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The rational clinical exam

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https://www.readbyqxmd.com/read/29425539/-quality-standards-for-ultrasonographic-assessment-of-peripheral-vascular-malformations-and-vascular-tumors-report-of-the-french-society-for-vascular-medicine-2018%C3%A2-update
#1
J P Laroche, S Blaise, F Becker, C Laaeng Massoni, M Nou-Howaldt, O Pichot, H Desmurs-Clavel, J Jeancolas, C Jurus, G Sarlon-Bartoli, V Soulier-Sotto, H Thiel, M A Sevestre-Pietri, J Maloizel-Delaunay, S Mestre-Godin
The quality standards of the French Society of Vascular Medicine for the ultrasonographic assessment of vascular malformations are based on the two following requirements: (1) technical know-how: mastering the use of ultrasound devices and the method of examination; (2) medical know-how: ability to adapt the methods and scope of the examination to its clinical indication and purpose, and to rationally analyze and interpret its results. AIMS OF THE QUALITY STANDARDS: To describe an optimal method of examination in relation to the clinical question and hypothesis...
February 2018: Journal de Médecine Vasculaire
https://www.readbyqxmd.com/read/29424102/complex-care-and-contradictions-of-choice-in-the-safety-net
#2
Meredith Van Natta, Nancy J Burke, Irene H Yen, Sara Rubin, Mark D Fleming, Ariana Thompson-Lastad, Janet K Shim
This article explores the complicated and often-contradictory notions of choice at play in complex care management (CCM) programmes in the US healthcare safety net. Drawing from longitudinal data collected over two years of ethnographic fieldwork at urban safety-net clinics, our study examines the CCM goal of transforming frequent emergency department (ED) utilisers into 'active' patients who will reduce their service utilisation and thereby contribute to a more rational, cost-effective healthcare system. By considering our data alongside philosopher Annemarie Mol's (2008) conceptualisation of the competing logics of choice and care, we argue that these premises often undermine CCM teams' efforts to support patients and provide the care they need - not only to prevent medical crises, but to overcome socio-economic barriers as well...
February 8, 2018: Sociology of Health & Illness
https://www.readbyqxmd.com/read/29417298/targeting-the-pi3k-akt-mtor-pathway-in-triple-negative-breast-cancer-a-review
#3
REVIEW
Ricardo L B Costa, Hyo Sook Han, William J Gradishar
PURPOSE: Triple-negative breast cancer (TNBC) accounts for approximately 20% of breast cancer cases. Although there have been advances in the treatment of hormone receptor-positive and human epidermal growth factor receptor 2-positive breast cancers, targeted therapies for TNBC remain unavailable. In this narrative review, we summarize recent discoveries related to the underlying biology of the phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/mechanistic target of rapamycin (mTOR) pathway in TNBC, examine clinical progress to date, and suggest rational future approaches for investigational therapies in TNBC...
February 7, 2018: Breast Cancer Research and Treatment
https://www.readbyqxmd.com/read/29407161/rational-design-of-curcumin-loaded-multifunctional-mesoporous-silica-nanoparticles-to-enhance-the-cytotoxicity-for-targeted-and-controlled-drug-release
#4
Chao Chen, Wen Sun, Xiaoli Wang, Yibing Wang, Ping Wang
Curcumin has attracted increasing attentions in recent years due to its promising anticancer activities. However, the hydrophobicity of curcumin has limited greatly its efficacy in clinical trials. In this study, folate (FA)-receptor targeting mesoporous silica nanoparticles that promise high loadings of curcumin via pH-sensitive Schiff base reactions were constructed and examined for targeted delivery of curcumin. Such nano-delivery system showed significantly improved stability and biocompatibility of curcumin under physiological conditions...
April 1, 2018: Materials Science & Engineering. C, Materials for Biological Applications
https://www.readbyqxmd.com/read/29405771/biomarker-definitions-and-their-applications
#5
Robert M Califf
Biomarkers are critical to the rational development of medical therapeutics, but significant confusion persists regarding fundamental definitions and concepts involved in their use in research and clinical practice, particularly in the fields of chronic disease and nutrition. Clarification of the definitions of different biomarkers and a better understanding of their appropriate application could result in substantial benefits. This review examines biomarker definitions recently established by the U.S. Food and Drug Administration and the National Institutes of Health as part of their joint Biomarkers, EndpointS, and other Tools (BEST) resource...
