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Risk management in clinical trials

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https://www.readbyqxmd.com/read/28231064/three-dimensional-ultrasound-for-prenatal-assessment-of-conjoined-twins-additional-advantages
#1
Tuangsit Wataganara, Pornpimol Ruangvutilert, Prasert Sunsaneevithayakul, Kusol Russameecharoen, Katika Nawapun, Nisarat Phithakwatchara
Conjoined twins are a rare, but serious, complication of monozygotic twins. Early prenatal diagnosis of conjoined twins is increasingly made with transvaginal ultrasound and color Doppler studies. Most prenatally diagnosed conjoined twins are terminated due to the high perinatal mortality, but advancement in pediatric surgery has allowed for successful postnatal separation in a small number of cases, and some parents may consider this option over termination of pregnancy. It is important to get a detailed prenatal ultrasound for the site and extent of fusion for an accurate categorization...
February 23, 2017: Journal of Perinatal Medicine
https://www.readbyqxmd.com/read/28230899/shared-care-across-the-interface-between-primary-and-specialty-care-in-management-of-long-term-conditions
#2
REVIEW
Susan M Smith, Gráinne Cousins, Barbara Clyne, Shane Allwright, Tom O'Dowd
BACKGROUND: Shared care has been used in the management of many chronic conditions with the assumption that it delivers better care than primary or specialty care alone; however, little is known about the effectiveness of shared care. OBJECTIVES: To determine the effectiveness of shared care health service interventions designed to improve the management of chronic disease across the primary/specialty care interface. This is an update of a previously published review...
February 23, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28230712/updating-evidence-for-using-hypothermia-in-pediatric-severe-traumatic-brain-injury-conventional-and-bayesian-meta-analytic-perspectives
#3
Robert C Tasker, Frederick W Vonberg, Elizabeth D Ulano, Alireza Akhondi-Asl
OBJECTIVE: To evaluate clinical trials of hypothermia management on outcome in pediatric patients with severe traumatic brain injury using conventional and Bayesian meta-analyses. DATA SOURCES: Screening of PubMed and other databases to identify randomized controlled trials of hypothermia for pediatric severe traumatic brain injury published before September 2016. STUDY SELECTION: Four investigators assessed and reviewed randomized controlled trial data...
February 20, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28228151/unravelling-effectiveness-of-a-nurse-led-behaviour-change-intervention-to-enhance-physical-activity-in-patients-at-risk-for-cardiovascular-disease-in-primary-care-study-protocol-for-a-cluster-randomised-controlled-trial
#4
Heleen Westland, Irene D Bos-Touwen, Jaap C A Trappenburg, Carin D Schröder, Niek J de Wit, Marieke J Schuurmans
BACKGROUND: Self-management interventions are considered effective in patients with chronic disease, but trials have shown inconsistent results, and it is unknown which patients benefit most. Adequate self-management requires behaviour change in both patients and health care providers. Therefore, the Activate intervention was developed with a focus on behaviour change in both patients and nurses. The intervention aims for change in a single self-management behaviour, namely physical activity, in primary care patients at risk for cardiovascular disease...
February 22, 2017: Trials
https://www.readbyqxmd.com/read/28226343/-diagnosis-and-risk-assessment-of-postoperative-complications-of-gastric-cancer-in-japan-and-korea
#5
Xiang Hu, Chi Zhang
Radical surgery of gastric cancer (D2 lymph node dissection) as the standard operation is widely used in clinical practice and satisfactory prognosis can be obtained in patients who receive radical gastrectomy. But surgical invasion can cause high morbidity of complications and mortality. The data of large-scale evidence-based medical clinical trials and large databases in Japan and Korea showed that anastomotic leakage, pancreatic leakage and abdominal abscess were the most common complications after gastrectomy, and the morbidity of complication was about 20% and mortality was about 1%...
