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The rational clinical exam

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https://www.readbyqxmd.com/read/29035729/pre-clinical-in-vitro-infection-models
#1
REVIEW
George L Drusano
Given the current magnitude of the problem of antimicrobial resistance, particularly in the hospital setting, getting new agents to patients at the right dose and schedule is incredibly important. In vitro systems such as the 1-compartment model and the hollow fiber infection model (HFIM) can provide valuable information that allows rational decisions to be made which will drive the best choices of dose and schedule. Studies identifying the dynamically-linked index (dose fractionation studies) and the size of the index to obtain a specific amount of bacterial kill can be performed in both systems...
October 13, 2017: Current Opinion in Pharmacology
https://www.readbyqxmd.com/read/29029694/prescriber-response-to-computerized-drug-alerts-for-electronic-prescriptions-among-hospitalized-patients
#2
Yael Zenziper Straichman, Daniel Kurnik, Ilan Matok, Hillel Halkin, Noa Markovits, Amitai Ziv, Ari Shamiss, Ronen Loebstein
BACKGROUND: Clinical decision support systems (CDSS) reduce prescription errors, but their effectiveness is reduced by high alert rates, "alert fatigue", and indiscriminate rejection. OBJECTIVES: To compare acceptance rates of alerts generated by the SafeRx(®) prescription CDSS among different alert types and departments in a tertiary care hospital, identify factors associated with alert acceptance, and determine whether alert overrides were justified. METHODS: In a retrospective study, we compared acceptance rates of all prescription alerts generated in 2013 in 18 departments of Israel's largest tertiary care center...
November 2017: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/29027409/-developing-traditional-chinese-medicine-injection-is-the-need-for-curing-sickness-to-save-patients
#3
Ping He, Feng-Jie Li, Lian-da Li, Yi-Kui Li
Safety issues of traditional Chinese medicine injections has been heated debate. There are two diametrically opposed views: it should be used reasonable and developed healthily or be forbidden to use. Some people have many misunderstandings and prejudices about the safety of traditional Chinese medicine injections. Compared with western medicine,traditional Chinese medicine has its own particularity. Traditional Chinese medicine has complex components. Its research and clinical application is different from western medicine...
March 2017: Zhongguo Zhong Yao za Zhi, Zhongguo Zhongyao Zazhi, China Journal of Chinese Materia Medica
https://www.readbyqxmd.com/read/29019349/do-workers-health-surveillance-examinations-fulfill-their-occupational-preventive-objective-analysis-of-the-medical-practice-of-occupational-physicians-in-catalonia-spain
#4
Mari Cruz Rodríguez-Jareño, Emilia Molinero, Jaume de Montserrat, Antoni Vallès, Marta Aymerich
OBJECTIVES: Although routine workers' health examinations are extensively performed worldwide with important resource allocation, few studies have analyzed their quality. The objective of this study has been to analyze the medical practice of workers' health examinations in Catalonia (Spain) in terms of its occupational preventive aim. MATERIAL AND METHODS: A cross-sectional study was carried out by means of an online survey addressed to occupational physicians who were members of the Catalan Society of Safety and Occupational Medicine...
October 6, 2017: International Journal of Occupational Medicine and Environmental Health
https://www.readbyqxmd.com/read/28985300/focus-on-early-career-gps-qualitative-evaluation-of-a-multi-faceted-educational-intervention-to-improve-antibiotic-prescribing
#5
Laura Deckx, Sibyl Anthierens, Parker J Magin, Simon Morgan, Lawrie McArthur, Lucy Yardley, Anthea Dallas, Paul Little, Mieke L van Driel
Background: We conducted an educational intervention emphasizing rational antibiotic prescribing in early-career General Practitioners (GP) in vocational training (trainees). The intervention consisted of an online introduction module, an online communication training module, face-to-face workshops, and cases to be discussed one-on-one by the trainee-supervisor dyad during regular scheduled education sessions. Objectives: To explore the participants' experiences with the intervention...