February 2018: Experimental Biology and Medicine
https://www.readbyqxmd.com/read/29404575/factors-associated-with-variation-in-long-term-acute-care-hospital-vs-skilled-nursing-facility-use-among-hospitalized-older-adults
#6
Anil N Makam, Oanh Kieu Nguyen, Lei Xuan, Michael E Miller, James S Goodwin, Ethan A Halm
Importance: Despite providing an overlapping level of care, it is unknown why hospitalized older adults are transferred to long-term acute care hospitals (LTACs) vs less costly skilled nursing facilities (SNFs) for postacute care. Objective: To examine factors associated with variation in LTAC vs SNF transfer among hospitalized older adults. Design, Setting, and Participants: We conducted this retrospective observational cohort study of hospitalized older adults (≥65 years) transferred to an LTAC vs SNF during fiscal year 2012 using national 5% Medicare data...
February 5, 2018: JAMA Internal Medicine
https://www.readbyqxmd.com/read/29400987/dose-rounding-of-biologic-and-cytotoxic-anticancer-agents-a-position-statement-of-the-hematology-oncology-pharmacy-association
#7
Rebecca Fahrenbruch, Polly Kintzel, Anne Marie Bott, Steven Gilmore, Ryan Markham
PURPOSE: To present a position statement from the Hematology/Oncology Pharmacy Association (HOPA) that pertains to dose rounding of biologic and cytotoxic anticancer agents. METHODS: The HOPA Standards Committee organized a work group of oncology pharmacist specialists to examine the safety and value of dose rounding of biologic and cytotoxic anticancer agents. Primary literature that describes methods for dose rounding, with clinical or economic data, were analyzed...
February 5, 2018: Journal of Oncology Practice
https://www.readbyqxmd.com/read/29368117/beyond-v40-31-narrative-phenomenology-of-wandering-in-autism-and-dementia
#8
Olga Solomon, Mary C Lawlor
Research on autism spectrum disorder (ASD) and on Alzheimer's Disease (AD) and other types of dementia describes a behaviour called 'wandering', a term that denotes movement through space lacking intention or exact destination, as when a person is disoriented or not self-aware. In the U.S., 'wandering' in both ASD and AD has been examined mostly from a management and prevention perspective. It prioritizes safety while primarily overlooking personal experiences of those who 'wander' and their families, thus limiting the range of potentially effective strategies to address this issue...
January 24, 2018: Culture, Medicine and Psychiatry
https://www.readbyqxmd.com/read/29349856/self-responsibility-rationing-and-treatment-decision-making-managing-moral-narratives-alongside-fiscal-reality-in-the-obesity-surgery-clinic
#9
Amanda Owen-Smith, Joanna Coast, Jenny L Donovan
BACKGROUND: Addressing the prevalence of severe obesity and its concomitant morbidities is widely acknowledged as one of the most pressing global health priorities. Nevertheless, a paucity of effective interventions and universal pressure on health-care budgets means that access to obesity treatments is often limited. Although health-care rationing can be conceived as a socially constructed process, little is known about how decisions emerge within the context of face-to-face doctor-patient interactions...
January 19, 2018: Health Expectations: An International Journal of Public Participation in Health Care and Health Policy
https://www.readbyqxmd.com/read/29340039/integrative-molecular-network-analysis-identifies-emergent-enzalutamide-resistance-mechanisms-in-prostate-cancer
#10
Carly J King, Josha Woodward, Jacob Schwartzman, Daniel J Coleman, Robert Lisac, Nicholas J Wang, Kathryn Van Hook, Lina Gao, Joshua Urrutia, Mark A Dane, Laura M Heiser, Joshi J Alumkal
Recent work demonstrates that castration-resistant prostate cancer (CRPC) tumors harbor countless genomic aberrations that control many hallmarks of cancer. While some specific mutations in CRPC may be actionable, many others are not. We hypothesized that genomic aberrations in cancer may operate in concert to promote drug resistance and tumor progression, and that organization of these genomic aberrations into therapeutically targetable pathways may improve our ability to treat CRPC. To identify the molecular underpinnings of enzalutamide-resistant CRPC, we performed transcriptional and copy number profiling studies using paired enzalutamide-sensitive and resistant LNCaP prostate cancer cell lines...