February 25, 2017: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
https://www.readbyqxmd.com/read/28226332/responsible-safe-and-effective-prescription-of-opioids-for-chronic-non-cancer-pain-american-society-of-interventional-pain-physicians-asipp-guidelines
#6
Laxmaiah Manchikanti, Adam M Kaye, Nebojsa Nick Knezevic, Heath McAnally, Konstantin Slavin, Andrea M Trescot, Susan Blank, Vidyasagar Pampati, Salahadin Abdi, Jay S Grider, Alan D Kaye, Kavita N Manchikanti, Harold Cordner, Christopher G Gharibo, Michael E Harned, Sheri L Albers, Sairam Atluri, Steve M Aydin, Sanjay Bakshi, Robert L Barkin, Ramsin M Benyamin, Mark V Boswell, Ricardo M Buenaventura, Aaron K Calodney, David L Cedeno, Sukdeb Datta, Timothy R Deer, Bert Fellows, Vincent Galan, Vahid Grami, Hans Hansen, Standiford Helm Ii, Rafael Justiz, Dhanalakshmi Koyyalagunta, Yogesh Malla, Annu Navani, Kent H Nouri, Ramarao Pasupuleti, Nalini Sehgal, Sanford M Silverman, Thomas T Simopoulos, Vijay Singh, Daneshvari R Solanki, Peter S Staats, Ricardo Vallejo, Bradley W Wargo, Arthur Watanabe, Joshua A Hirsch
BACKGROUND: Opioid use, abuse, and adverse consequences, including death, have escalated at an alarming rate since the 1990s. In an attempt to control opioid abuse, numerous regulations and guidelines for responsible opioid prescribing have been developed by various organizations. However, the US opioid epidemic is continuing and drug dose deaths tripled during 1999 to 2015. Recent data show a continuing increase in deaths due to natural and semisynthetic opioids, a decline in methadone deaths, and an explosive increase in the rates of deaths involving other opioids, specifically heroin and illicit synthetic fentanyl...
February 2017: Pain Physician
https://www.readbyqxmd.com/read/28225527/neuro-trauma-or-med-surg-intensive-care-unit-does-it-matter-where-multiple-injuries-patients-with-traumatic-brain-injury-are-admitted-secondary-analysis-of-the-american-association-for-the-surgery-of-trauma-multi-institutional-trials-committee-decompressive
#7
Sarah Lombardo, Thomas Scalea, Jason Sperry, Raul Coimbra, Gary Vercruysse, Toby Enniss, Gregory J Jurkovich, Raminder Nirula
INTRODUCTION: Patients with nontraumatic acute intracranial pathology benefit from neurointensivist care. Similarly, trauma patients with and without traumatic brain injury (TBI) fare better when treated by a dedicated trauma team. No study has yet evaluated the role of specialized neurocritical (NICU) and trauma intensive care units (TICU) in the management of TBI patients, and it remains unclear which TBI patients are best served in NICU, TICU, or general (Med/Surg) ICU. METHODS: This study is a secondary analysis of The American Association for the Surgery of Trauma Multi-Institutional Trials Committee (AAST-MITC) decompressive craniectomy study...
March 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28225198/adjunctive-steroid-therapy-versus-antibiotics-alone-for-acute-endophthalmitis-after-intraocular-procedure
#8
REVIEW
Carole H Kim, Monica F Chen, Anne L Coleman
BACKGROUND: Endophthalmitis refers to severe infection within the eye that involves the aqueous humor or vitreous humor, or both, and threatens vision. Most cases of endophthalmitis are exogenous (i.e. due to inoculation of organisms from an outside source), and most exogenous endophthalmitis is acute and occurs after an intraocular procedure. The mainstay of treatment is emergent administration of broad-spectrum intravitreous antibiotics. Due to their anti-inflammatory effects, steroids in conjunction with antibiotics have been proposed to be beneficial in endophthalmitis management...
February 22, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28225152/topical-phenytoin-for-treating-pressure-ulcers
#9
REVIEW
Xiang Yong Hao, Hong Ling Li, He Su, Hui Cai, Tian Kang Guo, Ruifeng Liu, Lei Jiang, Yan Fei Shen
BACKGROUND: Pressure ulcers are common in clinical practice and pose a significant health problem worldwide. Apart from causing suffering to patients, they also result in longer hospital stays and increase the cost of health care. A variety of methods are used for treating pressure ulcers, including pressure relief, patient repositioning, biophysical strategies, nutritional supplementation, debridement, topical negative pressure, and local treatments including dressings, ointments and creams such as bacitracin, silver sulphadiazine, neomycin, and phenytoin...
