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Clinical protocols

Gurpreet S Wander, Mohammed Yunus Khan Hukkeri, Sachin Yalagudri, Bharti Mahajan, Archana Toppo Panda
Cardiovascular (CV) diseases are a major cause of premature death and disability. Non-communicable diseases (NCD) are responsible for 52% of mortality amongst Indians, of these CV diseases are responsible for 66% of NCD mortality in India. We not only need widespread primary preventive strategy but also need effective secondary prevention protocols to reduce this. Secondary prevention in patients who already had myocardial infarction (MI) or revascularization is of utmost importance to reduce mortality, cardiac events and improve quality of life...
March 2018: Journal of the Association of Physicians of India
Marie Ashley Villard, Melissa C Helm, Tammy L Kindel, Matthew I Goldblatt, Jon C Gould, Rana M Higgins
BACKGROUND: The primary objective of this study was to evaluate the utility of CRP in early identification of post-operative complications after bariatric surgery. The ability of this marker to acutely predict post-operative complications in bariatric surgery patients has not been determined. METHODS: A retrospective chart review was conducted of adult patients who underwent a primary and revisional laparoscopic Roux-en-Y gastric bypass (LRYGB) or sleeve gastrectomy (LSG) between 2013 and 2017 at a single institution...
October 19, 2018: Surgical Endoscopy
Reinier B Beks, David Reetz, Mirjam B de Jong, Rolf H H Groenwold, Falco Hietbrink, Michael J R Edwards, Luke P H Leenen, Roderick Marijn Houwert, Jan Paul M Frölke
BACKGROUND: Over the years, a trend has evolved towards operative treatment of flail chest although evidence is limited. Furthermore, little is known about operative treatment for patients with multiple rib fractures without a flail chest. The aim of this study was to compare rib fixation based on a clinical treatment algorithm with nonoperative treatment for both patients with a flail chest or multiple rib fractures. METHODS: All patients with ≥ 3 rib fractures admitted to one of the two contributing hospitals between January 2014 and January 2017 were retrospectively included in this multicenter cohort study...
October 19, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Jae-Hwan Choi, Eun Hye Oh, Min-Gyu Park, Seung Kug Baik, Han-Jin Cho, Seo Young Choi, Tae-Hong Lee, Ji Soo Kim, Kwang-Dong Choi
The aim of this study was to determine the frequency, clinical and radiological features, and efficacy of clinical evaluation and perfusion-weighted imaging (PWI) for the prediction of final stroke in patients with DWI/MRI-negative posterior circulation stroke (PCS) presenting acute dizziness/vertigo. From our comprehensive prospective stroke registry of acute ischemic stroke during a 7-year period, we identified 1846 consecutive patients with PCS, 850 of whom presented with acute dizziness/vertigo. Of these 850 patients, initial DWI-MRI was negative in 35 (4...
October 19, 2018: Journal of Neurology
Xiao-Lan Li, Rui Huang, Cong Fang, Xiao-Yan Liang
As a novel biomarker, there is inconsistent evidence regarding the association between anti-Müllerian hormone (AMH) and live birth rate in freezing-all embryo transfer cycles. We aim to assess the prognostic effect of baseline AMH on clinical outcomes, especially live birth rate in freezing-all embryo transfer cycles. A total of 828 non-polycystic ovary patients that underwent their first frozen-thawed embryo transfers in our center between January 2010 and January 2015 were recruited in this retrospective analysis...
October 2018: Current medical science
Vivian P Bykerk, Gerd R Burmester, Bernard G Combe, Daniel E Furst, Tom W J Huizinga, Harris A Ahmad, Paul Emery
Clinical outcomes in patients with early rheumatoid arthritis (RA) were assessed by baseline symptom duration in the Assessing Very Early Rheumatoid arthritis Treatment trial (; NCT01142726). Patients with early, active RA were randomized to subcutaneous (SC) abatacept 125 mg/week plus methotrexate (MTX), SC abatacept alone, or MTX monotherapy for 12 months. All RA treatments were withdrawn after 12 months in patients with Disease Activity Score in 28 joints (C-reactive protein; DAS28-CRP) < 3...
