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Clinical competence

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https://www.readbyqxmd.com/read/28944597/caloric-restriction-induced-decreases-in-dopamine-receptor-availability-are-associated-with-leptin-concentration
#1
Julia P Dunn, Naji N Abumrad, Robert M Kessler, Bruce W Patterson, Rui Li, Pamela Marks-Shulman, Robyn A Tamboli
OBJECTIVE: It has been previously reported that early after Roux-en-Y-gastric bypass, dopamine (DA) type 2 and 3 receptor (D2/3R) binding potential (BPND ) was decreased from preoperative levels. The current study aimed to determine whether calorie restriction without weight loss modifies D2/3R BPND and whether such changes are explained by neuroendocrine regulation. METHODS: Fifteen females with obesity (BMI = 39 ± 6 kg/m(2) ) were studied before and after ∼10 days of a very-low-calorie-diet (VLCD)...
September 25, 2017: Obesity
https://www.readbyqxmd.com/read/28944447/serotonin-reuptake-inhibitors-and-mortality-in-epilepsy-a-linked-primary-care-cohort-study
#2
Colin B Josephson, Arturo Gonzalez-Izquierdo, Spiros Denaxas, Natalie K Fitzpatrick, Tolulope T Sajobi, Jordan D T Engbers, Scott Patten, Nathalie Jette, Samuel Wiebe
OBJECTIVE: Preliminary evidence suggests that serotonin reuptake inhibitor (SRI) use may increase postictal respiratory drive and prevent death. We sought to determine whether SRIs are associated with improved all-cause and possible seizure-specific mortality in patients with epilepsy. METHODS: Patients with epilepsy and a random 10:1 sample without epilepsy were extracted from The ClinicAl research using LInked Bespoke studies and Electronic health Records (CALIBER) resource...
September 24, 2017: Epilepsia
https://www.readbyqxmd.com/read/28943681/robust-treatment-comparison-based-on-utilities-of-semi-competing-risks-in-non-small-cell-lung-cancer
#3
Thomas A Murray, Peter F Thall, Ying Yuan, Sarah McAvoy, Daniel R Gomez
A design is presented for a randomized clinical trial comparing two second-line treatments, chemotherapy versus chemotherapy plus reirradiation, for treatment of recurrent non-small-cell lung cancer. The central research question is whether the potential efficacy benefit that adding reirradiation to chemotherapy may provide justifies its potential for increasing the risk of toxicity. The design uses two co-primary outcomes: time to disease progression or death, and time to severe toxicity. Because patients may be given an active third-line treatment at disease progression that confounds second-line treatment effects on toxicity and survival following disease progression, for the purpose of this comparative study follow-up ends at disease progression or death...
2017: Journal of the American Statistical Association
https://www.readbyqxmd.com/read/28942086/validation-of-a-52-gene-risk-profile-for-outcome-prediction-in-patients-with-idiopathic-pulmonary-fibrosis-an-international-multicentre-cohort-study
#4
Jose D Herazo-Maya, Jiehuan Sun, Philip L Molyneaux, Qin Li, Julian A Villalba, Argyrios Tzouvelekis, Heather Lynn, Brenda M Juan-Guardela, Cristobal Risquez, Juan C Osorio, Xiting Yan, George Michel, Nachelle Aurelien, Kathleen O Lindell, Melinda J Klesen, Miriam F Moffatt, William O Cookson, Yingze Zhang, Joe G N Garcia, Imre Noth, Antje Prasse, Ziv Bar-Joseph, Kevin F Gibson, Hongyu Zhao, Erica L Herzog, Ivan O Rosas, Toby M Maher, Naftali Kaminski
BACKGROUND: The clinical course of idiopathic pulmonary fibrosis (IPF) is unpredictable. Clinical prediction tools are not accurate enough to predict disease outcomes. METHODS: We enrolled patients with IPF diagnosis in a six-cohort study at Yale University (New Haven, CT, USA), Imperial College London (London, UK), University of Chicago (Chicago, IL, USA), University of Pittsburgh (Pittsburgh, PA, USA), University of Freiburg (Freiburg im Breisgau, Germany), and Brigham and Women's Hospital-Harvard Medical School (Boston, MA, USA)...