February 22, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28224175/differences-between-active-and-passive-self-ligating-brackets-for-orthodontic-treatment-systematic-review-and-meta-analysis-based-on-randomized-clinical-trials
#10
Xianrui Yang, Yiruo He, Tian Chen, Mengyuan Zhao, Yinqiu Yan, Hongzhe Wang, Ding Bai
PURPOSE: In orthodontic treatment, the effects of differences in the design between active and passive self-ligating bracket (ASLB and PSLB, respectively) are usually neglected. This study investigated differences in effectiveness and efficiency between ASLBs and PSLBs. METHODS: To identify randomized, controlled clinical trials (RCTs) comparing ASLB with PSLB, the electronic databases Medline, Embase, Cochrane Central Register of Controlled Trials, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, and Chinese Medical Journal Database were searched without language or time limits...
February 21, 2017: Journal of Orofacial Orthopedics, Fortschritte der Kieferorthopädie
https://www.readbyqxmd.com/read/28223836/dyslipidemia-in-patients-with-chronic-kidney-disease-etiology-and-management
#11
REVIEW
Ivana Mikolasevic, Marta Žutelija, Vojko Mavrinac, Lidija Orlic
Patients with chronic kidney disease (CKD), including those with end-stage renal disease, treated with dialysis, or renal transplant recipients have an increased risk for cardiovascular disease (CVD) morbidity and mortality. Dyslipidemia, often present in this patient population, is an important risk factor for CVD development. Specific quantitative and qualitative changes are seen at different stages of renal impairment and are associated with the degree of glomerular filtration rate declining. Patients with non-dialysis-dependent CKD have low high-density lipoproteins (HDL), normal or low total cholesterol (TC) and low-density lipoprotein (LDL) cholesterol, increased triglycerides as well as increased apolipoprotein B (apoB), lipoprotein(a) (Lp (a)), intermediate- and very-low-density lipoprotein (IDL, VLDL; "remnant particles"), and small dense LDL particles...
2017: International Journal of Nephrology and Renovascular Disease
https://www.readbyqxmd.com/read/28220474/buprenorphine-for-managing-opioid-withdrawal
#12
REVIEW
Linda Gowing, Robert Ali, Jason M White, Dalitso Mbewe
BACKGROUND: Managed withdrawal is a necessary step prior to drug-free treatment or as the endpoint of substitution treatment. OBJECTIVES: To assess the effects of buprenorphine versus tapered doses of methadone, alpha2-adrenergic agonists, symptomatic medications or placebo, or different buprenorphine regimens for managing opioid withdrawal, in terms of the intensity of the withdrawal syndrome experienced, duration and completion of treatment, and adverse effects...
February 21, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28220472/renal-denervation-for-resistant-hypertension
#13
REVIEW
Giuseppe Coppolino, Anna Pisano, Laura Rivoli, Davide Bolignano
BACKGROUND: Resistant hypertension is highly prevalent among the general hypertensive population and the clinical management of this condition remains problematic. Different approaches, including a more intensified antihypertensive therapy, lifestyle modifications, or both, have largely failed to improve patients' outcomes and to reduce cardiovascular and renal risk. As renal sympathetic hyperactivity is a major driver of resistant hypertension, renal sympathetic ablation (renal denervation) has been recently proposed as a possible therapeutic alternative to treat this condition...
February 21, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28220330/synchronous-cardiocerebral-infarction-in-the-era-of-endovascular-therapy-which-to-treat-first
#14
Leonard L L Yeo, Tommy Andersson, Kong Wan Yee, Benjamin Y Q Tan, Prakash Paliwal, Anil Gopinathan, Mahendran Nadarajah, Eric Ting, Hock L Teoh, Robin Cherian, Erik Lundström, Edgar L W Tay, Vijay K Sharma
A cardiocerebral ischemic attack (CCI) or a concurrent acute ischemic stroke (AIS) and myocardial infarction (AMI) is a severe event with no clear recommendations for ideal management because of the rarity of the scenario. The narrow time window for treatment and complexity of the treatment decision puts immense pressure on the treating physician. We evaluated this challenging situation at our tertiary center. Using our prospective stroke database out of a total of 555 patients with acute ischemic stroke between 2009 and 2014, we identified five consecutive cases with CCI (incidence 0...
