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https://www.readbyqxmd.com/read/28642108/investing-in-new-technology-in-pulmonary-medicine-navigating-the-tortuous-path-to-success
#1
REVIEW
Robert Kruklitis, Kim French, Michael Joseph Cangelosi, Kevin L Kovitz
The introduction of new technologies offer the promise to advance medicine. This occurs alongside improved efforts to control costs of healthcare by hospital administrators, Center for Medicare and Medicaid Services' (CMS) pivot to value programs, and commercial payers' efforts to reduce reimbursement. These trends present a challenge for the pulmonologist, among others, who must navigate increasingly complex and highly scrutinized evaluation processes used to secure new technologies. Healthcare providers are turning toward value assessments, while simultaneously tasked with a mission of offering state-of-the art technologies and services...
June 19, 2017: Chest
https://www.readbyqxmd.com/read/28641753/cardiac-dysfunction-in-congenital-diaphragmatic-hernia-pathophysiology-clinical-assessment-and-management
#2
Neil Patel, Florian Kipfmueller
Cardiac dysfunction is an important consequence of pulmonary hypertension in congenital diaphragmatic hernia and a determinant of disease severity. Increased afterload leads to right ventricular dilatation and diastolic dysfunction. Septal displacement and dysfunction impair left ventricular function, which may also be compromised by fetal hypoplasia. Biventricular failure contributes to systemic hypotension and hypoperfusion. Early and regular echocardiographic assessment of cardiac function and pulmonary artery pressure can guide therapeutic decision-making, including choice and timing of pulmonary vasodilators, cardiotropes, ECMO, and surgery...
June 2017: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/28641588/health-technology-performance-assessment-real-world-evidence-for-public-healthcare-sustainability
#3
Augusto Afonso Guerra-Júnior, Lívia Lovato Pires de Lemos, Brian Godman, Marion Bennie, Cláudia Garcia Serpa Osorio-de-Castro, Juliana Alvares, Aine Heaney, Carlos Alberto Vassallo, Björn Wettermark, Gaizka Benguria-Arrate, Iñaki Gutierrez-Ibarluzea, Vania Cristina Canuto Santos, Clarice Alegre Petramale, Fransciso de Assis Acurcio
OBJECTIVES: Health technology financing is often based on randomized controlled trials (RCTs), which are often the same ones used for licensing. Because they are designed to show the best possible results, typically Phase III studies are conducted under ideal and highly controlled conditions. Consequently, it is not surprising that technologies do not always perform in real life in the same way as controlled conditions. Because financing (and price paid) decisions can be made with overestimated results, health authorities need to ask whether health systems achieve the results they expect when they choose to pay for a technology...
June 23, 2017: International Journal of Technology Assessment in Health Care
https://www.readbyqxmd.com/read/28641322/scuba-diving-and-otology-a-systematic-review-with-recommendations-on-diagnosis-treatment-and-post-operative-care
#4
REVIEW
Devon M Livingstone, Kristine A Smith, Beth Lange
Scuba diving is a popular recreational and professional activity with inherent risks. Complications related to barotrauma and decompression illness can pose significant morbidity to a diver's hearing and balance systems. The majority of dive-related injuries affect the head and neck, particularly the outer, middle and inner ear. Given the high incidence of otologic complications from diving, an evidence-based approach to the diagnosis and treatment of otic pathology is a necessity. We performed a systematic and comprehensive literature review including the pathophysiology, diagnosis, and treatment of otologic pathology related to diving...
June 2017: Diving and Hyperbaric Medicine: the Journal of the South Pacific Underwater Medicine Society
https://www.readbyqxmd.com/read/28640869/development-of-an-automated-size-based-filtration-system-for-isolation-of-circulating-tumor-cells-in-lung-cancer-patients
#5
Satomi Yagi, Yasuhiro Koh, Hiroaki Akamatsu, Kuninobu Kanai, Atsushi Hayata, Nahomi Tokudome, Keiichiro Akamatsu, Katsuya Endo, Seita Nakamura, Masayuki Higuchi, Hisashige Kanbara, Masanori Nakanishi, Hiroki Ueda, Nobuyuki Yamamoto
Circulating tumor cells (CTCs), defined as tumor cells circulating in the peripheral blood of patients with solid tumors, are relatively rare. Diagnosis using CTCs is expected to help in the decision-making for precision cancer medicine. We have developed an automated microcavity array (MCA) system to detect CTCs based on the differences in size and deformability between tumor cells and normal blood cells. Herein, we evaluated the system using blood samples from non-small-cell lung cancer (NSCLC) and small-cell lung cancer (SCLC) patients...