September 20, 2017: Lancet Respiratory Medicine
https://www.readbyqxmd.com/read/28941721/experience-with-integrating-pharmacist-documenters-on-cardiac-arrest-teams-to-improve-quality
#5
Mojdeh S Heavner, Ginger E Rouse, Steven M Lemieux, Kent A Owusu, David Pritchard, Marina Yazdi, Lorraine A Lee
OBJECTIVES: To determine if adding a clinical pharmacist to the cardiac arrest team in a documenter role improves completeness of documentation and quality of advanced cardiovascular life support (ACLS). SETTING: A 1541-bed, tertiary care, academic medical center with an integrated clinical pharmacy practice model. PRACTICE DESCRIPTION: In 2012, we identified documentation of resuscitation activities during cardiac arrest events and compliance with published ACLS guidelines as opportunities for systematic quality improvement at our tertiary care academic medical center...
September 20, 2017: Journal of the American Pharmacists Association: JAPhA
https://www.readbyqxmd.com/read/28941641/targeting-tumor-associated-macrophages-the-new-challenge-for-nanomedicine
#6
REVIEW
Fernando Torres Andón, Elisabeth Digifico, Akihiro Maeda, Marco Erreni, Alberto Mantovani, María José Alonso, Paola Allavena
The engineering of new nanomedicines with ability to target and kill or re-educate Tumor Associated Macrophages (TAMs) stands up as a promising strategy to induce the effective switching of the tumor-promoting immune suppressive microenvironment, characteristic of tumors rich in macrophages, to one that kills tumor cells, is anti-angiogenic and promotes adaptive immune responses. Alternatively, the loading of monocytes/macrophages in blood circulation with nanomedicines, may be used to profit from the high infiltration ability of myeloid cells and to allow the drug release in the bulk of the tumor...
September 20, 2017: Seminars in Immunology
https://www.readbyqxmd.com/read/28941147/timing-and-impact-of-decisions-to-adjust-disease-modifying-antirheumatic-drug-therapy-for-rheumatoid-arthritis-patients-with-active-disease
#7
Yomei Shaw, Chung-Chou H Chang, Marc C Levesque, Julie M Donohue, Kaleb Michaud, Mark S Roberts
OBJECTIVE: Guidelines recommend that rheumatoid arthritis (RA) patients with moderate to high disease activity (MHDAS) adjust disease-modifying antirheumatic drug (DMARD) therapy at least every 3 months until reaching low disease activity or remission (LDAS). We examined how quickly RA patients with MHDAS adjust DMARD therapy in clinical practice, and whether those who adjust DMARDs within 90 days in response to MHDAS reach LDAS sooner. METHODS: We identified RA patients with MHDAS in the University of Pittsburgh Rheumatoid Arthritis Comparative Effectiveness Research (RACER) registry, and conducted a competing risks regression on time to DMARD therapy adjustment and a Cox regression on time to LDAS...
September 21, 2017: Arthritis Care & Research
https://www.readbyqxmd.com/read/28940970/enabling-honest-reflection-a-review
#8
REVIEW
Naomi Gostelow, Faye Gishen
BACKGROUND: Reflective practice provides a backbone to professionalism, a commitment to lifelong learning and competency-based education in the form of reflective portfolios. Changes in health care culture have promoted a move towards openness and reflection on challenging clinical encounters. ISSUE: Engagement with reflection has historically proved challenging to clinical educators. This Faculty Development Review examines this using a case study from the UK in which a postgraduate trainee was asked to disclose their reflective portfolio by a patient's legal representation...
September 20, 2017: Clinical Teacher
https://www.readbyqxmd.com/read/28940673/statins-reduce-the-risk-of-liver-decompensation-and-death-in-chronic-viral-hepatitis-a-propensity-score-weighted-landmark-analysis
#9
J C-T Wong, H L-Y Chan, Y-K Tse, T C-F Yip, V W-S Wong, G L-H Wong
BACKGROUND: Decompensated liver disease due to portal hypertension leads to significant morbidity and mortality. Statins can modulate intrahepatic vascular tone, but the clinical significance remains uncertain. AIM: To determine the effects of statin use on the risk of liver decompensation and death among patients with chronic viral hepatitis. METHODS: We conducted a population wide cohort study using a hospital based database from the Hong Kong Hospital Authority...
