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https://www.readbyqxmd.com/read/29455368/sepsis-calculator-implementation-reduces-empiric-antibiotics-for-suspected-early-onset-sepsis
#1
Niek B Achten, J Wendelien Dorigo-Zetsma, Paul D van der Linden, Monique van Brakel, Frans B Plötz
Significant overtreatment with antibiotics for suspected early onset sepsis (EOS) constitutes a persisting clinical problem, generating unnecessary risks, harms, and costs for many newborns. We aimed to study feasibility and impact of a sepsis calculator to help guide antibiotic for suspected EOS in a European setting. In this single-center study, the sepsis calculator was implemented as an addition to and in accordance with existing protocols. One thousand eight hundred seventy-seven newborns ≥ 35 weeks of gestational age were prospectively evaluated; an analogous retrospective control group (n = 2076) was used for impact analysis...
February 18, 2018: European Journal of Pediatrics
https://www.readbyqxmd.com/read/29454309/perceptions-about-screening-for-prostate-cancer-using-genetic-lifetime-risk-assessment-a-qualitative-study
#2
Pia Kirkegaard, Adrian Edwards, Trine Laura Overgaard Nielsen, Torben Falck Ørntoft, Karina Dalsgaard Sørensen, Michael Borre, Flemming Bro
BACKGROUND: Most health authorities do not recommend screening for prostate cancer with PSA tests in asymptomatic patients who are not at increased risk. However, opportunistic screening for prostate cancer is still wanted by many patients and it is widely used in primary care clinics, with potential for overdiagnosis and overtreatment. Better tools for risk assessment have been called for, to better target such opportunistic screening. Our aim was to explore perceptions about prostate cancer risk and subsequent opportunistic screening among patients who were not at increased risk of prostate cancer after a first PSA test plus a genetic lifetime risk assessment...
February 17, 2018: BMC Family Practice
https://www.readbyqxmd.com/read/29453690/the-effectiveness-of-targeted-relative-to-empiric-prophylaxis-on-infectious-complications-after-transrectal-ultrasound-guided-prostate-biopsy-a-meta-analysis
#3
REVIEW
Susan Scott, Patrick N Harris, Deborah A Williamson, Michael A Liss, Suhail A R Doi, Matthew J Roberts
PURPOSE: Rectal culture screening for fluoroquinolone (FQ)-resistant Enterobacteriaceae before transrectal ultrasound guided prostate (TRUSPB) biopsy and targeted antibiotic prophylaxis (TAP) may decrease post-TRUSPB infection rates compared to empiric (EAP) regimens. The objective of this study was to evaluate the effectiveness of targeted relative to empiric prophylaxis regimens on rates of infectious complications after TRUSPB and to determine the baseline prevalence of FQ resistance based on prior rectal swabs...
February 16, 2018: World Journal of Urology
https://www.readbyqxmd.com/read/29452300/therapeutic-strategy-for-rheumatoid-arthritis-patients-who-have-achieved-remission
#4
Bruno Fautrel
Once remission or low disease activity (LDA) is attained in established rheumatoid arthritis (RA) patients, attempting disease-modifying anti-rheumatic drug (DMARD) tapering appears to be a viable option to avoid patient overtreatment. Potential benefits include reduction in the treatment burden and the risk of adverse events, although the latter has not been demonstrated convincingly.The feasibility of DMARD discontinuation has been tested in numerous studies or trials. All have revealed a high risk of relapse, ranging from 56% to 87% at one year...