2017: PloS One
https://www.readbyqxmd.com/read/28639060/surgical-options-in-benign-parotid-tumors-a-proposal-for-classification
#6
REVIEW
Miquel Quer, Vincent Vander Poorten, Robert P Takes, Carl E Silver, Carsten C Boedeker, Remco de Bree, Alessandra Rinaldo, Alvaro Sanabria, Ashok R Shaha, Albert Pujol, Peter Zbären, Alfio Ferlito
Different surgical options are currently available for treating benign tumors of the parotid gland, and the discussion on optimal treatment continues despite several meta-analyses. These options include more limited resections (extracapsular dissection, partial lateral parotidectomy) versus more extensive and traditional options (lateral parotid lobectomy, total parotidectomy). Different schools favor one option or another based on their experience, skills and tradition. This review provides a critical analysis of the literature regarding these options...
June 21, 2017: European Archives of Oto-rhino-laryngology
https://www.readbyqxmd.com/read/28638988/same-day-genomic-and-epigenomic-diagnosis-of-brain-tumors-using-real-time-nanopore-sequencing
#7
Philipp Euskirchen, Franck Bielle, Karim Labreche, Wigard P Kloosterman, Shai Rosenberg, Mailys Daniau, Charlotte Schmitt, Julien Masliah-Planchon, Franck Bourdeaut, Caroline Dehais, Yannick Marie, Jean-Yves Delattre, Ahmed Idbaih
Molecular classification of cancer has entered clinical routine to inform diagnosis, prognosis, and treatment decisions. At the same time, new tumor entities have been identified that cannot be defined histologically. For central nervous system tumors, the current World Health Organization classification explicitly demands molecular testing, e.g., for 1p/19q-codeletion or IDH mutations, to make an integrated histomolecular diagnosis. However, a plethora of sophisticated technologies is currently needed to assess different genomic and epigenomic alterations and turnaround times are in the range of weeks, which makes standardized and widespread implementation difficult and hinders timely decision making...
June 21, 2017: Acta Neuropathologica
https://www.readbyqxmd.com/read/28638933/-implementation-status-of-regulation-eu-536-2014-in-the-member-states
#8
REVIEW
Elke Stahl
The upcoming Regulation EU 536/2014 for clinical trials of medicinal products for human use requires multinational cooperation in the assessment of clinical trial applications by the member states concerned as well as one single decision per member state concerned, supported by the new EU Portal and database system. The implementation makes national reorganisation of the processes necessary, especially coordination and cooperation between the national competent authorities and the ethics committees, necessary...
June 21, 2017: Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz
https://www.readbyqxmd.com/read/28638239/using-transfer-learning-for-improved-mortality-prediction-in-a-data-scarce-hospital-setting
#9
Thomas Desautels, Jacob Calvert, Jana Hoffman, Qingqing Mao, Melissa Jay, Grant Fletcher, Chris Barton, Uli Chettipally, Yaniv Kerem, Ritankar Das
Algorithm-based clinical decision support (CDS) systems associate patient-derived health data with outcomes of interest, such as in-hospital mortality. However, the quality of such associations often depends on the availability of site-specific training data. Without sufficient quantities of data, the underlying statistical apparatus cannot differentiate useful patterns from noise and, as a result, may underperform. This initial training data burden limits the widespread, out-of-the-box, use of machine learning-based risk scoring systems...
2017: Biomedical Informatics Insights
https://www.readbyqxmd.com/read/28637667/thrombocytopenia-in-pregnancy
#10
Douglas B Cines, Lisa D Levine
Thrombocytopenia develops in 5-10% of women during pregnancy or in the immediate post-partum period. A low platelet count is often an incidental feature, but it can also provide a biomarker of a coexisting systemic or gestational disorder and a potential reason for a maternal intervention or treatment that might pose harm to the fetus. This chapter reflects our approach to these issues with an emphasis on advances in understanding and managing the more common causes of thrombocytopenia in pregnancy made over the past 5-10 years...
