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Care pathways

Taka-Aki Matsuyama, Ryo Haraguchi, Junko Nakashima, Kengo Kusano, Hatsue Ishibashi-Ueda
Myocardial bundles working as accessory pathways in Wolff-Parkinson-White (WPW) syndrome are generally tiny tissues, so elucidating the culprit histology of atrioventricular (AV) myocardial connections requires careful serial sectioning of the AV junction. We performed a postmortem examination of accessory AV myocardial connections in an 84-year-old man who died from pneumonia 20 years after surgical cryoablation for WPW syndrome. Three-dimensional reconstruction images of serial histologic sections revealed accessory AV connections between the atrial and ventricular myocardium in the vicinity of the cryoablation scar...
July 27, 2018: Cardiovascular Pathology: the Official Journal of the Society for Cardiovascular Pathology
Hazem Akkad, Nicola Cacciani, Monica Llano-Diez, Rebeca Corpeno Kalamgi, Tamara Tchkonia, James L Kirkland, Lars Larsson
AIM: Critical illness myopathy (CIM) is a consequence of modern critical care, leading to skeletal muscle atrophy/paralysis with negative consequences for mortality/morbidity and health care costs. Glucocorticoids (GCs) have been proposed to trigger CIM. Here, we compare outcomes of two GCs, the commonly used prednisolone and the newly developed dissociative vamorolone in response to the intensive care unit (ICU) condition for 5 days, i.e., sedation, immobilization, and mechanical ventilation...
August 18, 2018: Acta Physiologica
Robert Roskoski
The Ras-Raf-MEK-ERK signal transduction cascade is arguably the most important oncogenic pathway in human cancers. Ras-GTP promotes the formation of active homodimers or heterodimers of A-Raf, B-Raf, and C-Raf by an intricate process. These enzymes are protein-serine/threonine kinases that catalyze the phosphorylation and activation of MEK1 and MEK2 which, in turn, catalyze the phosphorylation and activation of ERK1 and ERK2. The latter catalyze the regulatory phosphorylation of dozens of cytosolic and nuclear proteins...
August 14, 2018: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
Aaron B Caughey, Stephen L Wood, George A Macones, Ian J Wrench, Jeffrey Huang, Mikael Norman, Karin Pettersson, William J Fawcett, Medhat M Shalabi, Amy Metcalfe, Leah Gramlich, Gregg Nelson, R Douglas Wilson
OBJECTIVE: This ERAS Guideline for intraoperative care in Cesarean Delivery (CD) will provide best practice, evidenced-based, recommendations for intra-operative care with primarily, a maternal focus. The 'focused' pathway process for scheduled and unscheduled CD, for this ERAS CD guideline will consider, from decision to operate (starting with the 30 - 60 minutes prior to skin incision) through the conduct of the surgery. METHODS: The literature search (1966-2017) used Embase and PubMed to search medical subject headings including "Cesarean Section", "Cesarean Section", "Cesarean Section Delivery" and all pre- and intra-operative ERAS® items...
August 14, 2018: American Journal of Obstetrics and Gynecology
Summer L Martins, Susan M Mason, Wendy L Hellerstedt, Sonya S Brady
CONTEXT: International travel is common and may influence women's sexual and reproductive health through myriad pathways. Existing studies focus on travelers' risk of acquiring STDs, but not their pregnancy prevention behaviors. Further, it is unclear whether sexual and reproductive health outcomes observed for female travelers are associated with travel itself, because few studies compare travelers with nontravelers. METHODS: An online survey was conducted in 2016-2017 among females attending a U...
August 17, 2018: Perspectives on Sexual and Reproductive Health
Nicola Disma, James D O'Leary, Andreas W Loepke, Ansgar M Brambrink, Karin Becke, Nicola G Clausen, Jurgen C De Graaff, Fang Liu, Tom G Hansen, Mary E McCann, Cynthia F Salorio, Sulpicio Soriano, Lena S Sun, Peter Szmuk, David O Warner, Laszlo Vutskits, Andrew J Davidson
All commonly used general anesthetics have been shown to cause neurotoxicity in animal models, including nonhuman primates. Opinion, however, remains divided over how cumulative evidence from preclinical and human studies in this field should be interpreted and its translation to current practices in pediatric anesthesia and surgery. A group of international experts in laboratory and clinical sciences recently convened in Genoa, Italy, to evaluate the current state of both laboratory and clinical research and discuss future directions for basic, translational, and clinical studies in this field...
