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reviews in clinical medicine

Brian J Christensen, Earl Peter Park, Steven Nelson, Brett J King
PURPOSE: Pain and swelling from a necrotic tooth is a common complaint in emergency departments. These patients impose substantial burdens on hospital budgets and provider time. The initial triage of odontogenic infections can be difficult without advanced knowledge and training in head and neck anatomy and odontogenic disease pathogenesis. The purpose of this study was to determine the frequency with which emergency medicine physicians correctly determine the need for computed tomography (CT) and specialist consultation in patients with odontogenic infections...
July 24, 2018: Journal of Oral and Maxillofacial Surgery
Mohamadmahdi Samandari, María Gil Juliá, Alistair Rice, Antonios Chronopoulos, Armando E Del Río Hernández
Pancreatic cancer is one of the main causes of cancer related deaths worldwide. It is asymptomatic at an early stage, and most diagnosis occurs when the disease is already at a late stage, by which time the tumor is nonresectable. In order to increase the overall survival of patients with pancreatic cancer, as well as to decrease the cancer burden, it is necessary to perform early diagnosis, prognosis stratifications and cancer monitoring using accurate, minimally invasive and cost-effective methods. Liquid biopsies seek to detect tumor-associated biomarkers in a variety of extractable body fluids and can help to monitor treatment response and disease progression, and even predict patient outcome...
July 26, 2018: Translational Research: the Journal of Laboratory and Clinical Medicine
Jose Garnacho-Montero, Irene Barrero-García, Maria de Gracia Gómez-Prieto, Ignacio Martín-Loeches
Despite advances in modern medicine, severe community-acquired pneumonia (CAP) continues to be a potentially deadly disease. Mortality rate reaches up to the 50% in patients requiring admission to the Intensive Care Unit (ICU) when developing septic shock. Areas covered: We aim to describe the optimal management of severe CAP including antibiotic therapy, future antimicrobial options, and non-antibiotic (so-called adjunctive) therapies. A literature search was performed to identify all clinical trials, observational studies, meta-analysis, and reviews about this topic from PubMed...
August 17, 2018: Expert Review of Anti-infective Therapy
Abdul Karim Suleman Cara, Syed Tabish Razi Zaidi, Fatima Suleman
Background Gram negative pathogens are increasingly resistant to commonly used first line antibiotics and colistin is in most cases the only medicine available. There is very limited information available comparing the effectiveness and costs of low versus high dose colistin with studies showing efficacy with both doses and with variable levels of adverse effects. The absence of a definite dosing strategy makes a model to compare low dose and high dose colistin invaluable in making decisions regarding the appropriate use of colistin...
August 16, 2018: International Journal of Clinical Pharmacy
Gabrielle King, Kathryn D Baker, Madelyne A Bisby, Diana Chan, Caitlin S M Cowan, Anthea A Stylianakis, Kelsey S Zimmermann, Rick Richardson
There is a pressing need to improve treatments for anxiety. Although exposure-based therapy is currently the gold-standard treatment, many people either do not respond to this therapy or experience a relapse of symptoms after treatment has ceased. In recent years, there have been many novel pharmacological agents identified in preclinical research that have potential as adjuncts for exposure therapy, yet very few of these are regularly integrated into clinical practice. Unfortunately, the robust effects observed in the laboratory animal often do not translate to a clinical population...
August 16, 2018: Psychopharmacology
Steven O Tenny, Kyle P Schmidt, Kenneth A Follett
Introduction Requests for muscle biopsy for evaluation of myopathy originate from a variety of different specialties. It is unknown whether the specialty of the referring service affects the likelihood of diagnostic biopsy or the therapeutic usefulness of a biopsy. Methods We reviewed 106 consecutive muscle biopsies requested by healthcare providers in neurology, rheumatology, family medicine, oncology, and gastroenterology. We tested for an association between referring service and whether the biopsy yielded a definitive pathology result or provided therapeutically useful results...
June 13, 2018: Curēus
Runfeng Li, Mark Zanin, Xueshan Xia, Zifeng Yang
Despite major advances in medicine, infectious diseases still pose a significant threat to humanity. Mammalian models of disease have proved extremely useful in adding to the understanding of infectious diseases and the development of prophylactic and/or therapeutic interventions. Arguably the most important considerations of any animal model are (I) the similarity of the model to humans with respect to anatomy, physiology, immunology and disease progression, and (II) the expense of conducting experiments using the model organism...