July 17, 2017: Family Practice
https://www.readbyqxmd.com/read/28958590/a-novel-approach-using-metabolomics-coupled-with-hematological-and-biochemical-parameters-to-explain-the-enriching-blood-effect-and-mechanism-of-unprocessed-angelica-sinensis-and-its-4-kinds-of-processed-products
#6
Peng Ji, Yanming Wei, Yongli Hua, Xiaosong Zhang, Wanling Yao, Qi Ma, Ziwen Yuan, Yanqiao Wen, Chaoxue Yang
ETHNOPHARMACOLOGICAL RELEVANCE: Angelica sinensis (AS), root of Angelica sinensis (Oliv.) Diels, an important kind of Chinese traditional herbal medicine, has been used for women to enrich the blood for thousands of years. It is mainly distributed in Gansu province of China. According to Traditional Chinese medicine usage, unprocessed AS (UAS) and its 4 kinds of processed products (ASs) are all used to treat different diseases or syndromes. The difference among the enriching-blood effects of ASs is unclear...
September 25, 2017: Journal of Ethnopharmacology
https://www.readbyqxmd.com/read/28957417/molecular-subtype-specific-efficacy-of-mek-inhibitors-in-pancreatic-cancers
#7
Diána Brauswetter, Bianka Gurbi, Attila Varga, Edit Várkondi, Richárd Schwab, Gábor Bánhegyi, Orsolya Fábián, György Kéri, István Vályi-Nagy, István Peták
Pancreatic cancer is an increasing cause of cancer related death worldwide. KRAS is the dominant oncogene in this cancer type and molecular rationale would indicate, that inhibitors of the downstream target MEK could be appropriate targeted agents, but clinical trials have failed so far to achieve statistically significant benefit in unselected patients. We aimed to identify predictive molecular biomarkers that can help to define subgroups where MEK inhibitors might be beneficial alone or in combination. Next-generation sequencing data of 50 genes in three pancreatic cancer cell lines (MiaPaCa2, BxPC3 and Panc1) were analyzed and compared to the molecular profile of 138 clinical pancreatic cancer samples to identify the molecular subtypes of pancreatic cancer these cell lines represent...
2017: PloS One
https://www.readbyqxmd.com/read/28951964/ct-guided-minimally-invasive-treatment-for-an-extensive-spinal-epidural-abscess-a-case-report-and-literature-review
#8
Bing Ran, XinRong Chen, Qiong Zhong, Min Fu, Jun Wei
PURPOSE: We present a case involving an extensive epidural abscess that was successfully treated with computed tomography (CT)-guided percutaneous needle drainage and systemic antibiotic therapy. METHODS: A 44-year-old woman with a history of spine injection procedures complained of severe backache and progressive radiating pain in her right lower extremity followed by sensory deficits in her right lower limb. A laboratory examination revealed leukocytosis and hyperglycemia...
September 22, 2017: European Spine Journal
https://www.readbyqxmd.com/read/28938415/rationalizing-thyroid-function-testing-which-tsh-cut-offs-are-optimal-for-testing-free-t4
#9
Meg Henze, Suzanne J Brown, Narelle C Hadlow, John P Walsh
Context: Thyroid function testing often utilizes TSH measurement first, then reflex testing for free T4 if TSH is outside reference range limits. The utility of different TSH cut-offs for reflex testing is unknown. Objective: To examine different TSH cut-offs for reflex free T4 testing. Design, setting and patients: We analyzed concurrent TSH and free T4 results from 120 403 individuals from a single laboratory in Western Australia (clinical cohort) and 4568 Busselton Health Study participants (community cohort)...
August 30, 2017: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28932912/behavioral-cognitive-and-emotional-coping-strategies-of-women-with-endometriosis-a-critical-narrative-review
#10
REVIEW
Cristina Zarbo, Agostino Brugnera, Luigi Frigerio, Chiara Malandrino, Massimo Rabboni, Emi Bondi, Angelo Compare
Endometriosis is a disabling and long-term medical condition affecting quality of life and mental health. Behavioral, cognitive, and emotional coping strategies, emotional intelligence, and metacognition could in part explain the link between the disease and impaired psychological and life functioning. This critical narrative review aimed at examining the state of the art of the relationships between endometriosis and these factors. According to PRISMA principles, we performed a systematic search for quantitative and qualitative studies on multiple electronic databases as regards coping strategies, emotional intelligence, and metacognition in women with endometriosis...