August 16, 2018: Paediatric Anaesthesia
Kevin M Elias, Alexander B Stone, Katharine McGinigle, Jo'An I Tankou, Michael J Scott, William J Fawcett, Nicolas Demartines, Dileep N Lobo, Olle Ljungqvist, Richard D Urman
BACKGROUND: Enhanced recovery after surgery (ERAS) programs are multimodal care pathways designed to minimize the physiological and psychological impact of surgery for patients. Increased compliance with ERAS guidelines is associated with improved patient outcomes across surgical types. As ERAS programs have proliferated, an unintentional effect has been significant variation in how ERAS-related studies are reported in the literature. METHODS: To improve the quality of ERAS reporting, ERAS® USA and the ERAS® Society launched an effort to create an instrument to assist authors in manuscript preparation...
August 16, 2018: World Journal of Surgery
Matthew Evison, Kevin G Blyth, Rahul Bhatnagar, John Corcoran, Tarek Saba, Tracy Duncan, Rob Hallifax, Liju Ahmed, Alex West, Justin Charles Thane Pepperell, Mark Roberts, Pasupathy Sivasothy, Ioannis Psallidas, Amelia O Clive, Jennifer Latham, Andrew E Stanton, Nick Maskell, Najib Rahman
Physicians face considerable challenges in ensuring safe and effective care for patients admitted to hospital with pleural disease. While subspecialty development has driven up standards of care, this has been tempered by the resulting loss of procedural experience in general medical teams tasked with managing acute pleural disease. This review aims to define a framework though which a minimum standard of care might be implemented. This review has been written by pleural clinicians from across the UK representing all types of secondary care hospital...
2018: BMJ Open Respiratory Research
Wouter R Verberne, Janneke Dijkers, Johannes C Kelder, Anthonius B M Geers, Wilbert T Jellema, Hieronymus H Vincent, Johannes J M van Delden, Willem Jan W Bos
BACKGROUND: Conservative care is argued to be a reasonable treatment alternative for dialysis in older patients with advanced chronic kidney disease (CKD). However, comparisons are scarce and generally focus on survival only. Comparative data on more patient-relevant outcomes are needed to truly foster shared decision-making on an individual level, and cost comparison is needed to assess value of care. METHODS: We conducted a retrospective observational single-center cohort study in 366 patients aged ≥70 years with advanced CKD, who chose dialysis (n = 240) or conservative care (n = 126) after careful counselling by a multidisciplinary team in a non-academic teaching hospital in The Netherlands...
August 16, 2018: BMC Nephrology
N Stormon, A Pradhan, A McAuliffe, P J Ford
Access to dental care is poorer for people experiencing homelessness and disadvantage due to barriers such as lengthy waiting lists, lack of transport, lack of information and fear of authorities and treatment. This study aimed to evaluate a system integration model for oral health care for clients of homeless services in Brisbane, Australia. This model aimed to provide a facilitated access pathway between homeless community organisations and a public dental service to improve access to dental care. Participants were adult (≥18 years) clients Brisbane homeless community organisations...
August 8, 2018: Evaluation and Program Planning
Michael C Grant, Melinda M Gibbons, Clifford Y Ko, Elizabeth C Wick, Maxime Cannesson, Michael J Scott, Matthew D McEvoy, Adam B King, Christopher L Wu
Enhanced recovery after surgery protocols for bariatric surgery are increasingly being implemented, and reports suggest that they may be associated with superior outcomes, reduced length of hospital stay, and cost savings. The Agency for Healthcare Research and Quality, in partnership with the American College of Surgeons and the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, has developed the Safety Program for Improving Surgical Care and Recovery. We have conducted an evidence review to select anesthetic interventions that positively influence outcomes and facilitate recovery after bariatric surgery...
August 14, 2018: Anesthesia and Analgesia
Claudia Kasper, Francois Olivier Hebert, Nadia Aubin-Horth, Barbara Taborsky
Juveniles of the cooperatively-breeding cichlid fish Neolamprologus pulcher either consistently provide help in form of alloparental egg care ('cleaners') or consistently abstain from helping ('non-cleaners'). These phenotypes are not based on heritable genetic differences. Instead they arise during ontogeny, which should lead to differences in brain structure or physiology, a currently untested prediction. We compared brain gene expression profiles of cleaners and non-cleaners in two experimental conditions, a helping opportunity and a control condition...
August 15, 2018: Molecular Ecology
Megan Schechtman, Keith E Kocher, Michele M Nypaver, Jason J Ham, Melissa K Zochowski, Michelle L Macy
OBJECTIVES: To characterize emergency department (ED) leader's attitudes toward potentially avoidable admissions and experiences with the use of clinical pathways to guide admission decisions, including the challenges and successes with implementation of these pathways. METHODS: A mixed-methods study of Michigan ED leaders was conducted. First, a cross-sectional web-based survey was distributed via email to all 135 hospital-based EDs in the state. Descriptive statistics were calculated...
August 15, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
O Bamidele, B M Lagan, H McGarvey, D Wittmann, E McCaughan
PURPOSE: Evidence suggests that partners of men with prostate cancer (CaP) experience greater psychosocial distress compared with men themselves. However, the experiences of partners of high-risk (1 in 4) Black African (BA) and Black Caribbean (BC) men with CaP remain poorly understood as existing research has predominantly focused on Caucasian populations. This study aimed to address this gap by exploring partners' experience and support needs as influenced both by the specific impacts of CaP, treatment side effects and socio-cultural context...
