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Procedures internal medicine

Sara Gasparini, Ettore Beghi, Edoardo Ferlazzo, Massimiliano Beghi, Vincenzo Belcastro, Klaus P Biermann, Gabriella Bottini, Giuseppe Capovilla, Rosa A Cervellione, Vittoria Cianci, Giangennaro Coppola, Cesare M Cornaggia, Pasquale De Fazio, Salvatore De Masi, Giovambattista De Sarro, Maurizio Elia, Giuseppe Erba, Lucia Fusco, Antonio Gambardella, Valentina Gentile, Anna T Giallonardo, Renzo Guerrini, Francesca Ingravallo, Alfonso Iudice, Angelo Labate, Ersilia Lucenteforte, Adriana Magaudda, Laura Mumoli, Costanza Papagno, Giovanni B Pesce, Eugenio Pucci, Pietrantonio Ricci, Antonino Romeo, Rui Quintas, Chiara Sueri, Giovanna Vitaliti, Riccardo Zoia, Umberto Aguglia
BACKGROUND: The International League Against Epilepsy (ILAE) proposed a diagnostic scheme for psychogenic nonepileptic seizures (PNES). The debate on ethical aspects of the diagnostic procedures is ongoing, the treatment is not standardized, and management might differ according to the age groups. OBJECTIVE: To reach an expert and stakeholder consensus on PNES management. METHODS: A board comprising adult and child neurologists, neuropsychologists, psychiatrists, pharmacologists, experts in forensic medicine and bioethics as well as patients' representatives was formed...
October 9, 2018: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Melanie A Lindenberg, Valesca P Retèl, Joost H van den Berg, Marnix H Geukes Foppen, John B Haanen, Wim H van Harten
Tumor-infiltrating lymphocytes (TIL)-therapy in advanced melanoma is an advanced therapy medicinal product (ATMP) which, despite promising results, has not been implemented widely. In a European setting, TIL-therapy has been in use since 2011 and is currently being evaluated in a randomized controlled trial. As clinical implementation of ATMPs is challenging, this study aims to evaluate early application of TIL-therapy, through the application of a constructive technology assessment (CTA). First the literature on ATMP barriers and facilitators in clinical translation was summarized...
November 2018: Journal of Immunotherapy
Raymond Kelly, Aisling McMahon, Dominic Hegarty
BACKGROUND: The growth of interventional pain medicine in recent years has resulted in more procedures being carried out under fluoroscopic guidance. The proximity of the pain physician (PP) to ionization radiation (IR) potentially increases the risk of radiation exposure to the ocular region. A European directive has reduced the limits of occupational ocular dose 7.5-fold. OBJECTIVES: The objectives of this study are to quantify the typical IR exposure in the ocular region of PP and to compare it to recommended international guidelines...
September 2018: Pain Physician
Stephen Gauthier, Lindsay Melvin, Maria Mylopoulos, Nadine Abdullah
OBJECTIVES: Direct observation is the foundation of assessment and learning in competency-based medical education (CBME). Despite its importance, there is significant uncertainty about how to effectively implement frequent and high-quality direct observation. This is particularly true in specialties where observation of non-procedural skills is highly valued and presents unique challenges. It is therefore important to understand perceptions of direct observation to ensure successful acceptance and implementation...
October 1, 2018: Medical Education
Ian M Godber, Sally C Benton, Callum G Fraser
Quantitative faecal immunochemical tests for haemoglobin (FIT) have now been advocated by the National Institute for Care and Health Excellence (NICE: DG30) to assist in the triage of patients presenting with symptoms that suggest a low risk of colorectal (bowel) cancer. The evidence is that FIT provides a good rule out test for significant bowel disease. However, a small number of cases will be missed, and robust safety-netting procedures are required to follow up some FIT-negative patients. A range of diagnostic pathways are possible, and there is no best approach at present...