December 19, 2017: Oncotarget
https://www.readbyqxmd.com/read/29246887/anti-cancer-activity-of-natural-and-synthetic-capsaicin-analogs
#11
Jamie R Friedman, Nick A Nolan, Sarah L Miles, Kathleen C Brown, Austin T Akers, Kate W Colclough, Jessica W Seidler, John M Rimoldi, Monica A Valentovic, Piyali Dasgupta
The nutritional compound capsaicin is the major spicy ingredient of chili peppers. Although traditionally associated analgesic activity, recent studies have shown that capsaicin has profound anti-neoplastic effects in several types of human cancers. However, the applications of capsaicin as a clinically viable drug are limited by its unpleasant side effects like gastric irritation, stomach cramps and burning sensation. This has led to extensive research focused on the identification and rational design of a second generation of non-pungent capsaicin-analogs which will retain the biological activity of capsaicin...
December 15, 2017: Journal of Pharmacology and Experimental Therapeutics
https://www.readbyqxmd.com/read/29246213/the-role-of-emotion-in-clinical-decision-making-an-integrative-literature-review
#12
Desirée Kozlowski, Marie Hutchinson, John Hurley, Joanne Rowley, Joanna Sutherland
BACKGROUND: Traditionally, clinical decision making has been perceived as a purely rational and cognitive process. Recently, a number of authors have linked emotional intelligence (EI) to clinical decision making (CDM) and calls have been made for an increased focus on EI skills for clinicians. The objective of this integrative literature review was to identify and synthesise the empirical evidence for a role of emotion in CDM. METHODS: A systematic search of the bibliographic databases PubMed, PsychINFO, and CINAHL (EBSCO) was conducted to identify empirical studies of clinician populations...
December 15, 2017: BMC Medical Education
https://www.readbyqxmd.com/read/29243783/research-on-the-nutrition-and-cognition-of-high-risk-stroke-groups-in-community-and-the-relevant-factors
#13
N-N Zhao, K-X Zeng, Y-L Wang, P-J Sheng, C-Z Tang, P Xiao, X-W Liu
OBJECTIVE: To investigate the prevalence rate of nutritional risk in high-risk stroke groups in community, analyze its influencing factors, and analyze and compare the relationship between nutritional risk or malnutrition assessed by different nutritional evaluation methods and cognitive function, so as to provide the basis and guidance for clinical nutritional assessment and support. PATIENTS AND METHODS: A cross-sectional survey was performed for 1196 cases in high-risk stroke groups in community from December 2015 to January 2017...
December 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/29204954/chronic-fluoxetine-induces-activity-changes-in-recovery-from-poststroke-anxiety-depression-and-cognitive-impairment
#14
Faranak Vahid-Ansari, Paul R Albert
Poststroke depression (PSD) is a common outcome of stroke that limits recovery and is only partially responsive to chronic antidepressant treatment. In order to elucidate changes in the cortical-limbic circuitry associated with PSD and its treatment, we examined a novel mouse model of persistent PSD. Focal endothelin-1-induced ischemia of the left medial prefrontal cortex (mPFC) in male C57BL6 mice resulted in a chronic anxiety and depression phenotype. Here, we show severe cognitive impairment in spatial learning and memory in the stroke mice...
December 4, 2017: Neurotherapeutics: the Journal of the American Society for Experimental NeuroTherapeutics
https://www.readbyqxmd.com/read/29202449/clonal-relationships-of-csf-b-cells-in-treatment-naive-multiple-sclerosis-patients
#15
Erica L Eggers, Brady A Michel, Hao Wu, Sheng-Zhi Wang, Carolyn J Bevan, Aya Abounasr, Natalie S Pierson, Antje Bischof, Max Kazer, Elizabeth Leitner, Ariele L Greenfield, Stanislas Demuth, Michael R Wilson, Roland G Henry, Bruce Ac Cree, Stephen L Hauser, H-Christian von Büdingen
A role of B cells in multiple sclerosis (MS) is well established, but there is limited understanding of their involvement during active disease. Here, we examined cerebrospinal fluid (CSF) and peripheral blood (PB) B cells in treatment-naive patients with MS or high-risk clinically isolated syndrome. Using flow cytometry, we found increased CSF lymphocytes with a disproportionate increase of B cells compared with T cells in patients with gadolinium-enhancing (Gd+) lesions on brain MRI. Ig gene heavy chain variable region (Ig-VH) repertoire sequencing of CSF and PB B cells revealed clonal relationships between intrathecal and peripheral B cell populations, which could be consistent with migration of B cells to and activation in the CNS in active MS...