July 2018: Journal of Thoracic Disease
Joshua J Meeks, Amir Goldkorn, Ana M Aparicio, David J McConkey
Translational medicine (TM) components of prospective clinical trials provide an invaluable opportunity to test hypotheses that contribute to our knowledge of human disease biology and/or the mechanism of action of a given therapeutic intervention. Our ability to sample tumors and their microenvironment, and the depth and breadth of biological information that can be extracted from them, has increased exponentially in recent years. This information is critical to guide the next steps clinical research if we are to accelerate the pace of progress in cancer treatment...
August 13, 2018: Urologic Oncology
Barbara L Parsons
An accurate understanding of the clonal origins of tumors is critical for designing effective strategies to treat or prevent cancer and for guiding the field of cancer risk assessment. The intent of this review is to summarize evidence of multiclonal tumor origin and, thereby, contest the commonly held assumption of monoclonal tumor origin. This review describes relevant studies of X chromosome inactivation, analyses of tumor heterogeneity using other markers, single cell sequencing, and lineage tracing studies in aggregation chimeras and engineered rodent models...
July 2018: Mutation Research
Vladica M Veličković, Ursula Rochau, Annette Conrads-Frank, Frank Kee, Stefan Blankenberg, Uwe Siebert
Introduction Despite the emphasis on the clinical importance of cardiac troponin assays (cTn), there are insufficient cost-effectiveness comparisons of various troponin test protocols for the diagnosis of myocardial infarction (MI). Therefore, the purpose of review was to identify and systematically assess published economic evaluations using decision-analytic models for diagnostic testing strategies based on cTn, and to make recommendations for the development of future models. Areas covered MEDLINE, Science Direct, Cochrane Database, CRD Database and grey literature were screened for full economic evaluation studies with relevant clinical outcomes over a defined time horizon addressing a population with suspected myocardial infarction (MI) and comparison of different diagnostic test strategies...
August 17, 2018: Expert Review of Pharmacoeconomics & Outcomes Research
Dave deBronkart
Professionalism in any field requires keeping pace with change, and nowhere is it more true than medicine. Knowledge flow has changed dramatically since today's accreditation standards were developed, and change continues more rapidly than ever. It's time for a fresh look at how best to achieve care in this altered environment, where valid knowledge may come from the patient as well as from clinician resources: a sociological change driven by technological change. The power structure of the clinical relationship is inevitably altered as constraints on patient knowledge are loosened by the internet, apps, and devices, undermining a paradigm of patients as uninformed recipients of care based on a one-way flow of wisdom from providers...
August 16, 2018: International Journal of Psychiatry in Medicine
Ya-Lan Shih, Yu-Ching Hsu, Wei-Hsin Chiu, Co-Shi Chantal Chao
Preparing for a good death is an important and meaningful concept in Chinese culture because people hope to know residual life to make effort for their unfinished business. However, the family of terminally ill patients with cancer may be annoyed and frustrated about unexpected bereavement if they have unresolved conflicts with the loved one, missing a chance for declaring love, untimely apologizing and saying goodbye. The study aimed to explore this difficult issue. The medical records of 121 deceased terminally ill patients with cancer at National Cheng Kung University Hospital between December 2010 and February 2012 were reviewed...
September 2018: Holistic Nursing Practice
Toshio Takahashi
A wide variety of organs are in a dynamic state, continuously undergoing renewal as a result of constant growth and differentiation. Stem cells are required during these dynamic events for continuous tissue maintenance within the organs. In a steady state of production and loss of cells within these tissues, new cells are constantly formed by differentiation from stem cells. Today, organoids derived from either adult stem cells or pluripotent stem cells can be grown to resemble various organs. As they are similar to their original organs, organoids hold great promise for use in medical research and the development of new treatments...
August 16, 2018: Annual Review of Pharmacology and Toxicology
John W Devlin, Yoanna Skrobik, Céline Gélinas, Dale M Needham, Arjen J C Slooter, Pratik P Pandharipande, Paula L Watson, Gerald L Weinhouse, Mark E Nunnally, Bram Rochwerg, Michele C Balas, Mark van den Boogaard, Karen J Bosma, Nathaniel E Brummel, Gerald Chanques, Linda Denehy, Xavier Drouot, Gilles L Fraser, Jocelyn E Harris, Aaron M Joffe, Michelle E Kho, John P Kress, Julie A Lanphere, Sharon McKinley, Karin J Neufeld, Margaret A Pisani, Jean-Francois Payen, Brenda T Pun, Kathleen A Puntillo, Richard R Riker, Bryce R H Robinson, Yahya Shehabi, Paul M Szumita, Chris Winkelman, John E Centofanti, Carrie Price, Sina Nikayin, Cheryl J Misak, Pamela D Flood, Ken Kiedrowski, Waleed Alhazzani
OBJECTIVE: To update and expand the 2013 Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the ICU. DESIGN: Thirty-two international experts, four methodologists, and four critical illness survivors met virtually at least monthly. All section groups gathered face-to-face at annual Society of Critical Care Medicine congresses; virtual connections included those unable to attend. A formal conflict of interest policy was developed a priori and enforced throughout the process...
