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Risk management in clinical trials

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https://www.readbyqxmd.com/read/29782333/the-role-of-clinic-blood-pressure-for-the-diagnosis-of-hypertension
#1
Mohamed Ayan, Sabeeda Kadarath, Patrick T Campbell
PURPOSE OF REVIEW: Recent data from randomized clinical trials and updates to hypertension guidelines warrant a review of the literature for the diagnosis and management of hypertension in the clinic setting. Although there have been significant advances in ambulatory blood pressure (BP) monitoring and home BP monitoring, office BP (OBP) measurements remains the primary means of diagnosis and treatment. RECENT FINDINGS: The current review focuses on updated guidelines, proper technique, device selection, and the recent controversy regarding unattended BP measurements...
May 17, 2018: Current Opinion in Cardiology
https://www.readbyqxmd.com/read/29781504/epidural-versus-non-epidural-or-no-analgesia-for-pain-management-in-labour
#2
REVIEW
Millicent Anim-Somuah, Rebecca Md Smyth, Allan M Cyna, Anna Cuthbert
BACKGROUND: Epidural analgesia is a central nerve block technique achieved by injection of a local anaesthetic close to the nerves that transmit pain, and is widely used as a form of pain relief in labour. However, there are concerns about unintended adverse effects on the mother and infant. This is an update of an existing Cochrane Review (Epidural versus non-epidural or no analgesia in labour), last published in 2011. OBJECTIVES: To assess the effectiveness and safety of all types of epidural analgesia, including combined-spinal-epidural (CSE) on the mother and the baby, when compared with non-epidural or no pain relief during labour...
May 21, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29781063/anticoagulation-resumption-after-intracerebral-hemorrhage
#3
REVIEW
Yan-Guang Li, Gregory Y H Lip
PURPOSE OF REVIEW: Decision-making on resuming oral anticoagulant (OAC) after intracerebral hemorrhage (ICH) evokes significant debate among clinicians. Such patients have been excluded from randomized clinical trials. This review article provides a comprehensive summary of the evidence on anticoagulation resumption after ICH. RECENT FINDINGS: OAC resumption does not increase the risk of recurrent ICH and can also reduce the risk of all-cause mortality. OAC cessation exposes patients to a significantly higher risk of thromboembolism, which could be reduced by resumption...
May 21, 2018: Current Atherosclerosis Reports
https://www.readbyqxmd.com/read/29781062/antioxidants-in-the-fight-against-atherosclerosis-is-this-a-dead-end
#4
REVIEW
Paola Toledo-Ibelles, Jaime Mas-Oliva
PURPOSE OF REVIEW: The purpose of this review is to focus on the outcome of recent antioxidant interventions using synthetic and naturally occurring molecules established as adjuvant strategies to lipid-lowering or anti-inflammatory therapies designed to reduce the risk of cardiovascular disease. RECENT FINDINGS: To date, accumulated evidence regarding oxidation as a pro-atherogenic factor indicates that redox biochemical events involved in atherogenesis are indeed a very attractive target for the management of cardiovascular disease in the clinic...
May 21, 2018: Current Atherosclerosis Reports
https://www.readbyqxmd.com/read/29780812/characteristics-of-mobile-phone-access-and-usage-in-rural-and-urban-guatemala-assessing-feasibility-of-text-message-reminders-to-increase-childhood-immunizations
#5
Gretchen J Domek, Ingrid L Contreras-Roldan, Edwin J Asturias, Michael Bronsert, Guillermo Antonio Bolaños Ventura, Sean T O'Leary, Allison Kempe, Sheana Bull
Background: Despite efforts to promote vaccination in low- and middle-income countries (LMICs), over 20 million infants remain under-immunized and at risk for unnecessary morbidity and mortality. Mobile health technologies, such as Short Message Service (SMS) texts, have tremendous and untapped potential for disease management. Patient reminder systems are an important mechanism for improving childhood vaccination coverage and can be easily adapted to SMS platforms. However, current research lacks an understanding of the barriers and facilitators to mHealth program design, implementation, and scale in LMICs...