October 20, 2018: Rheumatology International
Jacob Lauwring Andersen, Borbala Gesser, Erik Daa Funder, Christine Juul Fælled Nielsen, Helle Gotfred-Rasmussen, Mads Kirchheiner Rasmussen, Rachel Toth, Kurt Vesterager Gothelf, J Simon C Arthur, Lars Iversen, Poul Nissen
Dimethyl fumarate (DMF) has been applied for decades in the treatment of psoriasis and now also multiple sclerosis. However, the mechanism of action has remained obscure and involves high dose over long time of this small, reactive compound implicating many potential targets. Based on a 1.9 Å resolution crystal structure of the C-terminal kinase domain of the mouse p90 Ribosomal S6 Kinase 2 (RSK2) inhibited by DMF we describe a central binding site in RSKs and the closely related Mitogen and Stress-activated Kinases (MSKs)...
October 19, 2018: Nature Communications
A-F Medeiros-Albuquerque, C-M Sampaio-Melo, E-C Studart-Soares, T Rodrigues-Ribeiro, C-S Roriz-Fonteles, K-M Alves-Pereira, D-A Ferreira-Barbosa, P-G de-Barros-Silva, F-W Gurgel-Costa
BACKGROUND: This study aimed to review translational studies focusing on third molar removal surgeries through a systematic analytical approach. MATERIAL AND METHODS: A PROSPERO-registered systematic review (CRD42017060455) was conducted following the PRISMA statement to summarize current knowledge on gene expression in third molar surgeries. A search was performed in PubMed's Medline and Scopus databases, without date or language restrictions, using the logical expression {[(Third molar) OR (preemptive) OR (cyclooxygenase inhibitors) OR (acute inflammation) AND (gene expression)]}...
October 20, 2018: Medicina Oral, Patología Oral y Cirugía Bucal
Johanna Junker, Valerie Brandt, Brian D Berman, Marie Vidailhet, Emmanuel Roze, Anne Weissbach, Cynthia Comella, Irene A Malaty, Joseph Jankovic, Mark S LeDoux, Alfredo Berardelli, Richard Barbano, Stephen G Reich, Joel S Perlmutter, H A Jinnah, Norbert Brüggemann
OBJECTIVE: To determine predictors of alcohol responsiveness in a large cohort of patients with dystonia. METHODS: A total of 2,159 participants with dystonia were prospectively enrolled in the cross-sectional Dystonia Coalition multicenter study. Patients with secondary, combined, or confirmed genetic dystonia (total n = 164) or unknown alcohol responsiveness (n = 737) were excluded. Patients answered a standardized questionnaire and were clinically examined using a standardized video protocol and the Burke-Fahn-Marsden Dystonia Rating Scale...
October 19, 2018: Neurology
Danielle B Rice, Brian Hutton, Patricia Poulin, Beth A Sproule, Dianna Wolfe, David Moher, Kednapa Thavorn, Gary Garber, Sheena Taha, Amy Porath, Melanie Willows, Leila Esmaeilisaraji, Fatemeh Yazdi, Beverley Shea, Becky Skidmore, Kimberly Corace
INTRODUCTION: The opioid crisis has resulted in increasing rates of death caused by problematic opioid use. Current clinical guidelines recommend that individuals with persons with opioid use disorder (OUD) receive pharmacological (eg, opioid agonist therapy) and psychosocial (eg, cognitive behavioural therapy) therapy; however, the best combination of pharmacologic and psychosocial components is not known. Our objective of the planned study is to conduct a comprehensive systematic review to assess the relative benefits of psychosocial interventions as an adjunct to opioid agonist therapy among persons with OUD...
