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https://www.readbyqxmd.com/read/29161399/global-lessons-developing-military-trauma-care-and-lessons-for-civilian-practice
#1
T Woolley, J A Round, M Ingram
The wars in Iraq and Afghanistan have helped to shape the modern Defence Medical Services. Many lessons were learnt including the need for rapid haemorrhage control, senior decision-making and the evolution of deployed transfusion support. These changes were implemented simultaneously with a coherent, end-to-end medical plan from point of wounding through to rehabilitation. Implementation of the medical plan is harmonious with the NHS trauma pathway, and is key to ensuring effective delivery. Military anaesthetists have a long pre-deployment training pathway starting with a Certificate of Completion of Training (CCT) in anaesthesia and/or critical care, and with an emphasis on military skills related to their specific role...
December 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29160420/next-generation-sequencing-based-genomic-profiling-fostering-innovation-in-cancer-care
#2
Gustavo S Fernandes, Daniel F Marques, Daniel M Girardi, Maria Ignez F Braghiroli, Renata A Coudry, Sibele I Meireles, Artur Katz, Paulo M Hoff
OBJECTIVES: With the development of next-generation sequencing (NGS) technologies, DNA sequencing has been increasingly utilized in clinical practice. Our goal was to investigate the impact of genomic evaluation on treatment decisions for heavily pretreated patients with metastatic cancer. METHODS: We analyzed metastatic cancer patients from a single institution whose cancers had progressed after all available standard-of-care therapies and whose tumors underwent next-generation sequencing analysis...
October 2017: Clinics
https://www.readbyqxmd.com/read/29159860/assessment-of-sedation-level-prior-to-neonatal-intubation-a%C3%A2-systematic-review
#3
REVIEW
Ellen H M de Kort, Nienke M Halbmeijer, Irwin K M Reiss, Sinno H P Simons
BACKGROUND: Adequate premedication before neonatal endotracheal intubation reduces pain, stress, and adverse physiological responses, diminishes duration and number of attempts at intubation, and prevents traumatic airway injury. Therefore, intubation should not be started until an adequate level of sedation is reached. It is not clear how this should be measured in the clinical situation. OBJECTIVES: The aim of this study is to provide a systematic review of the usability and validity of scoring systems or other objective parameters to evaluate the level of sedation before intubation in neonates...
November 20, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29159273/a-health-economic-evaluation-of-needle-based-confocal-laser-endomicroscopy-for-the-diagnosis-of-pancreatic-cysts
#4
Claude Le Pen, Laurent Palazzo, Bertrand Napoléon
Background and study aims:  The low sensitivity of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), especially for the diagnosis of serous cystadenomas (SCAs), can be associated with diagnostic uncertainty that can regularly lead to unnecessary surgical procedures. Needle-based confocal laser endomicroscopy (nCLE) used with EUS-FNA improves diagnostic accuracy, helping to reduce unnecessary surgery and patient follow-up. This study was conducted to evaluate the economic benefit of EUS-FNA + nCLE...
October 2017: Endoscopy International Open
https://www.readbyqxmd.com/read/29159255/comparative-diagnostic-performance-of-the-granulocyte-and-neutrophil-counts
#5
Nicola S Pether, Jessica L Brothwood, Cornelis van Berkel, Elaine H Dunwoodie, Robert L Blake, Christopher P Price, Richard G Jones, Karl S Baker, Geoff Hall
Objectives: Use of point-of-care testing is increasing, however many haematology analysers can only determine granulocyte count without further differentiation into neutrophils, eosinophils and basophils. Since the diagnosis of life-threatening neutropenia in cancer patients requires a distinct neutrophil count, this study aimed to determine the comparative performance between the neutrophil and granulocyte count. Design and methods: A database of 508 646 venous full blood count results measured on a laboratory reference analyser was mined from a large oncology unit...