October 1, 2018: Journal of Clinical Pathology
D Ryan Ormond, Joseph Kahamba, Kevin O Lillehei, Nicephorus Rutabasibwa
Tanzania sits on the Indian Ocean in East Africa and has a population of over 53 million people. While the gross domestic product has been increasing in recent years, distribution of wealth remains a problem, and challenges in the distribution of health services abound. Neurosurgery is a unique case study of this problem. The challenges facing the development of neurosurgery in Tanzania are many and varied, built largely out of the special needs of modern neurosurgery. Task shifting (training nonphysician surgical providers) and 2-tiered systems (fast-track certification of general surgeons to perform basic neurosurgical procedures) may serve some of the immediate need, but these options will not sustain the development of a comprehensive neurosurgical footprint...
October 2018: Neurosurgical Focus
Ioannis Tsakiridis, Apostolos Mamopoulos, Apostolos Athanasiadis, Themistoklis Dagklis
Importance: Vaginal birth after previous cesarean birth (VBAC) is a reasonable option for many women with previous cesarean delivery. Objective: The aim of this study was to summarize evidence and compare recommendations from national guidelines regarding VBAC. Evidence Acquisition: A descriptive review of 3 national guidelines on VBAC was conducted: Royal College of Obstetricians and Gynaecologists on "Birth After Previous Caesarean Birth," American College of Obstetricians and Gynecologists on "Vaginal Birth After Cesarean Delivery," and Society of Obstetricians and Gynaecologists of Canada on "Guidelines for Vaginal Birth After Previous Caesarean Birth...
September 2018: Obstetrical & Gynecological Survey
Lucio Brugioni, Marco Barchetti, Giovanni Tazzioli, Roberta Gelmini, Massimo Girardis, Marcello Bianchini, Filippo Schepis, Matteo Nicolini, Giovanni Pinelli, Pietro Martella, Marco Barozzi, Francesca Mori, Serena Scarabottini, Andrea Righetti, Mirco Ravazzini, Elisabetta Bertellini
BACKGROUND: In patients with difficult peripheral venous access, alternative techniques require expertise and are invasive, expensive, and prone to serious adverse events. This brought us to designing a new venous catheter (JLB® Deltamed, Inc.) for the cannulation of medium and large bore veins; it is echogenic, and available in different lengths (60 / 70 / 80 mm) and Gauges (14 / 16 / 17 / 18). METHODS: We led a multi-center observational convenience sampling study to evaluate safety and effectiveness of JLB...
September 25, 2018: Journal of Vascular Access
Kazuma Ikeda, Kenneth E Nollet, Hans Vrielink, Hitoshi Ohto
Hematopoietic stem cell transplantation requires a wide-range of expertise and procedural competence, in which nurses play important roles throughout, including stem cell mobilization and collection by apheresis. Little is published about post-licensure nursing education in apheresis, which suggests that it proceeds at the discretion of individual institutions, supplemented with practical training by equipment manufacturers. Information can be obtained on a small number of apheresis training courses for nurses in Australia, Canada, Indonesia, Italy, The Netherlands, Sweden and Turkey, and on nurse certification systems in Turkey and the United States...
September 11, 2018: Transfusion and Apheresis Science
Frederick North, Sidna M Tulledge-Scheitel, John C Matulis, Jennifer L Pecina, Andrew M Franqueira, Sarah S Johnson, Rajeev Chaudhry
Background: There are numerous recommendations from expert sources that help guide primary care providers in cancer screening, infectious disease screening, metabolic screening, monitoring of drug levels, and chronic disease management. Little is known about the potential effort needed for a healthcare system to address these recommendations, or the patient effort needed to complete the recommendations. Methods: For 73 recommended population healthcare items, we examined each of 28,742 patients in a primary care internal medicine practice to determine whether they were up-to-date on recommended screening, immunizations, counseling, and chronic disease management goals...