February 13, 2018: Joint, Bone, Spine: Revue du Rhumatisme
https://www.readbyqxmd.com/read/29449294/disease-characteristics-and-management-of-hospitalised-adolescents-and-adults-with-community-acquired-pneumonia-in-china-a-retrospective-multicentre-survey
#5
Liang Chen, Fei Zhou, Hui Li, Xiqian Xing, Xiudi Han, Yiming Wang, Chunxiao Zhang, Lijun Suo, Jingxiang Wang, Guohua Yu, Guangqiang Wang, Xuexin Yao, Hongxia Yu, Lei Wang, Meng Liu, Chunxue Xue, Bo Liu, Xiaoli Zhu, Yanli Li, Ying Xiao, Xiaojing Cui, Lijuan Li, Timothy M Uyeki, Chen Wang, Bin Cao
OBJECTIVES: To describe the clinical characteristics and management of patients hospitalised with community-acquired pneumonia (CAP) in China. DESIGN: This was a multicentre, retrospective, observational study. SETTING: 13 teaching hospitals in northern, central and southern China from 1 January 2014 to 31 December 2014 PARTICIPANTS: Information on hospitalised patients aged ≥14 years with radiographically confirmed pneumonia with illness onset in the community was collected using standard case report forms...
February 15, 2018: BMJ Open
https://www.readbyqxmd.com/read/29440886/missed-diagnosis-and-overtreatment-of-copd-among-smoking-primary-care-population-in-central-greece-old-problems-persist
#6
Eirini Stafyla, Ourania S Kotsiou, Konstantina Deskata, Konstantinos I Gourgoulianis
Background: The diagnosis of COPD is not always consistent with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy in daily clinical practice, especially in primary care. This study aimed to estimate the overall COPD prevalence and severity, to identify differences between newly and previously diagnosed patients, and to evaluate the potential COPD overtreatment in a smoking population attending a primary care spirometry surveillance program. Methods: A study was conducted in 10 primary health care centers of Central Greece during a 7-month period...
2018: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/29440512/clinically-detected-non-aggressive-lung-cancers-implications-for-overdiagnosis-and-overtreatment-in-lung-cancer-screening
#7
EDITORIAL
Kevin Ten Haaf, Carlijn M van der Aalst, Harry J de Koning
No abstract text is available yet for this article.
February 9, 2018: Thorax
https://www.readbyqxmd.com/read/29440213/does-industry-sponsored-education-foster-overdiagnosis-and-overtreatment-of-depression-osteoporosis-and-over-active-bladder-syndrome-an-australian-cohort-study
#8
Barbara Mintzes, Swestika Swandari, Alice Fabbri, Quinn Grundy, Ray Moynihan, Lisa Bero
OBJECTIVES: To investigate patterns of industry-sponsored educational events that focus on specific health conditions for which there are concerns about overdiagnosis and overtreatment. DESIGN AND SETTING: This retrospective cohort study examines publicly reported industry-sponsored events in Australia from October 2011 to September 2015 for three conditions potentially subject to overdiagnosis and overtreatment: depression, osteoporosis and overactive bladder. We used a database of transparency reports to identify events with a focus on depression, osteoporosis and overactive bladder and compared these with other sponsored events...
February 13, 2018: BMJ Open
https://www.readbyqxmd.com/read/29439059/noninvasive-follicular-thyroid-neoplasm-with-papillary-like-nuclear-features
#9
Isabel Amendoeira, Tiago Maia, M Sobrinho-Simões
The 2017 edition of the WHO book on Classification of Tumours of Endocrine Organs includes a new section entitled "Other encapsulated follicular-patterned thyroid tumours", in which the newly created NIFTP (Non-invasive follicular thyroid neoplasm with papillary-like nuclear features) is identified and detailed described. Despite deleting the word "carcinoma" from its name, NIFTP is not a benign tumor either, and is best regarded as a neoplasm with "very low malignant potential"...
February 9, 2018: Endocrine-related Cancer
https://www.readbyqxmd.com/read/29437696/clinical-outcomes-after-conservative-management-of-cervical-intraepithelial-neoplasia-grade-2-cin2-in-women-ages-21-39-years
#10
Michelle I Silver, Julia C Gage, Mark Schiffman, Barbara Fetterman, Nancy E Poitras, Thomas Lorey, Li C Cheung, Hormuzd A Katki, Alexander Locke, Walter K Kinney, Philip E Castle
Cervical intraepithelial neoplasia grade 2 (CIN2) frequently regresses, is typically slow-growing, and rarely progresses to cancer. Some women forgo immediate treatment, opting for conservative management (heightened surveillance with cytology and colposcopy), to minimize overtreatment and increased risk of obstetric complications; however, there are limited data examining clinical outcomes in these women. We performed a retrospective cohort analysis of younger women diagnosed with initially untreated CIN1/2, CIN2 and CIN2/3 lesions at Kaiser Permanente Northern California between 2003-2015...
