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Clinical problem solving

Xia Song, Yuting Wen, Jing-Ling Zhu, Feng Zhao, Zhongxing Zhang, Jun Li
Paclitaxel (PTX), a hydrophobic anticancer drug, is facing several clinical limitations such as low bioavailability and drug resistance. To solve the problems, a well-defined b-cyclodextrin-poly(N-isopropylacrylamide) star polymer was synthesized and used as a nanocarrier to improve the water solubility and aim to thermoresponsive delivery of PTX to cancer cells. The star polymer was able to form supramolecular self-assembled inclusion complex with PTX via host-guest interaction at room temperature, which is below the low critical solution temperature (LCST) of the star polymer, significantly improving the solubilization of PTX...
October 24, 2016: Biomacromolecules
Nicholas Brandmeir, Elena Nehrbass, James McInerney
INTRODUCTION:  Deep brain stimulator (DBS) infections are a persistent problem for patients undergoing this procedure. They may require further surgery, treatment with antibiotics, or even removal of the device. To date, no consensus exists on the best practices to avoid DBS infections or what factors predispose patients to an eventual infection. The goal of this study was to examine several patient factors for association with DBS infection. METHODS:  A single-center, single-surgeon quality improvement database was queried...
September 20, 2016: Curēus
Lane F Donnelly, Shirley S Cherian, Kimberly B Chua, Sam Thankachan, Laura A Millecker, Alex G Koroll, George S Bisset
BACKGROUND: Because of the increasing complexities of providing imaging for pediatric health care services, a more reliable process to manage the daily delivery of care is necessary. Objective We describe our Daily Readiness Huddle and the effects of the process on problem identification and improvement. MATERIALS AND METHODS: Our Daily Readiness Huddle has four elements: metrics review, clinical volume review, daily readiness assessment, and problem accountability...
October 22, 2016: Pediatric Radiology
Q H Chen, X K Yang, D H Hu
Patients with severe burn are characterized by strong oxidative stress and intense inflammatory response, which will cause metabolic disorder. Therefore, nutrition therapy is very important for severe burn. Nutrition therapy includes enteral nutrition (EN) and parenteral nutrition, and EN has the unique advantages. In recent years, more and more researchers focused on the EN for severe burn injuries, but there were still some confusing problems needing to solve. This article reviews the recent research about nutrition therapy for severe burn, including the route of feeding, energy requirements, and supplements of protein, carbohydrates, and microelements, and so on, so as to clarify some confusing questions about nutrition therapy for severe burn in clinical practice...
October 20, 2016: Zhonghua Shao Shang za Zhi, Zhonghua Shaoshang Zazhi, Chinese Journal of Burns
Isabell B Purdy, Mary Alice Melwak, Joan R Smith, Carole Kenner, Rebecca Chuffo-Siewert, Donna J Ryan, Sue Hall
BACKGROUND: The neonatal intensive care unit (NICU) can be a stressful environment for infants, their families, and the healthcare team. There is an immediate need for neonatal nurses to embrace and translate the new National Perinatal Association recommendations for psychosocial support of NICU parents into clinical practice to demonstrate best practices for infants, their families, and the whole team. PURPOSE: To summarize the current evidence-based practice recommendations and to provide suggestions for team members to develop strategies to adopt and implement them through quality improvement (QI) projects...
October 19, 2016: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
Zhibin Wang, Xiao-Guang Luo, Chao Gao
In the clinic, the diagnosis of Parkinson's disease (PD) largely depends on clinicians' experience. When the diagnosis is made, approximately 80% of dopaminergic cells in the substantia nigra (SN) have been lost. Additionally, it is rather challenging to differentiate PD from atypical parkinsonian disorders (APD). Clinially-available 3T conventional MRI contributes little to solve these problems. The pathologic alterations of parkinsonism show abnormal brain iron deposition, and therefore susceptibility-weighted imaging (SWI), which is sensitive to iron concentration, has been applied to find iron-related lesions for the diagnosis and differentiation of PD in recent decades...
2016: Translational Neurodegeneration
Anne Catharina Brockhaus, Stefan Sauerland, Stefan Saad
BACKGROUND: Single-incision laparoscopic colectomy (SILC) requires only one umbilical port site and (depending on technique) a specimen extraction site. The aim of this study was the assessment of the available evidence for the comparison of SILC to conventional multi-port laparoscopic colectomy (MLC) in adult patients, in whom elective colectomy is indicated because of malignant or benign disease. First, previous meta-analyses on this topic were assessed. Secondly, a systematic review and meta-analysis of randomised controlled trials, was performed...