October 18, 2018: BMJ Open
Ana Kowark, Christian Adam, Jörg Ahrens, Malek Bajbouj, Cornelius Bollheimer, Matthias Borowski, Richard Dodel, Michael Dolch, Thomas Hachenberg, Dietrich Henzler, Frank Hildebrand, Ralf-Dieter Hilgers, Andreas Hoeft, Susanne Isfort, Peter Kienbaum, Mathias Knobe, Pascal Knuefermann, Peter Kranke, Rita Laufenberg-Feldmann, Carla Nau, Mark D Neuman, Cynthia Olotu, Christopher Rex, Rolf Rossaint, Robert D Sanders, Rene Schmidt, Frank Schneider, Hartmut Siebert, Max Skorning, Claudia Spies, Oliver Vicent, Frank Wappler, Dieter Christian Wirtz, Maria Wittmann, Kai Zacharowski, Alexander Zarbock, Mark Coburn
INTRODUCTION: Hip fracture surgery is associated with high in-hospital and 30-day mortality rates and serious adverse patient outcomes. Evidence from randomised controlled trials regarding effectiveness of spinal versus general anaesthesia on patient-centred outcomes after hip fracture surgery is sparse. METHODS AND ANALYSIS: The iHOPE study is a pragmatic national, multicentre, randomised controlled, open-label clinical trial with a two-arm parallel group design...
October 18, 2018: BMJ Open
Nao Hagiwara, Briana Mezuk, Jennifer Elston Lafata, Scott R Vrana, Michael D Fetters
INTRODUCTION: Patient-physician racial discordance is associated with Black patient reports of dissatisfaction and mistrust, which in turn are associated with poor adherence to treatment recommendations and underutilisation of healthcare. Research further has shown that patient dissatisfaction and mistrust are magnified particularly when physicians hold high levels of implicit racial bias. This suggests that physician implicit racial bias manifests in their communication behaviours during medical interactions...
October 18, 2018: BMJ Open
Esther Williamson, Lesley Ward, Karan Vadher, Susan J Dutton, Ben Parker, Stavros Petrou, Charles E Hutchinson, Richard Gagen, Nigel K Arden, Karen Barker, Graham Boniface, Julie Bruce, Gary Collins, Jeremy Fairbank, Judith Fitch, David P French, Angela Garrett, Varsha Gandhi, Frances Griffiths, Zara Hansen, Christian Mallen, Alana Morris, Sarah E Lamb
INTRODUCTION: Neurogenic claudication due to spinal stenosis is common in older adults. The effectiveness of conservative interventions is not known. The aim of the study is to estimate the clinical and cost-effectiveness of a physiotherapist-delivered, combined physical and psychological intervention. METHODS AND ANALYSIS: This is a pragmatic, multicentred, randomised controlled trial. Participants are randomised to a combined physical and psychological intervention (Better Outcomes for Older people with Spinal Trouble (BOOST) programme) or best practice advice (control)...
October 18, 2018: BMJ Open
Jun Wang, Yin Wang, Hui Zhang, Ming Lu, Weilu Gao, Li Yin, Zongsheng Yin
INTRODUCTION: Osteoarthritis is a common degenerative joint disease that eventually leads to disability and poor quality of life. The main symptoms are joint pain and mobility disorders. If the patient has severe pain or other analgesics are contraindicated, opioids may be a viable treatment option. To evaluate and compare the efficacy and safety of opioids in the treatment of knee or hip osteoarthritis, we will integrate direct and indirect evidence using a Bayesian network meta-analysis to establish hierarchies of these drugs...
October 18, 2018: BMJ Open
Mohammad Rostami, Seyyed Jalal Younesi, Farahnaz Mohammadi Shahboulaghi, Seyed Kazem Malakouti, Mahshid Foroughan
INTRODUCTION: The rates of suicide in the elderly population are generally higher than other age groups. Models of suicide that explain the phenomenon of suicide in later life may have research, clinical and educational implications for the field of ageing. The primary purpose of this systematic review is to identify and review existing models of suicide that have a particular focus on the elderly. METHODS AND ANALYSIS: The authors intend reviewing the findings of observational studies including cohort studies, cross-sectional studies, case-control studies, and qualitative studies such as grounded theory designs which are published in Google Scholar, Scopus, PsycINFO, PubMed, Web of Science, Cochrane Database of Systematic Reviews and research-related journals...