2018: SAGE Open Medicine
Mohamed A El Mubarak, Evgenios K Stylos, Maria V Chatziathanasiadou, Charikleia Danika, George A Alexiou, Periklis Tsekeris, Alexander Renziehausen, Tim Crook, Nelofer Syed, Gregory B Sivolapenko, Andreas G Tzakos
Temozolomide (TEMODAL™) (TMZ) is an antineoplastic agent that is primarily used for the treatment of glioblastoma and anaplastic gliomas, two aggressive forms of brain cancer. Due to the poor prognosis of brain tumour patients, there is an increasing body of research into improving the stability and delivery of TMZ past the blood brain barrier using carrier molecules. These require accurate determination of TMZ levels for biodistribution and pharmacokinetic evaluation. Unfortunately, current methodologies for the determination of TMZ in human plasma suffer from low reproducibility, recovery, sensitivity or cost ineffective procedures associated with extensive sample cleaning...
September 8, 2018: Journal of Pharmaceutical and Biomedical Analysis
Liqiao Han, Xiaoting Huang, Lu Zhang, Qiaoxuan Zhang, Jianbing Wang, Haibiao Lin, Jun Yan, Junhua Zhuang, Xianzhang Huang
Urea is an important indicator of liver and kidney disease, and very frequently determined in clinical chemistry. The reference measurement procedures (RMPs) for serum urea recognized by the Joint Committee for Traceability in Laboratory Medicine are spectrophotometry, and isotope dilution (ID)-mass spectrometry (MS) coupled with gas chromatography. This study investigated a candidate RMP (cRMP) for detecting serum urea directly via ID-liquid chromatography (LC)-MS/MS, without derivatization, which simplifies pre-processing samples...
September 12, 2018: Journal of Pharmaceutical and Biomedical Analysis
Kathryn Watson, Ada Lam, Shane Arishenkoff, Samantha Halman, Neil E Gibson, Jeffrey Yu, Kathryn Myers, Marcy Mintz, Irene W Y Ma
BACKGROUND: Significant gaps currently exist in the Canadian internal medicine point-of-care ultrasound (POCUS) curriculum. From a learner's perspective, it remains unknown what key POCUS skills should be prioritized. This needs assessment study seeks to establish educational priorities for POCUS for internal medicine residents at five Canadian residency training programs. METHODS: All internal medicine trainees [postgraduate year (PGY) 1-5] from five internal medicine residency training programs in Canada (n = 598) were invited to complete an online survey on 15 diagnostic POCUS applications, 9 bedside procedures, and 18 POCUS knowledge items...
September 20, 2018: BMC Medical Education
Imre Bihari, George Ayoub, Szilvia Bokros, Péter Bihari
INTRODUCTION: With the development of medicine, technical inventions have been intoduced into the therapy of varicose veins, such as ultrasound examination and laser treatment. PATIENTS AND METHODS: Over 11 years 1729 laser surgery were performed on varicose veins. Junctions of saphenous veins, saphenous stems and perforator veins were treated with lasers, but reticular and spider veins were treated with other methods. The most important elements of laser surgery are the introduction of the laser fibre into the lumen of the vein and delivering the laser energy...
September 2018: Magyar Sebészet
N M Uzunov, L Melendez-Alafort, M Bello, G Cicoria, F Zagni, L De Nardo, A Selva, L Mou, C Rossi-Alvarez, G Pupillo, G Di Domenico, L Uccelli, A Boschi, F Groppi, A Salvini, A Taibi, A Duatti, P Martini, M Pasquali, M Loriggiola, M Marengo, L Strada, S Manenti, A Rosato, J Esposito
Evaluation of the radioisotopic purity of technetium-99m (99m Tc) produced in GBq amounts by proton bombardment of enriched molibdenum-100 (100 Mo) metallic targets at low proton energies (i.e. within 15-20 MeV) is conducted. This energy range was chosen since it is easily achievable by many conventional medical cyclotrons already available in the nuclear medicine departments of hospitals. The main motivation for such a study is in the framework of the research activities at the international level that have been conducted over the last few years to develop alternative production routes for the most widespread radioisotope used in medical imaging...
