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Clinical outcome research initiative

Michael K Dougherty, Alison T Brenner, Seth D Crockett, Shivani Gupta, Stephanie B Wheeler, Manny Coker-Schwimmer, Laura Cubillos, Teri Malo, Daniel S Reuland
Importance: Colorectal cancer screening (CRC) is recommended by all major US medical organizations but remains underused. Objective: To identify interventions associated with increasing CRC screening rates and their effect sizes. Data Sources: PubMed, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, and were searched from January 1, 1996, to August 31, 2017. Key search terms included colorectal cancer and screening...
October 15, 2018: JAMA Internal Medicine
Charles J Fox, Elyse M Cornett, Brendon M Hart, Aaron J Kaye, Shilpadevi S Patil, Michelle Carroll Turpin, Angelica Valdez, Richard D Urman, Alan D Kaye
Numerous conditions give rise to pulmonary arterial hypertension (PAH), with most of them being idiopathic. Signs and symptoms are generally difficult to recognize initially because they present as nonspecific and typically are mistaken for age-related physiological processes or alternate medical conditions. Many advances have been made toward PAH-specific therapies that have led to advanced clinical management of the disease. The present investigation describes new pulmonary vasodilator agents that are currently available or under development that could impact perioperative management...
June 2018: Best Practice & Research. Clinical Anaesthesiology
Nicola Krähenbühl, Maxwell W Weinberg, Beat Hintermann, Justin M Haller, Charles L Saltzman, Alexej Barg
BACKGROUND: Chronic injuries of the distal tibio-fibular syndesmosis often present with non-specific clinical and radiographic findings. If chronic instability to the distal tibio-fibular syndesmosis is verified, various reconstruction options are available. The purpose of this article is to give a systematic review of current surgical treatment options in patients with chronic syndesmotic injury. METHODS: Three major medical databases were searched from inception through December 12, 2017: PubMed, ScienceDirect, and SpringerLink...
August 30, 2018: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Dawn L DeMeo, Sreeram Ramagopalan, Abhishek Kavati, Ashok Vegesna, Meilan K Han, Anthony Yadao, Teresa K Wilcox, Barry J Make
Background: Previous studies suggest that gender differences exist in COPD diagnosis and symptoms; these differences may be more pronounced in younger adults. Our objective was to explore age-associated gender differences across a range of COPD severities. Materials and methods: A total of 4,484 current and former smokers with COPD from the Genetic Epidemiology of COPD cohort were investigated using regression modeling to explore the association between gender, age, disease severity, and the contributing elements of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification system (symptoms, exacerbation risk, airflow limitation)...
2018: International Journal of Chronic Obstructive Pulmonary Disease
Dana J Lukin, Garrett Lawlor, David P Hudesman, Laura Durbin, Jordan E Axelrad, Monica Passi, Kimberly Cavaliere, Elliot Coburn, Michelle Loftus, Henry Jen, Alexandra Feathers, Melissa H Rosen, Lisa B Malter, Arun Swaminath
Background: Clostridium difficile infection (CDI) is common in patients with inflammatory bowel disease (IBD), often leading to diagnostic confusion and delays in IBD therapy escalation. This study sought to assess outcomes after CDI in IBD patients exposed to new or escalated immunosuppressive therapy. Methods: This multicenter retrospective cohort study included IBD patients with documented CDI at 4 academic medical centers. Data were abstracted from clinical databases at each institution...
October 12, 2018: Inflammatory Bowel Diseases
Shin Ae Park, Harriet Davidson, Kimberly A Thompson, Rachel Policelli Smith, Erica Noland, Dodd Sledge, Jennifer S Thomas, András M Komáromy
CASE DESCRIPTION A client-owned 2-year-old 1.8-kg (4-lb) male pet Rouen duck (Anas platyrhynchos domesticus) was evaluated because of severe swelling around the left eye following traumatic injury to the upper and lower eyelids and 2 associated surgeries that resulted in the removal of the entire upper and lower eyelid margins. CLINICAL FINDINGS At initial evaluation, ankyloblepharon of the left eye was observed, with no upper or lower eyelid margins and a large, round, fluctuant subcutaneous mass over the left orbit...
November 1, 2018: Journal of the American Veterinary Medical Association
Peter E Penson, G B John Mancini, Peter P Toth, Seth S Martin, Gerald F Watts, Amirhossein Sahebkar, Dimitri P Mikhailidis, Maciej Banach
BACKGROUND: The 'placebo effect' and 'nocebo effect' are phenomena whereby beneficial (placebo) or adverse (nocebo) effects result from the expectation that an inert substance will relieve or cause a particular symptom. These terms are often inappropriately applied to effects experienced on drug therapy. Quantifying the magnitude of placebo and nocebo effects in clinical trials is problematic because it requires a 'no treatment' arm. To overcome the difficulties associated with measuring the nocebo effect, and the fact that its definition refers to inert compounds, rather than drugs, we introduce the concept of 'drucebo' (a combination of DRUg and plaCEBO or noCEBO) to relate to beneficial or adverse effects of a drug, which result from expectation and are not pharmacologically caused by the drug...