September 2018: Critical Care Medicine
Anthony J Lewis, Janet S Lee, Matthew R Rosengart
OBJECTIVE: Our knowledge of the molecular mechanisms of sepsis has attained exponential growth. Yet, the pillars of its care remain antibiotics, fluid resuscitation, and physiologic support of failing organ systems. The inability to bring biologic breakthroughs to the bedside is not for lack of effort. Over 60 clinical trials of novel therapies, each heavily supported by the momentum of biologic data suggesting clinical utility, have been conducted and have failed to identify benefit...
September 2018: Critical Care Medicine
Eliza Gordon-Lipkin, Ali Fatemi
Leukodystrophies are a heterogeneous class of genetic diseases affecting the white matter in the central nervous system with a broad range of clinical manifestations and a frequently progressive course. An interest in precision medicine has emerged over the last several decades, and biomedical research in leukodystrophies has made exciting advances along this front through therapeutic target discovery and novel disease model systems. In this review, we discuss current and emerging therapeutic approaches in leukodystrophies, including gene therapy, antisense oligonucleotide therapy, CRISPR/CAS-based gene editing, and cell and stem cell based therapies...
August 16, 2018: Journal of Child Neurology
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
Marcin F Osuchowski, Alfred Ayala, Soheyl Bahrami, Michael Bauer, Mihaly Boros, Jean-Marc Cavaillon, Irshad H Chaudry, Craig M Coopersmith, Clifford Deutschman, Susanne Drechsler, Philip Efron, Claes Frostell, Gerhard Fritsch, Waldemar Gozdzik, Judith Hellman, Markus Huber-Lang, Shigeaki Inoue, Sylvia Knapp, Andrey V Kozlov, Claude Libert, John C Marshall, Lyle L Moldawer, Peter Radermacher, Heinz Redl, Daniel G Remick, Mervyn Singer, Christoph Thiemermann, Ping Wang, W Joost Wiersinga, Xianzhong Xiao, Basilia Zingarelli
BACKGROUND: Pre-clinical animal studies precede the majority of clinical trials. While the clinical definitions of sepsis and recommended treatments are regularly updated, a systematic review of pre-clinical models of sepsis has not been done and clear modeling guidelines are lacking. OBJECTIVE: To address this deficit, a Wiggers-Bernard Conference on pre-clinical sepsis modeling was held in Vienna in May 2017. The goal of the conference was to identify limitations of pre-clinical sepsis models and to propose a set of guidelines, defined as the "Minimum Quality Threshold in Pre-Clinical Sepsis Studies" (MQTiPSS), to enhance translational value of these models...
August 14, 2018: Intensive Care Medicine Experimental
Tarun Sharma, Aradhna Sharma, Dheeraj Kapoor
Context: Aluminum phosphide (ALP) is a highly toxic agricultural fumigant pesticide commonly implicated in poisoning. Aim: The aim of the study was to study the profile of patients presenting with ALP poisoning in Dr. RPGMC Kangra, Tanda, Himachal Pradesh. Settings and Design: This was a retrospective study conducted in the Department of Medicine at Dr. RPGMC Kangra, Tanda, Himachal Pradesh, from August 2011 to January 2014. Material and Methods: Case record forms of 117 patients were reviewed and analyzed...
May 2018: Journal of Family Medicine and Primary Care
Hari Kusnanto, Dwi Agustian, Dany Hilmanto
Biopsychosocial model is a useful worldview for primary care or family doctors. However, it is often considered as impractical or too complicated. The objective of this study is to review the implementation of the biopsychosocial model in clinical practice, and its contributions to clinical outcomes. Hermeneutic circle literature review was conducted to provide experiential learning in an attempt to understand biopscyhosocial model, first developed by George Engel. Literature search started with review articles in Medline and Scopus as search engines...
May 2018: Journal of Family Medicine and Primary Care
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