June 21, 2017: Blood
https://www.readbyqxmd.com/read/28637576/antimicrobial-use-and-resistance-in-australia-aura-surveillance-system-coordinating-national-data-on-antimicrobial-use-and-resistance-for-australia
#11
John D Turnidge, Kathy T Meleady
Objective The aim of the present study was to describe the process of establishment and coordination of the national Antimicrobial Use and Resistance in Australia (AURA) surveillance system.Methods Existing surveillance programs conducted by health organisations at state or multi-jurisdictional levels were reviewed, and gaps and opportunities identified for the development of a national system. In view of the time frame available as part of the Australian Government Department of Health funding agreement, the strategy used by the Australian Commission on Safety and Quality in Health Care was to commence work with existing surveillance programs, expanding and enhancing them and developing new systems where gaps were identified...
June 22, 2017: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/28636981/development-and-validation-of-nomogram-based-on-mir-203-and-clinicopathological-characteristics-predicting-survival-after-neoadjuvant-chemotherapy-and-surgery-for-patients-with-non-metastatic-osteosarcoma
#12
Dong Cheng, Xubin Qiu, Ming Zhuang, Chenlei Zhu, Hongjun Zou, Ailiang Zhang
BACKGROUND: Recently, nomograms have been used as models for risk prediction in malignant tumor because they can predict the outcome of interest for a certain individual based on many variables. This study aimed to establish an effective prognostic nomogram for osteosarcoma based on the clinicopathological factors and microRNA-203. RESULTS: The results showed that miR-203 expression was significantly lower in osteosarcoma tissues compared with the corresponding adjacent tissues (P < 0...
June 17, 2017: Oncotarget
https://www.readbyqxmd.com/read/28636060/developing-mobile-clinical-decision-support-for-nursing-home-staff-assessment-of-urinary-tract-infection-using-goal-directed-design
#13
Wallace Jones, Cynthia Drake, David Mack, Blaine Reeder, Barbara Trautner, Heidi Wald
BACKGROUND: Unique characteristics of nursing homes (NHs) contribute to high rates of inappropriate antibiotic use for asymptomatic bacteriuria (ASB), a benign condition. A mobile clinical decision support system (CDSS) may support NH staff in differentiating urinary tract infections (UTI) from ASB and reducing antibiotic days. OBJECTIVES: We used Goal-Directed Design to: 1) Characterize information needs for UTI identification and management in NHs; 2) Develop UTI Decide, a mobile CDSS prototype informed by personas and scenarios of use constructed from Aim 1 findings; 3) Evaluate the UTI Decide prototype with NH staff...
June 20, 2017: Applied Clinical Informatics
https://www.readbyqxmd.com/read/28635437/assessment-of-diagnostic-information-and-quality-of-working-alliance-with-clients-diagnosed-with-personality-disorders-during-the-mental-health-intake
#14
Ora Nakash, Maayan Nagar
BACKGROUND: A primary purpose of diagnostic systems is to improve care, yet, little is known about how providers use it routine clinical care. AIMS: We investigated specific DSM-IV personality disorders (PDs) diagnostic information therapists collected during intake visits and the association between a therapist PD diagnosis and clients' and therapists' reports of the quality of working alliance during the intake. METHOD: A total of 122 intakes (n = 34, 27...
March 1, 2017: Journal of Mental Health
https://www.readbyqxmd.com/read/28635066/consensus-development-of-quality-indicators-for-end-of-life-care-for-elders-in-japan
#15
Harue Masaki, Nobuko Kawai, Keiko Matsumoto, Miyoko Kuwata, Sachiko Yoshioka, Midori Nishiyama, Ryoko Uchino, Hiroko Nagae, Megumi Teshima, Sayuri Sakai, Kazuko Endo
AIMS AND OBJECTIVES: Quality indicators for end-of-life care have been published; however, none have been developed specifically for nursing in the cultural and traditional context of Japan. This study aimed to develop and build a consensus of quality indicators for end-of-life care for elders in Japan from the perspective of nursing science. METHODS: To develop the quality indicators, we used a literature review, expert panel process, and the Delphi technique among clinical nurse specialists in geriatrics...