2018: MHealth
https://www.readbyqxmd.com/read/29779835/concerns-and-hopes-of-patients-with-type-1-diabetes-prior-to-islet-cell-transplantation-a-content-analysis
#6
Queena F Luu, Celine J Villareal, Cynthia Fritschi, Rebecca S Monson, Jose Oberholzer, Kirstie K Danielson
AIMS: Islet cell transplantation can functionally cure type 1 diabetes complicated by hypoglycemia unawareness (HU), but requires immunosuppression. This study identified the lived experiences and risk/benefit considerations of patients pre-transplant. METHODS: Content analysis identified themes from four open-ended questions pre-transplant in an islet transplant clinical trial. The sample included 23 (19 female) patients, with a mean age = 48.3 and diabetes duration = 29...
April 17, 2018: Journal of Diabetes and its Complications
https://www.readbyqxmd.com/read/29779800/treatment-strategies-and-survival-outcomes-in-older-women-with-breast-cancer-a-comparative-study-between-the-focus-cohort-and-nottingham-cohort
#7
Hugo Schuil, Marloes Derks, Gerrit-Jan Liefers, Johanneke Portielje, Cornelis van de Velde, Binafsha Syed, Andrew Green, Ian Ellis, Kwok-Leung Cheung, Esther Bastiaannet
OBJECTIVE: Clinical trials investigating breast cancer treatment often exclude or misrepresent older adults. This study compares treatment patterns and survival of older women diagnosed with breast cancer between a Dutch and a British observational cohort. MATERIALS AND METHODS: Women aged 70 years and older diagnosed with breast cancer after 1990 with a T0-T2 tumor stage and no evidence of metastatic disease were included from a population-based cohort in the Netherlands and a British hospital-based cohort in Nottingham...
May 18, 2018: Journal of Geriatric Oncology
https://www.readbyqxmd.com/read/29779392/heterogeneity-in-unclassifiable-interstitial-lung-disease-a-systematic-review-and-meta-analysis
#8
Sabina A Guler, Kina Ellison, Mohmmed Algamdi, Harold R Collard, Christopher J Ryerson
BACKGROUND: Accurate diagnosis of interstitial lung disease (ILD) is necessary to identify the most appropriate management strategy and to inform prognosis. Many patients cannot be provided a confident diagnosis despite an exhaustive search for potential etiologies and review in a multidisciplinary conference; and are consequently labelled with unclassifiable ILD. OBJECTIVE: to systematically review and meta-analyse previous studies reporting on the diagnostic criteria, prevalence, clinical features, and outcome of unclassifiable ILD...
May 20, 2018: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/29779139/insomnia-short-sleep-duration-and-high-blood-pressure-recent-evidence-and-future-directions-for-the-prevention-and-management-of-hypertension
#9
REVIEW
Christina J Bathgate, Julio Fernandez-Mendoza
PURPOSE OF REVIEW: To summarize research from the past 2 years on the association between insomnia, short sleep duration, and hypertension and provide a critical analysis of the evidence and suggestions for future directions in this field. RECENT FINDINGS: Evidence indicates that the association between insomnia and elevated blood pressure (BP) or stage 1 and 2 hypertension is stronger in those with chronic insomnia, as compared to those with isolated insomnia symptoms, and primarily found in those with the insomnia with objective short sleep duration phenotype...
May 19, 2018: Current Hypertension Reports
https://www.readbyqxmd.com/read/29777950/acceptance-and-commitment-therapy-for-prevention-of-chronic-post-surgical-pain-and-opioid-use-in-at-risk-veterans-a-pilot-randomized-controlled-study
#10
Lilian Dindo, M Bridget Zimmerman, Katherine Hadlandsmyth, Barbara StMarie, Jennie Embree, James Marchman, Toni Tripp-Reimer, Barbara Rakel
High levels of pain, significant anxiety, and/or depressive symptoms prior to surgery put patients at elevated risk forchronic pain and prolonged opioid use following surgery. The purpose of this preliminary study was to assess the efficacy of a one-day Acceptance and Commitment Therapy (ACT) workshop in "at-risk" Veterans for the prevention of chronic pain and opioid use following orthopedic surgery. In a randomized controlled trial, 88 at-risk Veterans undergoing orthopedic surgery were assigned to Treatment as Usual (TAU; N =44) or TAU plus a 1-day ACT workshop (N = 44)...