September 21, 2017: Archives of Women's Mental Health
https://www.readbyqxmd.com/read/28932314/cost-effectiveness-analysis-of-treatment-acute-deep-vein-thrombosis-in-clinic-of-vascular-surgery-sarajevo
#11
Haris Vukas, Samra Kadić-Vukas, Adis Salihbegović, Muhamed Djedović, Dragan Totić, Haris Vranić, Amel Hadžimehmedagić
AIM: To compare hospital costs of acute deep vein thrombosis (ADVT) treatment in two periods of time. Evidence of repercussions on reducing costs during successful treatment. Attention was given to the necessity, costs and effectiveness of diagnostic procedures, treatment and complications. METHODS: A retrospective analysis of data obtained from patients medical history in a period from 2000 to 2016. Model management and safe practice of ADVT care consisted of clinical examination, laboratory, colour Doppler and invasive diagnostics...
August 15, 2017: Open Access Macedonian Journal of Medical Sciences
https://www.readbyqxmd.com/read/28929083/emerging-therapies-for-stage-iii-non-small-cell-lung-cancer-stereotactic-body-radiation-therapy-and-immunotherapy
#12
REVIEW
Sameera S Kumar, Kristin A Higgins, Ronald C McGarry
The current standard of care for locally advanced non-small cell lung cancer (NSCLC) includes radiation, chemotherapy, and surgery in certain individualized cases. In unresectable NSCLC, chemoradiation has been the standard of care for the past three decades. Local and distant failure remains high in this group of patients, so dose escalation has been studied in both single institution and national clinical trials. Though initial studies showed a benefit to dose escalation, phase III studies examining dose escalation using standard fractionation or hyperfractionation have failed to show a benefit...
2017: Frontiers in Oncology
https://www.readbyqxmd.com/read/28918655/what-not-to-do-in-acute-otitis-media-the-top-five-recommendations-proposed-by-the-italian-society-of-preventive-and-social-pediatrics
#13
Elena Chiappini, Barbara Bortone, Mattia Doria, Massimo Landi, Giuseppe Di Mauro, Paola Marchisio
With the aim to reduce inappropriate procedures and antibiotic therapy in the management of acute otitis media (AOM) in children, the Italian Society of Preventive and Social Pediatrics (SIPPS) proposed a top five list of recommendations for clinical practice. Areas covered: AOM is one of the most frequent reasons for antibiotic prescription in pediatric age. The over-estimation of AOM is associated with inappropriate treatment, increased costs, adverse events and spread of antibiotic resistance. Thus, the most recent guidelines provided stringent diagnostic criteria and considered the 'watchful waiting' approach, limiting the immediate antibiotic therapy to a well-characterized subgroup of children...
October 2017: Expert Review of Anti-infective Therapy
https://www.readbyqxmd.com/read/28915554/resistance-to-ctla-4-checkpoint-inhibition-reversed-through-selective-elimination-of-granulocytic-myeloid-cells
#14
Paul E Clavijo, Ellen C Moore, Jianhong Chen, Ruth J Davis, Jay Friedman, Young Kim, Carter Van Waes, Zhong Chen, Clint T Allen
PURPOSE: Local immunosuppression remains a critical problem that limits clinically meaningful response to checkpoint inhibition in patients with head and neck cancer. Here, we assessed the impact of MDSC elimination on responses to CTLA-4 checkpoint inhibition. EXPERIMENTAL DESIGN: Murine syngeneic carcinoma immune infiltrates were characterized by flow cytometry. Granulocytic MDSCs (gMDSCs) were depleted and T-lymphocyte antigen-specific responses were measured...
August 22, 2017: Oncotarget
https://www.readbyqxmd.com/read/28911247/metabolic-pathways-and-pharmacokinetics-of-natural-medicines-with-low-permeability
#15
Mei Zeng, Lan Yang, Dan He, Yao Li, Mingxin Shi, Jingqing Zhang
Drug metabolism plays an important role in the drug disposal process. Differences in pharmacokinetics among individuals are the basis for personalized medicine. Natural medicines, formed by long-term evolution of nature, prioritize the action of a target protein with a drug. Natural medicines are valued for structural diversity, low toxicity, low cost, and definite biological activities. Metabolic pathway and pharmacokinetic research of natural medicines is highly beneficial for clinical dose adjustment and the development of personalized medicine...