June 2017: International Journal of Nursing Practice
https://www.readbyqxmd.com/read/28634907/incidence-and-predictors-of-repeat-bone-mineral-densitometry-a-longitudinal-cohort-study
#16
Emily C White VanGompel, Peter Franks, John A Robbins, Joshua J Fenton
BACKGROUND: Existing guidelines for repeat screening and treatment monitoring intervals regarding the use of dual-energy x-ray absorptiometry (DXA) scans are conflicting or lacking. The Choosing Wisely campaign recommends against repeating DXA scans within 2 years of initial screening. It is unclear how frequently physicians order repeat scans and what clinical factors contribute to their use. OBJECTIVE: To estimate cumulative incidence and predictors of repeat DXA for screening or treatment monitoring in a regional health system...
June 20, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28634503/monitoring-the-diagnostic-process-on-an-inpatient-neurology-service
#17
Amar Dhand, Robert Bucelli, Arun Varadhachary, Michael Tsiaklides, Gabriela de Bruin, Gurpreet Dhaliwal
The Institute of Medicine report Improving Diagnosis in Health Care called for tools to monitor physicians' diagnostic process. We addressed this need by developing a tool for clinicians to record and analyze their diagnostic process. The tool was a secure web application in which clinicians used a structured grading system to assess the relative impact of clinical, laboratory, and neuroimaging data for every new diagnosis. Four neurohospitalists used the tool for 6.5 months on a general neurology ward service at a single tertiary-level teaching hospital...
July 2017: Neurohospitalist
https://www.readbyqxmd.com/read/28633637/seroma-change-during-magnetic-resonance-imaging-guided-partial-breast-irradiation-and-its-clinical-implications
#18
Seung Hyuck Jeon, Kyung Hwan Shin, So-Yeon Park, Jung-In Kim, Jong Min Park, Jin Ho Kim, Eui Kyu Chie, Hong-Gyun Wu
BACKGROUND: To investigate the patterns of post-lumpectomy seroma volume (SV) change and related clinical factors to determine the benefits of adaptive planning in magnetic resonance imaging (MRI)-guided partial breast irradiation (PBI). METHODS: MRI data obtained from 37 women with early breast cancer acquired at simulation and at the 1st, 6th, and 10th fractions were analyzed. The planning target volume (PTV) was defined as unequal margins of 10-15 mm added according to the directional surgical margin status of each seroma...
June 20, 2017: Radiation Oncology
https://www.readbyqxmd.com/read/28633483/an-informatics-research-agenda-to-support-patient-and-family-empowerment-and-engagement-in-care-and-recovery-during-and-after-hospitalization
#19
Sarah Collins, Patricia Dykes, David W Bates, Brittany Couture, Ronen Rozenblum, Jennifer Prey, Kristin O'Reilly, Patricia Q Bourie, Cindy Dwyer, S Ryan Greysen, Jeffery Smith, Michael Gropper, Anuj K Dalal
As part of an interdisciplinary acute care patient portal task force with members from 10 academic medical centers and professional organizations, we held a national workshop with 71 attendees representing over 30 health systems, professional organizations, and technology companies. Our consensus approach identified 7 key sociotechnical and evaluation research focus areas related to the consumption and capture of information from patients, care partners (eg, family, friends), and clinicians through portals in the acute and post-acute care settings...
June 17, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28631809/anabolic-steroids-for-treating-pressure-ulcers
#20
REVIEW
Cho Naing, Maxine A Whittaker
BACKGROUND: Pressure ulcers, also known as bed sores, pressure sores or decubitus ulcers develop as a result of a localised injury to the skin or underlying tissue, or both. The ulcers usually arise over a bony prominence, and are recognised as a common medical problem affecting people confined to a bed or wheelchair for long periods of time. Anabolic steroids are used as off-label drugs (drugs which are used without regulatory approval) and have been used as adjuvants to usual treatment with dressings, debridement, nutritional supplements, systemic antibiotics and antiseptics, which are considered to be supportive in healing of pressure ulcers...
June 20, 2017: Cochrane Database of Systematic Reviews
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