December 2017: Pract Lab Med
https://www.readbyqxmd.com/read/29159075/enzyme-replacement-therapy-in-perinatal-hypophosphatasia-case-report-of-a-negative-outcome-and-lessons-for-clinical-practice
#6
Gregory Costain, Aideen M Moore, Lauren Munroe, Alison Williams, Randi Zlotnik Shaul, Cheryl Rockman-Greenberg, Martin Offringa, Peter Kannu
Enzyme replacement therapy (ERT) is a newly approved disease-modifying treatment for hypophosphatasia (HPP), a rare metabolic bone disorder. With an orphan drug and ultra-rare disease, sharing information about responders and non-responders is particularly important, as any one centre's familiarity with its use will be limited. Nearly all published data in infants and very young children with life-threatening HPP are from three small clinical trials that have reported generally positive outcomes. We describe in detail a patient with perinatal HPP for whom treatment with ERT was not successful...
March 2018: Molecular Genetics and Metabolism Reports
https://www.readbyqxmd.com/read/29156536/a-review-on-exudates-detection-methods-for-diabetic-retinopathy
#7
REVIEW
Shilpa Joshi, P T Karule
The presence of exudates on the retina is the most characteristic symptom of diabetic retinopathy. As exudates are among early clinical signs of DR, their detection would be an essential asset to the mass screening task and serve as an important step towards automatic grading and monitoring of the disease. Reliable identification and classification of exudates are of inherent interest in an automated diabetic retinopathy screening system. Here we review the numerous early studies that used for automatic exudates detection with the aim of providing decision support in addition to reducing the workload of an ophthalmologist...
November 16, 2017: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
https://www.readbyqxmd.com/read/29156198/the-evolving-role-of-genomic-testing-in-assessing-prognosis-of-patients-with-myelodysplastic-syndromes
#8
REVIEW
David P Steensma
The introduction into routine hematology-oncology clinical practice of molecular genetic testing assays based on next-generation sequencing platforms is prompting reassessment of the importance of molecular assay results in comparison to existing disease-specific risk stratification tools based on clinical assessment and light microscopy. For patients with myelodysplastic syndromes (MDS), the most commonly used tools for prognostication currently include the International Prognostic Scoring System (IPSS) and the Revised IPSS (IPSS-R), which are based on marrow blast proportion, number and degree of cytopenias, and the metaphase karyotype...
December 2017: Best Practice & Research. Clinical Haematology
https://www.readbyqxmd.com/read/29155170/bench-to-bedside-translation-of-dendrimers-reality-or-utopia-a-concise-analysis
#9
Serge Mignani, João Rodrigues, Helena Tomas, René Roy, Xiangyang Shi, Jean-Pierre Majoral
Nanomedicine, which is an application of nanotechnologies in healthcare is developed to improve the treatments and lives of patients suffering from a range of disorders and to increase the successes of drug candidates. Within the nanotechnology universe, the remarkable unique and tunable properties of dendrimers have made them promising tools for diverse biomedical applications such as drug delivery, gene therapy and diagnostic. Up-to-date, very few dendrimers has yet gained regulatory approval for systemic administration, why? In this critical review, we briefly focus on the list of desired basic dendrimer requirements for decision-making purpose by the scientists (go/no-go decision), in early development stages, to become clinical candidates, and to move towards Investigational New Drugs (IND) application submission...
November 16, 2017: Advanced Drug Delivery Reviews
https://www.readbyqxmd.com/read/29154810/multiple-performance-measures-are-needed-to-evaluate-triage-systems-in-the-emergency-department
#10
Joany M Zachariasse, Daan Nieboer, Rianne Oostenbrink, Henriëtte A Moll, Ewout W Steyerberg
OBJECTIVE: Emergency department triage systems can be considered prediction rules with an ordinal outcome, where different directions of misclassification have different clinical consequences. We evaluated strategies to compare the performance of triage systems and aim to propose a set of performance measures that should be used in future studies. STUDY DESIGN AND SETTING: We identified performance measures based on literature review and expert knowledge. Their properties are illustrated in a case study evaluating two triage modifications in a cohort of 14,485 pediatric emergency department visits...
November 14, 2017: Journal of Clinical Epidemiology
https://www.readbyqxmd.com/read/29154246/do-we-need-changes-in-the-organization-of-training-in-the-hernia-treatment-in-poland-a-survey-on-the-acknowledgment-of-the-recommendations-of-international-hernia-societies-by-surgeons
#11
Kryspin Mitura, Stanisław Dąbrowiecki, Maciej Śmietański, Andrzej Matyja
In the therapy of an inguinal hernia, there is a huge variety in the way of treating and the choice of surgical technique. Practice shows that the intraoperative improvisation and surgeons' own modifications of the original techniques have become part of routine procedure. No mandatory hernia registration system causes the actual detailed herniology status in our country remains unknown. The aim of the study was to summarize the results of a survey on knowledge of a hernia according to the standards developed by international hernia societies compared with everyday clinical practice...