September 21, 2017: Alimentary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28940580/digital-pathology-for-the-primary-diagnosis-of-breast-histopathological-specimens-an-innovative-validation-and-concordance-study
#10
Bethany Jill Williams, Andrew Hanby, Rebecca Millican-Slater, Anju Nijhawan, Eldo Verghese, Darren Treanor
AIM: To train and individually validate a group of breast pathologists in specialty specific digital primary diagnosis using a novel protocol endorsed by the Royal College of Pathologists' new guideline for digital pathology. The protocol allows early exposure to live digital reporting, in a risk mitigated environment, and focusses on patient safety and professional development. METHODS AND RESULTS: 3 specialty breast pathologist completed training in use of a digital microscopy system, and were exposed to a training set of 20 challenging cases, designed to help them identify personal digital diagnostic pitfalls...
September 22, 2017: Histopathology
https://www.readbyqxmd.com/read/28940372/esophagus-segmentation-in-ct-via-3d-fully-convolutional-neural-network-and-random-walk
#11
Tobias Fechter, Sonja Adebahr, Dimos Baltas, Ismail Ben Ayed, Christian Desrosiers, Jose Dolz
PURPOSE: Precise delineation of organs at risk is a crucial task in radiotherapy treatment planning for delivering high doses to the tumour while sparing healthy tissues. In recent years, automated segmentation methods have shown an increasingly high performance for the delineation of various anatomical structures. However, this task remains challenging for organs like the esophagus, which have a versatile shape and poor contrast to neighboring tissues. For human experts, segmenting the esophagus from CT images is a time-consuming and error-prone process...
September 21, 2017: Medical Physics
https://www.readbyqxmd.com/read/28939725/evaluation-of-the-capacity-to-marry
#12
Anna Glezer, Jeffrey J Devido
Clinical and forensic evaluators are often faced with the task of answering unique questions about capacity and competency. One seldom-discussed question is that of an individual's capacity to marry. This article uses a case example as a framework for discussing the challenges of evaluating an individual's capacity to marry. We will set the background with legal history and then provide guidance for making this type of assessment.
September 2017: Journal of the American Academy of Psychiatry and the Law
https://www.readbyqxmd.com/read/28939253/heterodimerization-of-retinoid-x-receptor-with-xenobiotic-receptor-partners-occurs-in-the-cytoplasmic-compartment-mechanistic-insights-of-events-in-living-cells
#13
Amit K Dash, Ashutosh S Yende, Bharti Jaiswal, Rakesh K Tyagi
Retinoid X Receptor (RXR) serves as the heterodimeric partner of two major xenobiotic nuclear receptors, Pregnane and Xenobiotic Receptor (PXR) and Constitutive Androstane Receptor (CAR). These receptors are primarily involved in the metabolism and clearance of endobiotics and xenobiotics (including clinical drugs) from the body. Here, we report for the first time that intermolecular interactions between RXR-PXR and RXR-CAR occurs in the cytoplasmic compartment of the cell in a ligand-independent manner. These interactions lead to nuclear import of the heterodimeric complex thereby making them competent for chromatin binding and transactivation of target genes...
September 19, 2017: Experimental Cell Research
https://www.readbyqxmd.com/read/28938744/an-improved-ivm-method-for-cumulus-oocyte-complexes-from-small-follicles-in-polycystic-ovary-syndrome-patients-enhances-oocyte-competence-and-embryo-yield
#14
F Sánchez, F Lolicato, S Romero, M De Vos, H Van Ranst, G Verheyen, E Anckaert, J E J Smitz
STUDY QUESTION: Are meiotic and developmental competence of human oocytes from small (2-8 mm) antral follicles improved by applying an optimized IVM method involving a prematuration step in presence of C-Type Natriuretic Peptide (CNP) followed by a maturation step in presence of FSH and Amphiregulin (AREG)? SUMMARY ANSWER: A strategy involving prematuration culture (PMC) in the presence of CNP followed by IVM using FSH + AREG increases oocyte maturation potential leading to a higher availability of Day 3 embryos and good-quality blastocysts for single embryo transfer...
October 1, 2017: Human Reproduction
https://www.readbyqxmd.com/read/28938738/resolution-of-infertility-and-number-of-children-1386-couples-followed-for-a-median-of-13-years
#15
A A Righarts, A Gray, N P Dickson, L Parkin, W R Gillett
STUDY QUESTION: How common were children among infertile couples? SUMMARY ANSWER: A total of 61.7% of infertile couples presenting for care subsequently had live born children 13.1 years after first being clinically assessed, with a mean of 1.7 children among those who had at least one. WHAT IS KNOWN ALREADY: While the prognoses for infertile couples undertaking specific treatments have been well described, less is known about those not undergoing these treatments or the total number of children...