May 16, 2018: Journal of Pain: Official Journal of the American Pain Society
https://www.readbyqxmd.com/read/29774943/-progress-in-prophylatic-hyperthermic-intraperitoneal-chemotherapy-for-advanced-gastric-carcinoma
#11
Xinhua Chen, Jun Luo, Hao Liu, Yuehong Chen, Yanfeng Hu, Tuanjie Li, Tian Lin, Yu Zhu, Mingli Zhao, Hao Chen, Guoxin Li, Jiang Yu
Advanced gastric cancer (AGC) has a high recurrence rate (especially peritoneal relapse) and a poor prognosis. Systematic chemotherapy or targeted therapy have not been able to significantly reduce the major cause of an unfavorable prognosis, namely the high peritoneal AGC recurrence rate post-surgery. Further studies concerning the application of hyperthermic intraperitoneal chemotherapy (HIPEC) post curative surgery for AGC patients, namely the prophylactic HIPEC (P-HIPEC), have involved a prophylactic approach to prevent peritoneal relapse following curative gastrectomy in high-risk patients...
May 25, 2018: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
https://www.readbyqxmd.com/read/29774765/-staying-safe-a-narrative-review-of-falls-prevention-in-people-with-parkinson-s-pdsafe
#12
Sophia Hulbert, Lynn Rochester, Alice Nieuwboer, Vicki Goodwin, Carolyn Fitton, Kim Chivers-Seymour, Ann Ashburn
BACKGROUND: Parkinson's disease demonstrates a spectrum of motor and non-motor symptoms. Falling is common and disabling. Current medical management shows minimal impact to reduce falls or fall-related risk factors, such as deficits in gait, strength, and postural instability. Despite evidence supporting rehabilitation in reducing fall risk factors, the most appropriate intervention to reduce overall fall rate remains inconclusive. This article aims to 1) synthesise current evidence and conceptual models of falls rehabilitation in Parkinson's in a narrative review; and based on this evidence, 2) introduce the treatment protocol used in the falls prevention and multi-centre clinical trial "PDSAFE"...
May 18, 2018: Disability and Rehabilitation
https://www.readbyqxmd.com/read/29773934/iglarlixi-a-new-once-daily-fixed-ratio-combination-of-basal-insulin-glargine-and-lixisenatide-for-the-management-of-type-2-diabetes
#13
Debbie Hinnen, Jodi Strong
Background: Patients with type 2 diabetes require treatment intensification to maintain glycemic control. Clinician reluctance, patient injection fears, hypoglycemia, weight gain, or other objections may lead to clinical inertia, whereby therapy is not intensified and patients live with uncontrolled hyperglycemia and increased risk for complications. Initiation of injectable therapy with a glucagon-like peptide (GLP)-1 receptor agonist and/or basal insulin is a recommended option for patients with type 2 diabetes inadequately controlled on one or more oral agents...
May 2018: Diabetes Spectrum: a Publication of the American Diabetes Association
https://www.readbyqxmd.com/read/29772928/a-clinical-carepath-for-obese-pregnant-women-a-pragmatic-pilot-cluster-randomized-controlled-trial
#14
Sarah D McDonald, Kristen A Viaje, Rebecca A Rooney, Alexander Jarde, Lucia Giglia, Cynthia V Maxwell, David Small, Tracy Pearce Kelly, B H Sc Midwifery, Lisa Sabatino, Lehana Thabane
OBJECTIVES: Obese women are at increased risks for complications during pregnancy, birth and in their infants. Although guidelines have been established for the clinical care of obese pregnant women, management is sometimes suboptimal. Our goal was to determine the feasibility of implementing and testing a clinical carepath for obese pregnant women compared to standard care, in a pilot cluster randomized controlled trial (RCT). METHODS: A pragmatic pilot cluster RCT was conducted, randomly allocating eight clinics to the carepath or standard care for obese pregnant women...
May 17, 2018: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29771855/does-multimodal-rehabilitation-for-ankle-instability-improve-patients-self-assessed-functional-outcomes-a-network-meta-analysis
#15
Konstantinos Tsikopoulos, Dimitris Mavridis, Dimitrios Georgiannos, Haris S Vasiliadis
BACKGROUND: Although there are many nonsurgical treatment options for the primary management of chronic ankle instability, the most effective nonoperative intervention has not been defined. QUESTIONS/PURPOSES: The purpose of this study was to perform a network meta-analysis to compare the results of different standalone and/or combined nonsurgical interventions on chronic ankle instability as measured by (1) the Cumberland Ankle Instability Tool (CAIT) at 0 to 6 months after treatment and (2) treatment-related complications...