August 15, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Xiao-Hui Chen, Dong-Tai Chen, Xiong-Mei Huang, Yong-Hua Chen, Jia-Hao Pan, Xiao-Chun Zheng, Wei-An Zeng
Dexmedetomidine (Dex) is a widely used sedative in anesthesia and critical care units, and it exhibits neuroprotective activity. However, the precise mechanism of Dex-exerted neuroprotection is not clear. Increased neuronal NADPH oxidase 2 (NOX2) contributes to oxidative stress and neuronal damage in various hypoxia-related neurodegenerative disorders. The present study investigated whether Dex regulated neuronal NOX2 to exert its protective effects under hypoxic conditions. Well-differentiated PC12 cells were exposed to cobalt chloride (CoCl2 ) to mimic a neuronal model of chemical hypoxia-mediated neurotoxicity...
August 15, 2018: Neurotoxicity Research
Ros Wade, Alessandro Grosso, Emily South, Claire Rothery, Pedro Saramago, Laetitia Schmitt, Kath Wright, Stephen Palmer
As part of the National Institute for Health and Care Excellence single technology appraisal process, brodalumab was assessed to determine the clinical and cost effectiveness of its use in the treatment of moderate-to-severe plaque psoriasis. The Centre for Reviews and Dissemination and the Centre for Health Economics Technology Assessment Group at the University of York were commissioned to act as the independent Evidence Review Group. This article provides a summary of the Evidence Review Group's review of the company's submission, the Evidence Review Group report and the National Institute for Health and Care Excellence Appraisal Committee's subsequent guidance issued in March 2018...
August 16, 2018: PharmacoEconomics
Constantinos D Zeinalipour-Yazdi, Justin S J Hargreaves, Said Laassiri, C Richard A Catlow
In this perspective we present recent experimental and computational progress in catalytic ammonia synthesis research on metal nitrides involving a combined approach. On this basis, it suggested that the consideration of nitrogen vacancies in the synthesis of ammonia can offer new low energy pathways that were previously unknown. We have shown that metal nitrides that are also known to have high activity for ammonia synthesis can readily form nitrogen vacancies on their surfaces. These vacancies adsorb dinitrogen much more strongly than the defect-free surfaces and can efficiently activate the strong N-N triple bond...
August 16, 2018: Physical Chemistry Chemical Physics: PCCP
Robert Antoniak, Laretta Grabowska-Derlatka, Rafał Maciąg, Tomasz Ostrowski, Ireneusz Nawrot, Zbigniew Gałązka, Sławomir Nazarewski, Olgierd Rowiński
Introduction: True aneurysms of peripancreatic arterial arcades (PAAAs) coexisting with celiac axis lesion are often asymptomatic. However, they may rupture regardless of their size and cause life-threatening hypovolemia. No treatment guidelines exist to date. We present a series of 21 patients and our management algorithm. Material and Methods: For ruptured aneurysms we preformed endovascular embolization. Further treatment was dependent on patient's condition and control studies...
2018: BioMed Research International
Hans-Ullrich Voelker, Lea Frey, Annette Strehl, Michael Weigel
During the multidisciplinary planning of postoperative therapy after breast cancer, borderline cases can arise with no clear rationale for or against adjuvant chemotherapy. In 50 hormone- receptor-positive, Her2neu-negative carcinomas of the breast with no or only minimal lymph node involvement (max. pT1a) we initiated an Oncotype DX® multigene assay in addition to the evaluation of usual parameters. In the oncology conference a vote for or against chemotherapy was taken on the basis of the conventional criteria for decision-making before the test results were available...
2018: International Journal of Breast Cancer
Saffron A G Willis-Owen, Anna Thompson, Paul R Kemp, Michael I Polkey, William O C M Cookson, Miriam F Moffatt, Samantha A Natanek
Skeletal muscle dysfunction is a frequent extra-pulmonary manifestation of Chronic Obstructive Pulmonary Disease (COPD) with implications for both quality of life and survival. The underlying biology nevertheless remains poorly understood. We measured global gene transcription in the quadriceps using Affymetrix HuGene1.1ST arrays in an unselected cohort of 79 stable COPD patients in secondary care and 16 healthy age- and gender-matched controls. We detected 1,826 transcripts showing COPD-related variation. Eighteen exhibited ≥2fold changes (SLC22A3, FAM184B, CDKN1A, FST, LINC01405, MUSK, PANX1, ANKRD1, C12orf75, MYH1, POSTN, FRZB, TNC, ACTC1, LINC00310, MYH3, MYBPH and AREG)...
August 15, 2018: Scientific Reports
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