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https://www.readbyqxmd.com/read/29772673/reducing-amputations-in-people-with-diabetes-rapid-evaluation-of-a-new-care-pathway
#1
Sandra MacRury, Kate Stephen, Fiona Main, Jane Gorman, Sandra Jones, David Macfarlane
People with diabetes are at increased risk of foot ulcers, which, if left untreated, can lead to infection, gangrene, and subsequent amputation. Management by a multidisciplinary diabetes foot team has been shown to reduce amputation rates; however, accessing specialist treatment is made particularly difficult when living in remote and rural locations, such as many individuals cared for within NHS Highland. The RAPID project was made up of two phases: firstly, to evaluate the technical feasibility of a new integrated care pathway using innovative technology, and secondly, to establish process enhancement of the pathway to justify a larger-scale study...
May 16, 2018: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/29771249/-new-italian-law-about-end-of-life-self-determination-and-shared-care-pathway
#2
Rosagemma Ciliberti, Matteo Gulino, Ilaria Gorini
The Italian Parliament has recently approved the Law n. 219/2017 concerning "Rules on informed consent and advance directives". The manuscript points out the main key points of the new law, in order to clarify the role of the advance directives and to provide clear operational guidelines for healthcare personnel. Taking into consideration the Italian deontological and juridical context, along with the main jurisprudential judgements, the law has been analysed. The Authors discussed the new rules and the bioethical issues also in relation to the provisions stated by the Convention on Human Rights and Biomedicine (Convention of Oviedo)...
May 2018: Recenti Progressi in Medicina
https://www.readbyqxmd.com/read/29755917/sharing-is-caring-minimizing-the-disruption-with-palliative-care
#3
EDITORIAL
Abd Moain Abu Dabrh, Robert P Shannon, Richard J Presutti
There is an upward trend incidence of multiple chronic life-limiting conditions with a well-documented associated impact on patients and their caregivers. When patients approach the end of life, they are often faced with a challenging multidimensional burden while navigating a complex health care system. Patients and families/caregivers are faced with daily decisions, often with little or no frame of reference or medical knowledge. The "what, how, when, and where" puzzle during this challenging time can be overwhelming for patients and their families, and when clinicians do not contemplate this associated workload's impact on patients and caregivers' capacity for self-care, patients and caregivers scramble to find compensatory solutions, often putting their health care at lower priority...
March 13, 2018: Curēus
https://www.readbyqxmd.com/read/29752620/mechanism-of-change-in-cognitive-behavioral-therapy-for-body-image-and-self-care-on-art-adherence-among-sexual-minority-men-living-with-hiv
#4
Kalina M Lamb, Kelsey A Nogg, Steven A Safren, Aaron J Blashill
Body image disturbance is a common problem reported among sexual minority men living with HIV, and is associated with poor antiretroviral therapy (ART) adherence. Recently, a novel integrated intervention (cognitive behavioral therapy for body image and self-care; CBT-BISC) was developed and pilot tested to simultaneously improve body image and ART adherence in this population. Although CBT-BISC has demonstrated preliminary efficacy in improving ART adherence, the mechanisms of change are unknown. Utilizing data from a two-armed randomized controlled trial (N = 44 sexual minority men living with HIV), comparing CBT-BISC to an enhanced treatment as usual (ETAU) condition, sequential process mediation via latent difference scores was assessed, with changes in body image disturbance entered as the mechanism between treatment condition and changes in ART adherence...
May 11, 2018: AIDS and Behavior
https://www.readbyqxmd.com/read/29741571/struggling-with-nutrition-in-patients-with-advanced-cancer-nutrition-and-nourishment-focusing-on-metabolism-and-supportive-care
#5
J Arends
Patients with advanced cancer are at high risk of losing vital body resources resulting in malnutrition, immunodeficiency, impaired quality of life and worse clinical outcome. Prominent among the diverse factors contributing to this complex condition are metabolic derangements characterized by systemic inflammation, catabolism and accumulating changes in body composition. Because cure in advanced cancer still remains elusive, optimal supportive and integrated palliative care are required to allow patients to tolerate aggressive or long-term anticancer treatments, to maintain an adequate quality of life or to stay the course of advancing disease...