September 14, 2017: Drug Metabolism Reviews
https://www.readbyqxmd.com/read/28891406/clinical-practice-guideline-evaluation-of-the-neck-mass-in-adults
#16
Melissa A Pynnonen, M Boyd Gillespie, Benjamin Roman, Richard M Rosenfeld, David E Tunkel, Laura Bontempo, Itzhak Brook, Davoren Ann Chick, Maria Colandrea, Sandra A Finestone, Jason C Fowler, Christopher C Griffith, Zeb Henson, Corinna Levine, Vikas Mehta, Andrew Salama, Joseph Scharpf, Deborah R Shatzkes, Wendy B Stern, Jay S Youngerman, Maureen D Corrigan
Objective Neck masses are common in adults, but often the underlying etiology is not easily identifiable. While infections cause most of the neck masses in children, most persistent neck masses in adults are neoplasms. Malignant neoplasms far exceed any other etiology of adult neck mass. Importantly, an asymptomatic neck mass may be the initial or only clinically apparent manifestation of head and neck cancer, such as squamous cell carcinoma (HNSCC), lymphoma, thyroid, or salivary gland cancer. Evidence suggests that a neck mass in the adult patient should be considered malignant until proven otherwise...
September 2017: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/28874138/erp29-controls-invasion-and-metastasis-of-gastric-carcinoma-by-inhibition-of-epithelial-mesenchymal-transition-via-pi3k-aktsignaling-pathway
#17
Jianxin Ye, Jinsheng Huang, Jie Xu, Qiang Huang, Jinzhou Wang, Wenjing Zhong, Xinjian Lin, Yun Li, Xu Lin
BACKGROUND: Gastric cancer (GC) accounts for the fourth most occurring malignancy and the third major cause of cancer death. Identifying novel molecular signaling pathways participating in gastric tumorigenesis and progression is pivotal for rational design of targeted therapies to improve advanced GC outcome. Recently, the endoplasmic reticulum (ER) protein 29 (ERp29) has been shown to inversely associate with primary tumor development and function as a tumor suppressor in breast cancer...
September 6, 2017: BMC Cancer
https://www.readbyqxmd.com/read/28863449/glioblastoma-targeted-therapy-updated-approaches-from-recent-biological-insights
#18
M Touat, A Idbaih, M Sanson, K L Ligon
Glioblastoma (WHO grade IV astrocytoma) is the most frequent primary brain tumor in adults, representing a highly heterogeneous group of neoplasms that are among the most aggressive and challenging cancers to treat. An improved understanding of the molecular pathways that drive malignancy in glioblastoma has led to the development of various biomarkers and the evaluation of several agents specifically targeting tumor cells and the tumor microenvironment. A number of rational approaches are being investigated, including therapies targeting tumor growth factor receptors and downstream pathways, cell cycle and epigenetic regulation, angiogenesis and antitumor immune response...
July 1, 2017: Annals of Oncology: Official Journal of the European Society for Medical Oncology
https://www.readbyqxmd.com/read/28860840/influence-of-organizational-culture-on-provider-adherence-to-the-diabetic-clinical-practice-guideline-using-the-competing-values-framework-in-palestinian-primary-healthcare-centers
#19
Mahmoud Radwan, Ali Akbari Sari, Arash Rashidian, Amirhossein Takian, Sanaa Abou-Dagga, Aymen Elsous
BACKGROUND: Diabetes mellitus (DM) is a serious chronic disease and an important public health issue. This study aimed to identify the predominant culture within the Palestinian Primary Healthcare Centers of the Ministry of Health (PHC-MoH) and the Primary Healthcare Centers of the United Nations Relief and Works Agency for Palestine Refugees (PHC-UNRWA) by using the competing values framework (CVF) and examining its influence on the adherence to the Clinical Practice Guideline (CPG) for DM...
2017: International Journal of General Medicine
https://www.readbyqxmd.com/read/28859181/clinical-application-of-newly-developed-custom-made-mouthpiece-for-scuba-diving
#20
Toshiaki Hirose, Tomoya Gonda, Yoshinobu Maeda
PURPOSE: To describe a method for customizing scuba diving mouthpieces, to examine their usability, and to assess divers' satisfaction with their use. MATERIALS AND METHODS: A rational method for fabricating custom-made mouthpieces for scuba diving was developed. Twenty scuba divers agreed to use a custom-made mouthpiece for at least 4 weeks. After mouthpiece use, participants completed an 11-item questionnaire. RESULTS: Custom-made mouthpieces had significantly lower scores for all items on the questionnaire except uncomfortable sensation, indicating that they were more comfortable than ready-made mouthpieces...
September 2017: International Journal of Prosthodontics
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