October 11, 2018: Journal of Cachexia, Sarcopenia and Muscle
John-Michael Gamble, Jennifer R Donnan, Eugene Chibrikov, Laurie K Twells, William K Midodzi, Sumit R Majumdar
Although the glucose lowering effect of dipeptidyl peptidase-4 (DPP4) inhibitors is well established, several potential serious acute safety concerns have been raised including acute kidney injury, respiratory tract infections, and acute pancreatitis. Using the UK-based Clinical Practice Research Datalink (CPRD), we identified initiators (365-day washout period) of DPP4 inhibitors and relevant comparators including initiators of sulfonylureas, metformin, thiazolidinediones, and insulin between January 2007 and January 2016 to quantify the association between DPP4 inhibitors and three acute health events - acute kidney injury, respiratory tract infections, and acute pancreatitis...
October 11, 2018: Scientific Reports
Naomi Lince-Deroche, Craig van Rensburg, Jaqueline Roseleur, Busola Sanusi, Jane Phiri, Pam Michelow, Jennifer S Smith, Cindy Firnhaber
BACKGROUND: Cervical cancer incidence is significant in countries, such as South Africa, with high burdens of both HIV and human papillomavirus (HPV). Cervical cancer is largely preventable if dysplasia is diagnosed and treated early, but there is debate regarding the best approaches for screening and treatment, especially for low-resource settings. Currently South Africa provides Pap smears followed by colposcopic biopsy and LEEP if needed in its public health facilities. We estimated the costs and cost-effectiveness of two approaches for treating cervical intraepithelial neoplasia grade 2 or higher (CIN2+) among HIV-infected women, most of whom were taking antiretroviral treatment, at a public HIV treatment facility in Johannesburg, South Africa...
2018: PloS One
Claire Snyder, Katherine Smith, Bernhard Holzner, Yonaira M Rivera, Elissa Bantug, Michael Brundage
PURPOSE: Patient-reported outcomes (PROs) can promote patient-centered care in multiple ways: (1) using an individual patient's PRO data to inform his/her management, (2) providing PRO results from comparative research studies in patient educational materials/decision aids, and (3) reporting PRO results from comparative research studies in peer-reviewed publications. Patients and clinicians endorse the value of PRO data; however, variations in how PRO measures are scored and scaled, and in how the data are reported, make interpretation challenging and limit their use in clinical practice...
October 10, 2018: Quality of Life Research
Fang Fang, Xiaohan Hu, Xiaomei Dai, Sanfeng Wang, Zhenjiang Bai, Jiao Chen, Jian Pan, Xiaozhong Li, Jian Wang, Yanhong Li
BACKGROUND: Research on acute kidney injury (AKI) has focused on identifying early biomarkers. However, whether AKI could be diagnosed in the absence of the classic signs of clinical AKI and whether the condition of subclinical AKI, identified by damage or functional biomarkers in the absence of oliguria or increased serum creatinine (sCr) levels, is clinically significant remains to be elucidated in critically ill children. The aims of the study were to investigate the associations between urinary cystatin C (uCysC) levels and AKI and mortality and to determine whether uCysC-positive subclinical AKI is associated with adverse outcomes in critically ill neonates and children...
October 10, 2018: Critical Care: the Official Journal of the Critical Care Forum
Nicholas Rubashkin, Ruby Warnock, Nadia Diamond-Smith
INTRODUCTION: We conducted a systematic review to summarize the global evidence on person-centered care (PCC) interventions in delivery facilities in order to: (1) map the PCC objectives of past interventions (2) to explore the impact of PCC objectives on PCC and clinical outcomes. METHODS: We developed a search strategy based on a current definition of PCC. We searched for English-language, peer-reviewed and original research articles in multiple databases from 1990 to 2016 and conducted hand searches of the Cochrane library and gray literature...
October 10, 2018: Reproductive Health
Tiphaine Ruggeri, Cédric Jacqueline, Xavier Ambrosi, Alexis Broquet, Juliette Desfrançois, Antoine Roquilly, Frédéric Altare, Karim Asehnoune
OBJECTIVES: In patients with spinal cord injury, spinal cord injury-immune depression syndrome induces pneumonia. We aimed to develop a new spinal cord injury-immune depression syndrome mouse model and to test antiprogrammed cell death 1 therapy. DESIGN: Experimental study. SETTING: Research laboratory. SUBJECTS: RjOrl: SWISS and BALB/cJ mice. INTERVENTIONS: Mouse model of spinal cord injury-immune depression syndrome followed by a methicillin-susceptible Staphylococcus aureus pneumonia...