February 5, 2018: Cancer Prevention Research
https://www.readbyqxmd.com/read/29436700/-a-valid-quality-system-for-mental-health-care-from-accountability-and-control-in-institutionalised-settings-to-co-creation-in-small-areas-and-a-focus-on-community-vital-signs
#11
J van Os, P H Delespaul
In a given year, around 25% of the Dutch population may experience significant mental health problems, much more than the mental health service can attend to, given a maximum capacity of 6% of the population per year. Due to the lack of a public mental health system, there is fierce competition over who gets to receive care from mental health services and little control over how the level of needs can be matched with the appropriate intensity of care. As a result, resources are being wasted and both overtreatment and undertreatment are prevalent...
2018: Tijdschrift Voor Psychiatrie
https://www.readbyqxmd.com/read/29428953/medical-overtreatment-friend-or-foe
#12
Nortin M Hadler
"Overtreatment" is a neologism coined some 15 years ago to denote medical and surgical interventions that are unnecessary. It is a topical term for an old concept. However, it has rapidly become a shibboleth for those inclined toward finger-pointing and blaming in matters of health policy. As such, it is a "foe" that heats up rather than modulates debate. But if one examines the notion in the context of the contemporary patient-physician dialogue, it is anything but a foe. Overtreatment and its fellow travelers, overutilization and overprescription, face off with contrary notions when a patient contends with the challenge of evaluating any clinical option...
February 9, 2018: Gerontology
https://www.readbyqxmd.com/read/29424538/development-of-a-targeted-mass-spectrometry-serum-assay-to-quantify-m-protein-in-the-presence-of-therapeutic-monoclonal-antibodies
#13
Marina Zajec, Joannes F M Jacobs, Patricia J T A Groenen, Corrie M de Kat Angelino, Christoph Stingl, Theo M Luider, Yolanda B De Rijke, Martijn M VanDuijn
M-protein diagnostics can be compromised for patients receiving therapeutic monoclonal antibodies as treatment in multiple myeloma. Conventional techniques are often not able to distinguish between M-proteins and therapeutic monoclonal antibodies administered to the patient. This may prevent correct response assessment and can lead to overtreatment. We have developed a serum-based targeted mass spectrometry assay to detect M-proteins, even in the presence of three therapeutic monoclonal antibodies (daratumumab, ipilimumab and nivolumab)...
February 9, 2018: Journal of Proteome Research
https://www.readbyqxmd.com/read/29420980/mr-imaging-for-prostate-cancer-screening-and-active-surveillance
#14
REVIEW
Sasha C Druskin, Katarzyna J Macura
The current prostate cancer management paradigm has been criticized in recent years for contributing to the overdiagnosis and overtreatment of the disease. Active surveillance is an avenue by which to reduce overtreatment, but patient selection and monitoring remain a challenge. The use of prostate MR imaging has been growing in recent years and has been incorporated into prostate cancer screening and patient selection and monitoring for active surveillance. This review article discusses the current evidence for the use of MR imaging in each of those settings...
March 2018: Radiologic Clinics of North America
https://www.readbyqxmd.com/read/29420975/prostate-cancer-and-the-evolving-role-of-biomarkers-in-screening-and-diagnosis
#15
REVIEW
Joseph F Rodriguez, Scott E Eggener
The diagnosis and management of prostate cancer have substantially changed over the last 3 decades. Serum prostate-specific antigen (PSA) was adopted for screening in the 1990s after it was found to be a sensitive indicator of disease. Because of a lack of specificity for significant disease, indiscriminate PSA testing led to overdiagnosis and overtreatment. Several biomarkers have been developed that are superior to PSA in stratifying a man's risk for harboring potentially lethal prostate cancer.