October 31, 2017: Polski Przeglad Chirurgiczny
https://www.readbyqxmd.com/read/29153941/the-impact-of-readmission-hospital-on-failure-to-rescue-rates-following-major-urologic-cancer-surgery
#12
Jasmir G Nayak, Sarah K Holt, Jonathan L Wright, Matthew Mossanen, Atreya Dash, John L Gore
PURPOSE: Patients readmitted to secondary hospitals rather than the primary hospital where their surgery took place may be at risk for poorer outcomes. We sought to evaluate the effect of site of readmission on failure-to-rescue complication rates following urologic cancer surgery. MATERIALS AND METHODS: Retrospective review of major urologic cancer surgeries in the Washington State Comprehensive Hospital Abstract Reporting System between 1998 and 2013. Failure-to-rescue (FTR) rates, defined as inpatient death after a complication requiring hospital readmission, were compared between patients readmitted to their primary hospital with those readmitted to a secondary hospital...
November 16, 2017: Urologic Oncology
https://www.readbyqxmd.com/read/29152134/combined-neutrophil-platelet-score-and-hemoglobin-level-predict-survival-in-esophageal-squamous-cell-carcinoma-patients-treated-with-chemoradiotherapy
#13
Chuanwang Miao, Shan Zhu, Hong Pan, Xiaolan Cao, Shuanghu Yuan, Xudong Hu
Systemic inflammation and hematological markers have prognostic value in patients with esophageal squamous cell carcinoma (ESCC). The objective of this study was to evaluate the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), combined neutrophil-platelet (CNP) score, and hemoglobin (Hb) to inform treatment decisions and predict outcomes in patients with locally advanced ESCC treated with chemoradiotherapy (CRT). A total of 168 patients with locally advanced ESCC were retrospectively evaluated...
October 20, 2017: Oncotarget
https://www.readbyqxmd.com/read/29151960/r-e-n-a-l-nephrometry-score-a-preoperative-risk-factor-predicting-the-fuhrman-grade-of-clear-cell-renal-carcinoma
#14
Shao-Hao Chen, Yu-Peng Wu, Xiao-Dong Li, Tian Lin, Qing-Yong Guo, Ye-Hui Chen, Jin-Bei Huang, Yong Wei, Xue-Yi Xue, Qing-Shui Zheng, Ning Xu
Objective: The purpose of this study was to evaluate the efficacy and feasibility of the R.E.N.A.L. Nephrometry Score to postoperatively predict high-grade clear-cell renal carcinoma (ccRCC). Methods: The study included 288 patients diagnosed with ccRCC who had complete CT/CTA data and R.E.N.A.L. Nephrometry Scores and underwent renal surgery at our center between January 2012 and December 2015. The relationship between the pathological grade of renal masses and R.E.N.A.L. Nephrometry Score was evaluated. Results: Univariate analysis indicated that diagnostic modality, cystic necrosis, enlargement of the regional lymph node, distant metastasis, clinical T stage, TNM stage, surgical modality, tumor size, nearness of the tumor to the collecting system or sinus, total Nephrometry Score and individual anatomic descriptor components were significantly associated with postoperative tumor grade (P < 0...
2017: Journal of Cancer
https://www.readbyqxmd.com/read/29149658/evaluating-casama-contextualized-semantic-maps-for-summarization-of-lung-cancer-studies
#15
Jean I Garcia-Gathright, Nicholas J Matiasz, Carlos Adame, Karthik V Sarma, Lauren Sauer, Nova F Smedley, Marshall L Spiegel, Jennifer Strunck, Edward B Garon, Ricky K Taira, Denise R Aberle, Alex A T Bui
OBJECTIVE: It is crucial for clinicians to stay up to date on current literature in order to apply recent evidence to clinical decision making. Automatic summarization systems can help clinicians quickly view an aggregated summary of literature on a topic. Casama, a representation and summarization system based on "contextualized semantic maps," captures the findings of biomedical studies as well as the contexts associated with patient population and study design. This paper presents a user-oriented evaluation of Casama in comparison to a context-free representation, SemRep...