October 1, 2017: Human Reproduction
https://www.readbyqxmd.com/read/28938734/hyperspectral-microscopy-can-detect-metabolic-heterogeneity-within-bovine-post-compaction-embryos-incubated-under-two-oxygen-concentrations-7-versus-20
#16
Melanie L Sutton-McDowall, Martin Gosnell, Ayad G Anwer, Melissa White, Malcolm Purdey, Andrew D Abell, Ewa M Goldys, Jeremy G Thompson
STUDY QUESTION: Can we separate embryos cultured under either 7% or 20% oxygen atmospheres by measuring their metabolic heterogeneity? SUMMARY ANSWER: Metabolic heterogeneity and changes in metabolic profiles in morula exposed to two different oxygen concentrations were not detectable using traditional fluorophore and two-channel autofluorescence but were detectable using hyperspectral microscopy. WHAT IS KNOWN ALREADY: Increased genetic and morphological blastomere heterogeneity is associated with compromised developmental competence of embryos and currently forms the basis for embryo scoring within the clinic...
October 1, 2017: Human Reproduction
https://www.readbyqxmd.com/read/28937516/validation-of-ultrasound-guidance-targeting-tasks-relationship-of-performance-and-clinical-experience
#17
Joshua F Nitsche, Kristina M Shumard, Brian C Brost
OBJECTIVE: To assess whether health care provider performance on a novel task trainer and a set of newly created ultrasound guidance targeting tasks relates with their level of clinical experience. METHODS: In a prospective cohort study, two assessment sessions were carried out in which inexperienced (n=21 and n=15) and experienced (n=14 and n=10) health care providers completed five previously described ultrasound guidance targeting tasks. Raw completion time, number of targeting errors, and error-adjusted completion time for each task were compared between groups with a t test for independent measures...
October 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28937407/time-course-of-septic-shock-in-immunocompromised-and-nonimmunocompromised-patients
#18
Matthieu Jamme, Fabrice Daviaud, Julien Charpentier, Nathalie Marin, Michaël Thy, Yannick Hourmant, Jean-Paul Mira, Frédéric Pène
OBJECTIVES: To address the impact of underlying immune conditions on the course of septic shock with respect to both mortality and the development of acute infectious and noninfectious complications. DESIGN: An 8-year (2008-2015) monocenter retrospective study. SETTING: A medical ICU in a tertiary care center. PATIENTS: Patients diagnosed for septic shock within the first 48 hours of ICU admission were included. Patients were classified in four subgroups with respect to their immune status: nonimmunocompromised and immunocompromised distributed into hematologic or solid malignancies and nonmalignant immunosuppression...
September 20, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28937340/research-domain-criteria-as-psychiatric-nosology
#19
Faisal Akram, James Giordano
Diagnostic classification systems in psychiatry have continued to rely on clinical phenomenology, despite limitations inherent in that approach. In view of these limitations and recent progress in neuroscience, the National Institute of Mental Health (NIMH) has initiated the Research Domain Criteria (RDoC) project to develop a more neuroscientifically based system of characterizing and classifying psychiatric disorders. The RDoC initiative aims to transform psychiatry into an integrative science of psychopathology in which mental illnesses will be defined as involving putative dysfunctions in neural nodes and networks...
October 2017: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
https://www.readbyqxmd.com/read/28937264/multidisciplinary-team-and-clinical-meeting-data-jrf-national-survey-of-trainees-2015
#20
Sarah R Hudson, David Little, Anup Mathew, Diana Rosof-Williams, Fiona Pathiraja, Kabir Varghese, James Stephenson
OBJECTIVE: To collect radiology trainees' views on training for clinic-multidisciplinary team meetings (MDTMs), identify aspects requiring improvement and develop a guide to aid training. This is central to quality assurance and is within the core RCR curriculum. METHODS: The Junior Radiology Forum National Training Survey 2015 was emailed to 1222 UK trainees. Questions related to role in MDTMs, training, use of the MDTM eportfolio tool and experience of leading meetings...
September 13, 2017: British Journal of Radiology
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