June 2018: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/29770198/recent-advances-in-managing-understanding-meningioma
#16
REVIEW
Nawal Shaikh, Karan Dixit, Jeffrey Raizer
Meningiomas are the most common adult primary intracranial tumor. Despite their higher incidence, there have not-until recently-been as many advances in understanding and managing meningiomas. Thus far, two broad classes of meningiomas have emerged on the basis of their mutational profile: those driven by neurofibromatosis 2 (NF2) inactivation and those with non-NF2 driver gene alterations, such as mammalian target of rapamycin and Hedgehog, Wingless/b-catenin, Notch, transforming growth factor-b receptor, mitogen-activated protein kinase, and phospholipase C pathway alterations...
2018: F1000Research
https://www.readbyqxmd.com/read/29770171/risk-of-gastric-cancer-development-after-eradication-of-helicobacter-pylori
#17
REVIEW
Ka-Shing Cheung, Wai K Leung
Helicobacter pylori ( H. pylori ) infection is the most important risk factor for gastric cancer (GC) development through the Correa's gastric carcinogenesis cascade. However, H. pylori eradication alone does not eliminate GC, as pre-neoplastic lesions (atrophic gastritis, intestinal metaplasia and dysplasia) may have already developed in some patients. It is therefore necessary to identify patients at high-risk for gastric cancer after H. pylori eradication to streamline the management plan. If the patients have not undergone endoscopy with histologic assessment, the identification of certain clinical risk factors and non-invasive testing (serum pepsinogen) can predict the risk of atrophic gastritis...
May 15, 2018: World Journal of Gastrointestinal Oncology
https://www.readbyqxmd.com/read/29769117/a-protocol-for-a-network-meta-analysis-of-interventions-to-treat-patients-with-sudden-sensorineural-hearing-loss
#18
Nadera Ahmadzai, Shaun Kilty, Dianna Wolfe, Jamie Bonaparte, David Schramm, Elizabeth Fitzpatrick, Vincent Lin, Wei Cheng, Becky Skidmore, David Moher, Brian Hutton
BACKGROUND: Hearing loss is one of the leading causes of disability worldwide, with greater than 20% of Canadian adults having measurable hearing loss in at least one ear. Patients with hearing loss experience impaired quality of life, and emotional and financial consequences that affect themselves and their families. Sudden sensorineural hearing loss (SSNHL) is a common but difficult to treat form of hearing loss that has a sudden onset of ≤ 72 h associated with various etiologies, with the majority of cases being idiopathic...
May 16, 2018: Systematic Reviews
https://www.readbyqxmd.com/read/29768662/immersion-in-water-during-labour-and-birth
#19
REVIEW
Elizabeth R Cluett, Ethel Burns, Anna Cuthbert
BACKGROUND: Water immersion during labour and birth is increasingly popular and is becoming widely accepted across many countries, and particularly in midwifery-led care settings. However, there are concerns around neonatal water inhalation, increased requirement for admission to neonatal intensive care unit (NICU), maternal and/or neonatal infection, and obstetric anal sphincter injuries (OASIS). This is an update of a review last published in 2011. OBJECTIVES: To assess the effects of water immersion during labour and/or birth (first, second and third stage of labour) on women and their infants...
May 16, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29768064/a-look-at-treatment-strategies-for-relapsed-multiple-myeloma
#20
Giusy Cetani, Mario Boccadoro, Stefania Oliva
Multiple myeloma treatment considerably improved during the past decade, thanks to novel effective drugs, a better understanding of myeloma biology and clonal heterogeneity, and an improved management of toxicities. The choice of regimen at relapse is usually based on prior response, toxicities, age and comorbidities of relapsed patients. Areas covered: A review was performed of the most recent and effective therapeutic strategies for the relapsed myeloma setting, by documenting the latest clinical evidence from phase II and III clinical trials...
May 16, 2018: Expert Review of Anticancer Therapy
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