February 1, 2018: Annals of Oncology: Official Journal of the European Society for Medical Oncology
https://www.readbyqxmd.com/read/29740329/mechanisms-underlying-the-risk-to-develop-drug-addiction-insights-from-studies-in-drosophila-melanogaster
#6
REVIEW
Julia Ryvkin, Assa Bentzur, Shir Zer-Krispil, Galit Shohat-Ophir
The ability to adapt to environmental changes is an essential feature of biological systems, achieved in animals by a coordinated crosstalk between neuronal and hormonal programs that allow rapid and integrated organismal responses. Reward systems play a key role in mediating this adaptation by reinforcing behaviors that enhance immediate survival, such as eating or drinking, or those that ensure long-term survival, such as sexual behavior or caring for offspring. Drugs of abuse co-opt neuronal and molecular pathways that mediate natural rewards, which under certain circumstances can lead to addiction...
2018: Frontiers in Physiology
https://www.readbyqxmd.com/read/29731100/endotype-driven-care-pathways-in-patients-with-chronic-rhinosinusitis
#7
REVIEW
Claus Bachert, Nan Zhang, Peter W Hellings, Jean Bousquet
Chronic rhinosinusitis (CRS) has been differentiated clinically into CRS without nasal polyps and CRS with nasal polyps, with both forms subjected to glucocorticosteroid and antibiotic treatments and, if not successful, to nasal and sinus surgery tailored to endoscopic and computed tomographic scan findings. The elaboration of endotypes based on pathomechanisms involving different immune responses offers new possibilities in terms of prediction of prognosis and risks and sophisticated guidance in personalized pharmacotherapy, surgical approaches, and innovative treatment approaches in the CRS field with various biologics...
May 2018: Journal of Allergy and Clinical Immunology
https://www.readbyqxmd.com/read/29730070/exercise-prehabilitation-in-elective-intra-cavity-surgery-a-role-within-the-eras-pathway-a-narrative-review
#8
REVIEW
Samuel T Orange, Matthew J Northgraves, Phil Marshall, Leigh A Madden, Rebecca V Vince
The Enhanced Recovery after Surgery (ERAS) model integrates several elements of perioperative care into a standardised clinical pathway for surgical patients. ERAS programmes aim to reduce the rate of complications, improve surgical recovery, and limit postoperative length of hospital stay (LOHS). One area of growing interest that is not currently included within ERAS protocols is the use of exercise prehabilitation (PREHAB) interventions. PREHAB refers to the systematic process of improving functional capacity of the patient to withstand the upcoming physiological stress of surgery...
May 3, 2018: International Journal of Surgery
https://www.readbyqxmd.com/read/29726358/how-advances-in-imaging-will-affect-precision-radiation-oncology
#9
David A Jaffray, Shiva Das, Paula M Jacobs, Robert Jeraj, Philippe Lambin
Radiation oncology is 1 of the most structured disciplines in medicine. It is of a highly technical nature with reliance on robotic systems to deliver intervention, engagement of diverse expertise, and early adoption of digital approaches to optimize and execute the application of this highly effective cancer treatment. As a localized intervention, the dependence on sensitive, specific, and accurate imaging to define the extent of disease, its heterogeneity, and adjacency to normal tissues directly affects the therapeutic ratio...
June 1, 2018: International Journal of Radiation Oncology, Biology, Physics
https://www.readbyqxmd.com/read/29721771/oxidative-stress-stimulates-invasive-potential-in-rat-c6-and-human-u-87-mg-glioblastoma-cells-via-activation-and-cross-talk-between-pkm2-enpp2-and-ape1-enzymes
#10
Ravi P Cholia, Monisha Dhiman, Raj Kumar, Anil K Mantha
Maintaining genomic integrity is essential for cell survival and viability. Reactive oxygen species (ROS) overproduction results in oxidative stress leading to the genomic instability via generation of small base lesions in DNA and these unrepaired DNA damages lead to various cellular consequences including cancer. Recent data support the concept "oxidative stress is an indispensable participant in fostering proliferation, survival, and migration" in various cancer cell types including glioblastoma cells...