November 16, 2017: JCI Insight
https://www.readbyqxmd.com/read/29189822/-cognitive-traps-and-clinical-decisions
#16
Matteo Motterlini
We are fallible, we have limited computational capabilities, limited access to information, little memory. Moreover, in everyday life, we feel joy, fear, anger, and other emotions that influence our decisions in a little, "calculated" way. Not everyone, however, is also aware that the mistakes we make are often systematic and therefore, in particular circumstances, are foreseeable. Doctors and patients are constantly called upon to make decisions. They need to identify relevant information (for example, the symptoms or outcome of an examination), formulate a judgment (for example a diagnosis), choose an action course among the various possible ones based on one's own preferences (e...
December 2017: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/29188854/short-term-impact-of-a-combined-nutraceutical-on-cognitive-function-perceived-stress-and-depression-in-young-elderly-with-cognitive-impairment-a-pilot-double-blind-randomized-clinical-trial
#17
A F Cicero, M Bove, A Colletti, M Rizzo, F Fogacci, M Giovannini, C Borghi
BACKGROUND: The prevalence of senile dementia is increasing worldwide, especially in the developed countries. Nevertheless, drug therapy isn't often enough to treat this condition. Researchers are evaluating the possible impact of a preventive approach, based on an improvement of lifestyle and the intake of micronutrients. Moreover, there is an increasing interest for combined nutraceuticals that can act as memory and learning enhancers, with a significant and beneficial potential on the cognitive disorders...
2017: Journal of Prevention of Alzheimer's Disease
https://www.readbyqxmd.com/read/29184361/phenotypic-and-genotypic-characterization-of-antimicrobial-susceptibility-of-avian-pathogenic-escherichia-coli-isolated-from-broiler-chickens
#18
Gamal Younis, Amal Awad, Nada Mohamed
Aim: Avian pathogenic Escherichia coli (APEC) is pathogenic strains of E. coli that are responsible for one of the most common bacterial diseases affecting poultry worldwide. This study was designed to determine the occurrence, antibiotic resistance profile, and antibiotic resistance genes of E. coli isolated from diseased and freshly dead broilers. Materials and Methods: In that context, a total of 200 broilers samples were examined by standard microbiological techniques for isolation of E...
October 2017: Veterinary World
https://www.readbyqxmd.com/read/29183293/prescribing-patterns-of-rural-family-physicians-a-study-in-kermanshah-province-iran
#19
Fariba Ahmadi, Ehsan Zarei
BACKGROUND: The inappropriate use of drugs due to irrational prescriptions is a common problem in Iran, but there is little evidence of prescription patterns in rural family physicians. This study aimed to explore the prescribing pattern and rational drug use indicators for family physicians using Index of Rational Drug Prescribing (IRDP) in Kermanshah Province, Iran. METHODS: In this retrospective study, 352,399 prescriptions from 184 family physicians in 103 primary health care (PHC) centers were examined...
November 28, 2017: BMC Public Health
https://www.readbyqxmd.com/read/29178420/drooling-is-no-early-sign-of-dysphagia-in-parkinson-s-disease
#20
J C Nienstedt, C Buhmann, M Bihler, A Niessen, R Plaetke, C Gerloff, C Pflug
BACKGROUND: Dysphagia is frequent and clinically highly relevant in Parkinson's disease (PD). For a rational dysphagia screening predictors are required. Previous investigations suggested that drooling correlates with dysphagia and may serve as its early sign. The aim of this study was to clarify the interrelationship of drooling and dysphagia. METHODS: In a controlled, cross-sectional, observational study, a total of 119 Parkinson outpatients and 32 controls were examined clinically and by flexible-endoscopic evaluation of swallowing (FEES)...
November 27, 2017: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
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