February 20, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28219895/impact-of-practice-based-management-of-pa-pressures-in-2000-patients-implanted-with-the-cardiomems-sensor
#15
J Thomas Heywood, Rita Jermyn, David Shavelle, William T Abraham, Arvind Bhimaraj, Kunjan Bhatt, Fareed Sheikh, Eric Eichorn, Sumant Lamba, Rupinder Bharmi, Rahul Agarwal, Charisma Kumar, Lynne W Stevenson
Background -Elevated pulmonary artery (PA) pressures in patients with heart failure (HF) are associated with a high risk for hospitalization and mortality. Recent clinical trial evidence demonstrated a direct relationship between lowering remotely monitored PA pressures and HF hospitalization risk reduction using a novel implantable PA pressure monitoring system (CardioMEMS HF System, St Jude Medical). This study examines PA pressure changes in the first 2,000 US patients implanted in general practice use. Methods -De-identified data from the remote monitoring Merlin...
February 20, 2017: Circulation
https://www.readbyqxmd.com/read/28219383/the-alice-springs-hospital-readmission-prevention-project-ashrapp-a-randomised-control-trial
#16
Gabrielle Diplock, James Ward, Simon Stewart, Paul Scuffham, Penny Stewart, Carole Reeve, Lea Davidson, Graeme Maguire
BACKGROUND: Hospitals are frequently faced with high levels of emergency department presentations and demand for inpatient care. An important contributing factor is the subset of patients with complex chronic diseases who have frequent and preventable exacerbations of their chronic diseases. Evidence suggests that some of these hospital readmissions can be prevented with appropriate transitional care. Whilst there is a growing body of evidence for transitional care processes in urban, non-indigenous settings, there is a paucity of information regarding rural and remote settings and, specifically, the indigenous context...
February 20, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28218404/topical-medication-instillation-techniques-for-glaucoma
#17
REVIEW
Li Xu, Xuemei Wang, Meijing Wu
BACKGROUND: Glaucoma is a leading cause of irreversible blindness worldwide and the second most common cause of blindness after cataracts. The primary treatment for glaucoma aims to lower intraocular pressure (IOP) with the use of topical medicines. Topical medication instillation techniques, such as eyelid closure and nasolacrimal occlusion when instilling drops, have been proposed as potential methods to increase ocular absorption and decrease systemic absorption of the drops. OBJECTIVES: To investigate the effectiveness of topical medication instillation techniques compared with usual care or another method of instillation of topical medication in the management of glaucoma or ocular hypertension...
February 20, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28216211/the-association-of-surgical-method-with-outcomes-of-acute-subdural-hematoma-patients-experience-with-643-consecutive-patients
#18
Rimantas Vilcinis, Adomas Bunevicius, Arimantas Tamasauskas
OBJECTIVE: Optimal surgical management strategy of acute subdural hematoma (ASDH) patients is challenging. We investigated the association of decompressive craniectomy (DC) and osteoplastic craniotomy (OC) with outcomes in consecutive patients undergoing surgical evacuation of ASDH, and analyzed prognostic indicators. METHODS: We reviewed prospective institutional database of all adult ASDH patients operated by craniotomy from January, 2009 until January, 2016. Mortality and discharge outcomes (Glasgow outcomes scale or GOS) were analyzed as a function of surgical method adjusting for age, admission GCS, ASDH thickness and midline shift...
February 12, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28216196/hypericum-perforatum-st-john-s-wort-beyond-depression-a-therapeutic-perspective-for-pain-conditions
#19
REVIEW
Nicoletta Galeotti
ETHNOPHARMACOLOGICAL RELEVANCE: Hypericum perforatum L. (Hypericaceae), popularly called St. John's wort (SJW), has a rich historical background being one of the oldest used and most extensively investigated medicinal herbs. Many bioactivities and applications of SJW are listed in popular and in scientific literature, including antibacterial, antiviral, anti-inflammatory. In the last three decades many studies focused on the antidepressant activity of SJW extracts. However, several studies in recent years also described the antinociceptive and analgesic properties of SJW that validate the traditional uses of the plant in pain conditions...
February 12, 2017: Journal of Ethnopharmacology
https://www.readbyqxmd.com/read/28214975/surveillance-scans-in-lymphoma-friend-or-foe
#20
REVIEW
Tycel Phillips, Jessica Mercer
Advancements in the treatment of lymphoma over the last few decades have allowed more patients to achieve a remission after the completion of therapy. Due to the improvement in response rates, methods to detect recurrence early and accurately during follow-up, especially in patients with potential curable aggressive lymphomas, are a key. Observation has always involved close clinical follow-up with the use of physical exams and routine labs, but rapid changes in technology have allowed CT scans, PET scans, and MRIs to become an integral part of managing patients with lymphoma...
February 2017: Current Treatment Options in Oncology
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