May 2, 2018: Metabolic Brain Disease
https://www.readbyqxmd.com/read/29720120/telomere-length-differences-between-colorectal-polyp-subtypes-a-colonoscopy-based-case-control-study
#11
Sheetal Hardikar, Andrea N Burnett-Hartman, Amanda I Phipps, Melissa P Upton, Lee-Ching Zhu, Polly A Newcomb
BACKGROUND: Short telomeres have been associated with increased risk of many cancers, particularly cancers of the gastrointestinal tract including esophagus and stomach. However, the association between telomere length (TL) and colorectal cancer and its precursors, colorectal polyps, is not clear. METHODS: We investigated the relationship between TL and risk of colorectal polyp subtypes in a colonoscopy-based study in western Washington. Participants were 35-79 year-old enrollees at an integrated health care system, who underwent a colonoscopy between 1998 and 2007 (n = 190), completed a self-administered questionnaire, provided blood samples, and were distinguished as having adenomas, serrated polyps, or as polyp-free controls through a standardized pathology review...
May 2, 2018: BMC Cancer
https://www.readbyqxmd.com/read/29719431/connecting-people-with-cancer-to-physical-activity-and-exercise-programs-a-pathway-to-create-accessibility-and-engagement
#12
D Santa Mina, C M Sabiston, D Au, A J Fong, L C Capozzi, D Langelier, M Chasen, J Chiarotto, J R Tomasone, J M Jones, E Chang, S N Culos-Reed
Recent guidelines concerning exercise for people with cancer provide evidence-based direction for exercise assessment and prescription for clinicians and their patients. Although the guidelines promote exercise integration into clinical care for people with cancer, they do not support strategies for bridging the guidelines with related resources or programs. Exercise program accessibility remains a challenge in implementing the guidelines, but that challenge might be mitigated with conceptual frameworks ("pathways") that connect patients with exercise-related resources...
April 2018: Current Oncology
https://www.readbyqxmd.com/read/29717978/self-sampling-kits-to-increase-hiv-testing-among-black-africans-in-the-uk-the-haus-mixed-methods-study
#13
Maureen Seguin, Catherine Dodds, Esther Mugweni, Lisa McDaid, Paul Flowers, Sonali Wayal, Ella Zomer, Peter Weatherburn, Ibidun Fakoya, Thomas Hartney, Lorraine McDonagh, Rachael Hunter, Ingrid Young, Shabana Khan, Nick Freemantle, Jabulani Chwaula, Memory Sachikonye, Jane Anderson, Surinder Singh, Eleni Nastouli, Greta Rait, Fiona Burns
BACKGROUND: Timely diagnosis of human immunodeficiency virus (HIV) enables access to antiretroviral treatment, which reduces mortality, morbidity and further transmission in people living with HIV. In the UK, late diagnosis among black African people persists. Novel methods to enhance HIV testing in this population are needed. OBJECTIVES: To develop a self-sampling kit (SSK) intervention to increase HIV testing among black Africans, using existing community and health-care settings (stage 1) and to assess the feasibility for a Phase III evaluation (stage 2)...
April 2018: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/29714609/evolution-of-drug-development-integrating-the-patient-perspective-into-early-research
#14
Anthony J Yanni, Jennifer Fine
Soaring drug development costs, increasingly stringent regulatory requirements, and demanding market access environments have necessitated that pharmaceutical companies examine their research processes in order to provide novel and meaningful solutions for patients. In this paper, we describe an initiative that aims to incorporate a better appreciation of the exam room experience of both patients and practitioners into the drug development pathway from the earliest point of research. Focusing on 4 core pillars-medical value, patient need, scientific rationale, and market environment-an integrated analytic process is undertaken so as to facilitate early identification of ideal target populations and criteria that will need to be met for successful entry into the treatment continuum...
January 2018: Therapeutic Innovation & Regulatory Science
https://www.readbyqxmd.com/read/29712628/a-web-based-intervention-to-reduce-distress-after-prostate-cancer-treatment-development-and-feasibility-of-the-getting-down-to-coping-program-in-two-different-clinical-settings
#15
Jane Cockle-Hearne, Deborah Barnett, James Hicks, Mhairi Simpson, Isabel White, Sara Faithfull
BACKGROUND: Distress after prostate cancer treatment is a substantial burden for up to one-third of men diagnosed. Physical and emotional symptoms and health service use can intensify, yet men are reticent to accept support. To provide accessible support that can be cost effectively integrated into care pathways, we developed a unique, Web-based, self-guided, cognitive-behavior program incorporating filmed and interactive peer support. OBJECTIVE: To assess feasibility of the intervention among men experiencing distress after prostate cancer treatment...