March 2018: Radiologic Clinics of North America
https://www.readbyqxmd.com/read/29417185/diabetes-in-the-older-patient-heterogeneity-requires-individualisation-of-therapeutic-strategies
#16
REVIEW
Guntram Schernthaner, Marie Helene Schernthaner-Reiter
Owing to the worldwide increase in life expectancy, the high incidence of diabetes in older individuals and the improved survival of people with diabetes, about one-third of all individuals with diabetes are now older than 65 years. Evidence is accumulating that type 2 diabetes is associated with cognitive impairment, dementia and frailty. Older people with diabetes have significantly more comorbidities, such as myocardial infarction, stroke, peripheral arterial disease and renal impairment, compared with those without diabetes...
February 7, 2018: Diabetologia
https://www.readbyqxmd.com/read/29416733/genome-wide-profiling-identifies-the-thyt1-signature-as-a-distinctive-feature-of-widely-metastatic-papillary-thyroid-carcinomas
#17
Greta Gandolfi, Moira Ragazzi, Dario de Biase, Michela Visani, Eleonora Zanetti, Federica Torricelli, Valentina Sancisi, Mila Gugnoni, Gloria Manzotti, Luca Braglia, Silvio Cavuto, Domenico Franco Merlo, Giovanni Tallini, Andrea Frasoldati, Simonetta Piana, Alessia Ciarrocchi
Background: Papillary Thyroid Carcinomas (PTCs) are generally indolent tumors. However, a small but significant percentage of PTCs behaves aggressively, progressing to a diffuse metastatic spreading and leading to patient's death. The lack of reliable markers for predicting the metastatic behavior of these tumors prevents a correct risk based stratification of the disease, thus contributing to the issue of patients' overtreatment. In this study we aimed at identifying genetic features associated with the development of distant metastasis in PTCs...
January 5, 2018: Oncotarget
https://www.readbyqxmd.com/read/29406340/an-easy-to-use-prognostic-model-for-survival-estimation-for-patients-with-symptomatic-long-bone-metastases
#18
J J Willeumier, Y M van der Linden, C W P G van der Wal, P C Jutte, J M van der Velden, M A Smolle, P van der Zwaal, P Koper, L Bakri, I de Pree, A Leithner, M Fiocco, P D S Dijkstra
BACKGROUND: A survival estimation for patients with symptomatic long bone metastases (LBM) is crucial to prevent overtreatment and undertreatment. This study analyzed prognostic factors for overall survival and developed a simple, easy-to-use prognostic model. METHODS: A multicenter retrospective study of 1,520 patients treated for symptomatic LBM between 2000 and 2013 at the radiation therapy and/or orthopaedic departments was performed. Primary tumors were categorized into 3 clinical profiles (favorable, moderate, or unfavorable) according to an existing classification system...
February 7, 2018: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/29406053/prostate-cancer-screening
#19
REVIEW
William J Catalona
During the prostate-specific antigen-based prostate cancer (PCa) screening era there has been a 53% decrease in the US PCa mortality rate. Concerns about overdiagnosis and overtreatment combined with misinterpretation of clinical trial data led to a recommendation against PCa screening, resulting in a subsequent reversion to more high-risk disease at diagnosis. Re-evaluation of trial data and increasing acceptance of active surveillance led to a new draft recommendation for shared decision making for men aged 55 to 69 years old...
March 2018: Medical Clinics of North America
https://www.readbyqxmd.com/read/29402557/optimization-of-the-risk-benefit-ratio-of-differentiated-thyroid-cancer-treatment
#20
REVIEW
Hani Nasef, Iain J Nixon, Volkert Wreesmann
The vast majority of differentiated thyroid cancers (DTC) are characterized by an innocuous nature, excellent patient survival, and limited treatment requirement. However, a significant proportion of affected patients is prone to receiving overtreatment, due to undertreatment concerns associated with the difficulty to differentiate them from a small minority affected by aggressive DTC. Identification of prognostic factors and development of staging systems has helped to reduce the proportion of overtreatment in DTC...
January 31, 2018: European Journal of Surgical Oncology
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