November 3, 2017: Computers in Biology and Medicine
https://www.readbyqxmd.com/read/29149473/exploring-communication-during-the-journey-from-noticing-bodily-changes-to-a-diagnosis-of-endometrial-cancer
#16
Catherine Cook, Margaret Brunton, Tepora Pukepuke, Ai Ling Tan
AIMS AND OBJECTIVES: To understand women's perspectives about the trajectory from first bodily changes to diagnosis. BACKGROUND: With endometrial cancer, as with all gynaecological cancers, early diagnosis is key to successful outcomes. However, women do not always seek clinical advice early. Previously, this gap has been referred to as a 'delay', blamed on fear or refusal to acknowledge symptoms. METHODS: A qualitative research project which involved face-to-face interviews with 16 women who had presented with symptoms of endometrial cancer...
November 17, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/29148849/towards-an-overarching-model-for-electronic-medical-record-systems-including-problem-oriented-goal-oriented-and-other-approaches
#17
Huibert Tange, Zsolt Nagykaldi, Jan De Maeseneer
There is no consensus among health professionals on how to structure medical records to serve clinical decision-making. Three approaches co-exist (source-oriented, problem-oriented, goal-oriented), each suiting a different subset of patients. In primary care, the problem-oriented approach is dominant, but for patients with multiple conditions (multimorbidity) the goal-oriented approach seems more appropriate. There is a need to combine different approaches in one medical-record system. In this article, we explain some misconceptions about 'problems' and 'goals' that hinder the way to consensus...
December 2017: European Journal of General Practice
https://www.readbyqxmd.com/read/29148566/factors-that-influence-the-provision-of-intrapartum-and-postnatal-care-by-skilled-birth-attendants-in-low-and-middle-income-countries-a-qualitative-evidence-synthesis
#18
REVIEW
Susan Munabi-Babigumira, Claire Glenton, Simon Lewin, Atle Fretheim, Harriet Nabudere
BACKGROUND: In many low- and middle-income countries women are encouraged to give birth in clinics and hospitals so that they can receive care from skilled birth attendants. A skilled birth attendant (SBA) is a health worker such as a midwife, doctor, or nurse who is trained to manage normal pregnancy and childbirth. (S)he is also trained to identify, manage, and refer any health problems that arise for mother and baby. The skills, attitudes and behaviour of SBAs, and the extent to which they work in an enabling working environment, impact on the quality of care provided...
November 17, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29148314/clinical-decision-support-systems-in-hospital-care-using-ubiquitous-devices-current-issues-and-challenges
#19
Mirza Mansoor Baig, Hamid GholamHosseini, Aasia A Moqeem, Farhaan Mirza, Maria Lindén
Supporting clinicians in decision making using advanced technologies has been an active research area in biomedical engineering during the past years. Among a wide range of ubiquitous systems, smartphone applications have been increasingly developed in healthcare settings to help clinicians as well as patients. Today, many smartphone applications, from basic data analysis to advanced patient monitoring, are available to clinicians and patients. Such applications are now increasingly integrating into healthcare for clinical decision support, and therefore, concerns around accuracy, stability, and dependency of these applications are rising...
November 1, 2017: Health Informatics Journal
https://www.readbyqxmd.com/read/29146455/successful-nonoperative-management-of-uncomplicated-appendicitis-predictors-and-outcomes
#20
Tyler J Loftus, Scott C Brakenridge, Chasen A Croft, R Stephen Smith, Philip A Efron, Frederick A Moore, Alicia M Mohr, Janeen R Jordan
BACKGROUND: Our objective was to identify predictors of successful nonoperative management (NOM) of uncomplicated appendicitis. We hypothesized that the absence of diabetes, absence of an appendicolith, short duration of symptoms, absence of systemic inflammation, and low modified Alvarado score would predict successful NOM. METHODS: We performed a retrospective cohort analysis of 81 consecutive patients who underwent NOM of uncomplicated appendicitis. Successful NOM was defined as resolution of appendicitis with antibiotics alone and no recurrent appendicitis within 180 days...
November 13, 2017: Journal of Surgical Research
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