September 19, 2018: Physics in Medicine and Biology
Takenobu Katagiri, Sho Tsukamoto, Yutaka Nakachi, Mai Kuratani
Fibrodysplasia ossificans progressiva (FOP) is a rare genetic disease that is characterized by the formation of heterotopic bone tissues in soft tissues, such as skeletal muscle, ligament, and tendon. It is difficult to remove such heterotopic bones via internal medicine or invasive procedures. The identification of activin A receptor, type I (ACVR1)/ALK2 gene mutations associated with FOP has allowed the genetic diagnosis of FOP. The ACVR1/ALK2 gene encodes the ALK2 protein, which is a transmembrane kinase receptor in the transforming growth factor-β family...
September 2018: Endocrinology and Metabolism
Jarl Torgerson, Lise-Lotte Risö Bergerlind
Patients with severe mental illness suffer an increased somatic mortality and morbidity from cardiovascular disease, diabetes and cancer. Furthermore, they are less likely to have adequate diagnostic and therapeutic procedures for somatic disorders. Life style issues, side effects of pharmacotherapy, cognitive impairment and suboptimal organization of the health care system all contribute. In total, a challenging situation that has to be addressed by the health care system. In Region Västra Götaland, Sweden, new medical routines for psychiatric patients are currently implemented...
September 17, 2018: Läkartidningen
Jing Wang, Yufei Wang, Tianjiao Zhang, Jie Zeng, Haijian Zhao, Qi Guo, Ying Yan, Jiangtao Zhang, Weiyan Zhou, Wenxiang Chen, Chuanbao Zhang
Background Alkaline phosphatase (ALP) is critical for various diseases. The International Federation of Clinical Chemistry and Laboratory Medicine had recommended the new reference procedure in 2011, but many manufacturers did not trace results to the higher procedure. Since 2012, the National Center for Clinical Laboratories (NCCL) in China has organized the trueness verification program (TV) with commutable materials. The present study summarizes the 4-year TV program to give an overview of the measurement standardization for ALP results...
September 18, 2018: Clinical Chemistry and Laboratory Medicine: CCLM
Mary Amanda Dew, Andrea F DiMartini, Fabienne Dobbels, Kathleen L Grady, Sheila G Jowsey-Gregoire, Annemarie Kaan, Kay Kendall, Quincy-Robyn Young, Susan E Abbey, Zeeshan Butt, Catherine C Crone, Sabina De Geest, Christina T Doligalski, Christiane Kugler, Laurie McDonald, Linda Ohler, Liz Painter, Michael G Petty, Desiree Robson, Thomas Schlöglhofer, Terry D Schneekloth, Jonathan P Singer, Patrick J Smith, Heike Spaderna, Jeffrey J Teuteberg, Roger D Yusen, Paula C Zimbrean
The psychosocial evaluation is well-recognized as an important component of the multifaceted assessment process to determine candidacy for heart transplantation, lung transplantation, and long-term mechanical circulatory support (MCS). However, there is no consensus-based set of recommendations for either the full range of psychosocial domains to be assessed during the evaluation, or the set of processes and procedures to be used to conduct the evaluation, report its findings, and monitor patients' receipt of and response to interventions for any problems identified...
July 10, 2018: Psychosomatics
William Beaubien-Souligny, Josée Bouchard, André Denault
PURPOSE OF REVIEW: Following the miniaturization of ultrasound devices, point-of-care ultrasound (POCUS) has been proposed as a tool to enhance the value of physical examination in various clinical settings. The objective of this review is to describe the potential applications of POCUS in end-stage renal disease patients (ESRD). RECENT FINDINGS: With basic training, the clinician can perform pulmonary, vascular, cardiac, and abdominal POCUS at the bedside of ESRD patients...
November 2018: Current Opinion in Nephrology and Hypertension
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