April 30, 2018: JMIR Cancer
https://www.readbyqxmd.com/read/29710235/national-institutes-of-health-pathways-to-prevention-workshop-methods-for-evaluating-natural-experiments-in-obesity
#16
Karen M Emmons, Chyke A Doubeni, Maria E Fernandez, Diana L Miglioretti, Jonathan M Samet
On 5 and 6 December 2017, the National Institutes of Health (NIH) convened the Pathways to Prevention Workshop: Methods for Evaluating Natural Experiments in Obesity to identify the status of methods for assessing natural experiments to reduce obesity, areas in which these methods could be improved, and research needs for advancing the field. This article considers findings from a systematic evidence review on methods for evaluating natural experiments in obesity, workshop presentations by experts and stakeholders, and public comment...
May 1, 2018: Annals of Internal Medicine
https://www.readbyqxmd.com/read/29697758/pathways-contributors-and-correlates-of-functional-limitation-across-specialties-workshop-summary
#17
Stephen B Kritchevsky, Daniel E Forman, Kathryn Callahan, E Wesley Ely, Kevin P High, Frances McFarland, Eliseo J Pérez-Stable, Kenneth Schmader, Stephanie Studenski, John Williams, Susan Zieman, Jack M Guralnik
Traditional clinical care models focus on the measurement and normalization of individual organ systems and de-emphasize aspects of health related to the integration of physiologic systems. Measures of physical, cognitive and sensory, and psychosocial or emotional function predict important health outcomes like death and disability independently from the severity of a specific disease, cumulative co-morbidity, or disease severity measures. A growing number of clinical scientists in several subspecialties are exploring the utility of functional assessment to predict complication risk, indicate stress resistance, inform disease screening approaches and risk factor interpretation, and evaluate care...
April 25, 2018: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
https://www.readbyqxmd.com/read/29694454/-we-ve-learned-it-s-a-medical-illness-not-a-moral-choice-qualitative-study-of-the-effects-of-a-multicomponent-addiction-intervention-on-hospital-providers-attitudes-and-experiences
#18
Honora Englander, Devin Collins, Sylvia Peterson Perry, Molly Rabinowitz, Elena Phoutrides, Christina Nicolaidis
BACKGROUND: Substance use disorders (SUD) represent a national epidemic with increasing rates of SUD-related hospitalizations. However, most hospitals lack expertise or systems to directly address SUD. Healthcare professionals feel underprepared and commonly hold negative views toward patients with SUD. Little is known about how hospital interventions may affect providers' attitudes and experiences toward patients with SUD. OBJECTIVE: To explore interprofessional hospital providers' perspectives on how integrating SUD treatment and care systems affect providers' attitudes, beliefs, and experiences...
April 25, 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/29692947/implementation-of-a-mobile-clinical-decision-support-application-to-augment-local-antimicrobial-stewardship
#19
Brian M Hoff, Diana C Ford, Dilek Ince, Erika J Ernst, Daniel J Livorsi, Brett H Heintz, Vincent Masse, Michael J Brownlee, Bradley A Ford
Background: Medical applications for mobile devices allow clinicians to leverage microbiological data and standardized guidelines to treat patients with infectious diseases. We report the implementation of a mobile clinical decision support (CDS) application to augment local antimicrobial stewardship. Methods: We detail the implementation of our mobile CDS application over 20 months. Application utilization data were collected and evaluated using descriptive statistics to quantify the impact of our implementation...
2018: Journal of Pathology Informatics
https://www.readbyqxmd.com/read/29684634/interactive-electronic-decision-trees-for-the-integrated-primary-care-management-of-febrile-children-in-low-resource-settings-review-of-existing-tools
#20
REVIEW
Kristina Keitel, Valérie D'Acremont
BACKGROUND: The lack of effective, integrated diagnostic tools pose a major challenge to the primary care management of febrile childhood illnesses. These limitations are especially evident in low-resource settings and are often inappropriately compensated by antimicrobial over-prescription. Interactive electronic decision trees (IEDTs) have the potential to close these gaps: guiding antibiotic use and better identifying serious disease. AIMS: This narrative review summarizes existing IEDTs, to provide an overview of their degree of validation, as well as to identify gaps in current knowledge and prospects for future innovation...
April 20, 2018: Clinical Microbiology and Infection
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