October 18, 2018: BMJ Open
Maki Jitsumura, Andrew Laurence Cunningham, Matthew David Hitchings, Saiful Islam, Angharad P Davies, Paula E Row, Andrew D Riddell, James Kinross, Tom S Wilkinson, G J Jenkins, John G Williams, Dean Anthony Harris
BACKGROUND: The interaction of the gut microbiota with the human host is implicated in the pathogenesis of inflammatory and immunological diseases including ulcerative colitis (UC). Faecal microbiota transplantation (FMT) as a method of restoring gut microbial diversity is of increasing interest as a therapeutic approach in the management of UC. The current literature lacks consensus about the dose of FMT, route of administration and duration of response. METHODS AND ANALYSIS: This single-blinded randomised trial will explore the feasibility of FMT in 30 treatment-naïve patients with histologically confirmed distal UC limited to the recto-sigmoid region (up to 40 cm from the anal verge)...
October 18, 2018: BMJ Open
Claire Dahyot-Fizelier, Denis Frasca, Sigismond Lasocki, Karim Asehnoune, Dorothée Balayn, Anne-Laure Guerin, Pierre-François Perrigault, Thomas Geeraerts, Philippe Seguin, Bertrand Rozec, Djilali Elaroussi, Vincent Cottenceau, Clément Guyonnaud, Olivier Mimoz
INTRODUCTION: Ventilator-associated pneumonia (VAP) is the first cause of healthcare-associated infections in intensive care units (ICUs) and brain injury is one of the main risk factors for early-onset VAP. Antibiotic prophylaxis has been reported to decrease their occurrence in brain-injured patients, but a lack of controlled randomised trials and the risk of induction of bacterial resistance explain the low level of recommendations. The goal of this study is to determine whether a single dose of ceftriaxone within the 12 hours postintubation after severe brain injury can decrease the risk of early-onset VAP...
October 18, 2018: BMJ Open
Núbia de Cassia Almeida Queiroz, Michelle Pedroza Jorge, Ilza Maria de Oliveira Sousa, Carmen Silvia Passos Lima, Maria Christina de Miranda Matias, Ana Cristina Dal Rio, Eduardo Baldon Pereira, Victória Hahn Kakas Galassi, João Ernesto de Carvalho, Tais Freire Galvao, Mary Ann Foglio
INTRODUCTION: Oral mucositis is an iatrogenic condition of erythematous inflammatory changes which tends to occur on buccal and labial surfaces, the ventral surface of the tongue, the floor of the mouth and the soft palate of patients receiving chemotherapy. This protocol of ongoing randomised parallel group clinical trial aims to access the therapeutic effect of an herbal gel containing 2.5% Arrabidaea chica Verlot standardised extract on oral mucositis in patients with head and neck cancer compared with low-level laser therapy...
October 18, 2018: BMJ Open
Thomas Langford, Zehra Arkir, Anastasia Chalkidou, Kate Goddard, Lamprini Kaftantzi, Mark Samaan, Peter Irving
BACKGROUND: Currently, treatment decisions for people with Crohn disease are based on clinical judgment and trial and error. Consequently, people may continue to receive high drug dosages and experience unnecessary toxicity when it is possible to reduce or discontinue without a detrimental effect on clinical outcomes. Therapeutic drug monitoring (TDM) involves regularly testing blood samples for drug and antibody levels that could help clinicians identify the optimal treatment strategy and pre-empt treatment failure...
October 19, 2018: JMIR Research Protocols
Olveen Carrasquillo, BreAnne Young, Stuti Dang, Orieta Fontan, Natalie Ferras, Jose G Romano, Chuanhui Dong, Sonjia Kenya
BACKGROUND: Hispanic-Latino populations face a disproportionate stroke burden and are less likely to have sufficient control over stroke risk factors in comparison with other ethnic populations. A promising approach to improving chronic health outcomes has been the use of community health workers (CHWs). OBJECTIVE: The objective of this randomized controlled trial is to evaluate the effectiveness of a CHW intervention among Latino patients at risk of recurrent stroke...
October 19, 2018: JMIR Research Protocols
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