October 9, 2018: Critical Care Medicine
Rebecca J Guy, James Ward, Louise M Causer, Lisa Natoli, Steven G Badman, Annie Tangey, Belinda Hengel, Handan Wand, David Whiley, Sepehr N Tabrizi, Mark Shephard, Christopher K Fairley, Basil Donovan, David A Anderson, David G Regan, Lisa Maher, John M Kaldor
BACKGROUND: Timely diagnosis and treatment of sexually transmissible infections will prevent morbidity and onward transmission. We aimed to assess the efficacy of a point-of-care molecular test for Chlamydia trachomatis and Neisseria gonorrhoeae infections at the cluster level to improve infection management among Indigenous Australian communities with high prevalence of sexually transmissible infections. METHODS: In this cluster-randomised crossover study, we recruited primary health services in Western Australia, Far North Queensland, and South Australia that provide care to Indigenous people in regional or remote locations...
October 2018: Lancet Infectious Diseases
Craig S Anderson, Mark Woodward, Hisatomi Arima, Xiaoying Chen, Richard I Lindley, Xia Wang, John Chalmers, Thompson G Robinson
Background The ENhanced Control of Hypertension And Thrombolysis strokE study (ENCHANTED) trial was initiated as a 2 × 2 partial-factorial active-comparison, prospective, randomized, open, blinded endpoint clinical trial to evaluate in thrombolysis-eligible acute ischemic stroke (AIS) patients whether: (1) Arm A - low-dose (0.6 mg/kg body weight) intravenous (iv) alteplase has noninferior efficacy and lower risk of symptomatic intracerebral hemorrhage (sICH) compared with standard-dose (0.9 mg/kg body weight) iv alteplase; and (2) Arm B - early intensive blood pressure (BP) lowering (systolic target 130-140 mmHg) has superior efficacy and lower risk of ICH compared with guideline-recommended BP control (systolic target <180 mmHg)...
October 9, 2018: International Journal of Stroke: Official Journal of the International Stroke Society
John-Michael Gamble, Eugene Chibrikov, William K Midodzi, Laurie K Twells, Sumit R Majumdar
OBJECTIVES: To compare population-based incidence rates of new-onset depression or self-harm in patients initiating incretin-based therapies with that of sulfonylureas (SU) and other glucose-lowering agents. DESIGN: Population-based cohort study. SETTING: Patients attending primary care practices registered with the UK-based Clinical Practice Research Datalink (CPRD). PARTICIPANTS: Using the UK-based CPRD, we identified two incretin-based therapies cohorts: (1) dipeptidyl peptidase-4 inhibitor (DPP-4i)-cohort, consisting of new users of DPP-4i and SU and (2) glucagon-like peptide-1 receptor agonists (GLP-1RA)-cohort, consisting of new users of GLP-1RA and SU, between January 2007 and January 2016...
October 8, 2018: BMJ Open
Nam S Hoang, Winifred Hwang, Danielle A Katz, Sean C Mackey, Lawrence V Hofmann
INTRODUCTION: Patient-reported outcomes are important for clinical research and will likely be used in the near future as a metric for physician reimbursement. This study aims to evaluate the implementation of an electronic data collection system for deep vein thrombosis and lymphedema quality-of-life (QOL) questionnaires in a tertiary care interventional radiology practice. METHODS: A single provider's clinic patients were automatically e-mailed validated questionnaires 1 week before their appointments...
October 5, 2018: Journal of the American College of Radiology: JACR
Adam T Hill, Philip M Gold, Ali El Solh, Joshua P Metlay, Belinda Ireland, Richard S Irwin
BACKGROUND: Patients commonly present to primary care services with upper and lower respiratory tract infections and guidelines to help clinicians investigate and treat acute cough due to suspected pneumonia and influenza are needed. METHODS: A systematic search was carried out with eight PICO questions related to acute cough with suspected pneumonia or influenza. RESULTS: There was a lack of randomized controlled trials in the setting of outpatients presenting with acute cough due to suspected pneumonia or influenza that were not hospitalized...
October 5, 2018: Chest
K Papaikonomou, Helena Kopp Kallner, Fabian Söderdahl, K Gemzell-Danielsson
STUDY QUESTION: Does pre-treatment with a low dose of mifepristone improve irregular vaginal bleeding patterns during the initial 3 months after LNG-IUS placement? SUMMARY ANSWER: Mifepristone treatment prior to LNG-IUS insertion results in significantly lower bleeding and spotting rates for the first month post insertion but no significant reduction at 3 months post insertion. WHAT IS KNOWN ALREADY: One of the leading causes of premature discontinuation of the LNG-IUS is unscheduled bleeding in the first months following its insertion...
October 8, 2018: Human Reproduction
Louis S Matza, Katie D Stewart, Rosirene Paczkowski, Karin S Coyne, Brooke Currie, Kristina S Boye
Background: Previous research has examined patient perceptions of insulin injection devices. However, a range of injectable medications other than insulin are now used to treat type 2 diabetes. No patient-reported outcome (PRO) instruments have been developed taking into account the perceptions of patients using newer injection devices, which are often different from those used in the past. Therefore, the primary purpose of this study was to evaluate a new PRO instrument focusing on patients' experiences with injection devices, including those used for newer treatments such as GLP-1 receptor agonists...
December 2018: Journal of patient-reported outcomes
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