Carmen Criscitiello, Angela Esposito, Giancarlo Pruneri
Avoidance of unnecessary or ineffective treatment should be one of the main goals in adjuvant breast oncology today. Unfortunately, both patients and doctors hunt for tiny statistical differences in survival curves. This search could not only lead to an oncological approach of unlimited addition that we will not be able to afford, but would also end inevitably in indeterminate overtreatment with substantial risks of unexpected toxic effects eating away whatever progress we might make. "Do not harm" remains the main principle in medicine...
November 17, 2016: Breast: Official Journal of the European Society of Mastology
https://www.readbyqxmd.com/read/27865536/breast-cancer
#18
REVIEW
Nadia Harbeck, Michael Gnant
Breast cancer is one of the three most common cancers worldwide. Early breast cancer is considered potentially curable. Therapy has progressed substantially over the past years with a reduction in therapy intensity, both for locoregional and systemic therapy; avoiding overtreatment but also undertreatment has become a major focus. Therapy concepts follow a curative intent and need to be decided in a multidisciplinary setting, taking molecular subtype and locoregional tumour load into account. Primary conventional surgery is not the optimal choice for all patients any more...
November 16, 2016: Lancet
https://www.readbyqxmd.com/read/27863486/costs-of-conservative-management-of-early-stage-prostate-cancer-compared-to-radical-prostatectomy-a-claims-data-analysis
#19
Alina Brandes, Florian Koerber, Larissa Schwarzkopf, Matthias Hunger, Wolf H Rogowski, Raphaela Waidelich
BACKGROUND: Due to widespread PSA testing incidence rates of localized prostate cancer increase but curative treatment is often not required. Overtreatment imposes a substantial economic burden on health care systems. We compared the direct medical costs of conservative management and radical therapy for the management of early-stage prostate cancer in routine care. METHODS: An observational study design is chosen based on claims data of a German statutory health insurance fund for the years 2008-2011...
November 18, 2016: BMC Health Services Research
https://www.readbyqxmd.com/read/27861639/survival-benefits-of-statins-for-primary-prevention-a-cohort-study
#20
Lisanne A Gitsels, Elena Kulinskaya, Nicholas Steel
OBJECTIVES: Estimate the effect of statin prescription on mortality in the population of England and Wales with no previous history of cardiovascular disease. METHODS: Primary care records from The Health Improvement Network 1987-2011 were used. Four cohorts of participants aged 60, 65, 70, or 75 years at baseline included 118,700, 199,574, 247,149, and 194,085 participants; and 1.4, 1.9, 1.8, and 1.1 million person-years of data, respectively. The exposure was any statin prescription at any time before the participant reached the baseline age (60, 65, 70 or 75) and the outcome was all-cause mortality at any age above the baseline age...
2016: PloS One
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