October 18, 2016: BMC Surgery
Marko Poglitsch, Ashraf H Ahmed, Michael Resl, Andrea Stoller, Dunja Van Oyen, Cornelia Schwager, Claudia Aigner, Oliver Domenig, Michael Krebs, Manuel Haschke, Michael Stowasser
OBJECTIVE: Primary aldosteronism (PA) is form of hypertension characterized by production of aldosterone by the adrenal that is excessive and relatively autonomous of the renin-angiotensin system. Once detected, unilateral PA can be usually cured by surgical removal of the affected adrenal, while bilateral PA can be specifically treated by medications, which antagonize aldosterone action. Clinical guidelines of Endocrine Societies in Europe and the US recommend screening for PA among most hypertensive patients...
September 2016: Journal of Hypertension
Adenauer Marinho de Oliveira Góes Junior, Salim Abdon Haber Jeha
Endovascular treatment of a giant extracranial internal carotid aneurysm by a stent graft implantation was unsuccessful due to a high flow leak directly through the stent graft's coating. The problem was solved deploying a second stent graft inside the previously implanted one resulting in complete exclusion of the aneurysmal sac and patent carotid lumen preservation. The review of the literature did not provide a case using this endovascular strategy. Follow-up for more than 12 months, using CT angiography, showed confirmed aneurysmal exclusion and carotid patency and no clinical complications have been detected...
2016: Case Reports in Surgery
Filipa Alves da Costa, Luísa Silvestre, Catarina Periquito, Clara Carneiro, Pedro Oliveira, Ana Isabel Fernandes, Patrícia Cavaco-Silva
BACKGROUND: Currently, people live longer but often with poor quality of life. The decrease in healthy life-years is partly attributable to the institution of polypharmacy to treat various comorbidities. OBJECTIVES: The objectives of the study were to determine the prevalence and nature of drug-related problems (DRPs) in polypharmacy elderly patients residing in nursing homes and to test the acceptability of a pharmacist's intervention. METHODS: An exposure cohort was constituted in three Portuguese nursing homes, where all polypharmacy (five or more medicines) elderly patients (≥65 years of age) were analysed and then a random stratified sample was extracted to be subject to an intervention...
March 2016: Drugs—Real World Outcomes
G Iakimova, S Dimitrova, T Burté
OBJECTIVES: Computer-delivered Cognitive Behavioral Therapies (C-CBT) are emerging as therapeutic techniques which contribute to overcome the barriers of health care access in adult populations with depression. The C-CBTs provide CBT techniques in a highly structured format comprising a number of educational lessons, homework, multimedia illustrations and supplementary materials via interactive computer interfaces. Programs are often administrated with a minimal or regular support provided by a clinician or a technician via email, telephone, online forums, or during face-to-face consultations...
October 10, 2016: L'Encéphale
Divine E Ediebah, Jaap C Reijneveld, Martin J B Taphoorn, Corneel Coens, Efstathios Zikos, Neil K Aaronson, Jan J Heimans, Andrew Bottomley, Martin Klein
PURPOSE: Clinical trials in glioma patients with neurocognitive deficits face challenges due to lacking or unreliable patient self-reports on their health-related quality of life (HRQOL). Patient-proxy data could help solve this issue. We determined whether patient-proxy concordance levels were affected by patients' neurocognitive functioning. METHODS: Patient and patient-by-proxy HRQOL ratings were assessed via SF-36 and EORTC QLQ-BN20, respectively, in 246 patients...
October 15, 2016: Quality of Life Research
Kenneth E Schwieter, Jeffrey N Johnston
Peptide synthesis is a truly interdisciplinary tool, familiar to a broad group of scientists who do not otherwise overlap scientifically. For this reason, some may perceive even complex peptide synthesis to be a "solved problem", while others might argue that immense opportunity remains untapped or simply inaccessible. At the extreme of complexity, what might a concise assessment of the state-of-the-art in peptide synthesis look like? As one of the most practiced forms of synthetic chemistry by chemists and non-chemists alike, what restrictions remain that constrain access to chemical space? Using popular terminology, what forms of peptide synthesis are appropriately termed "on-demand"? The purpose of this Perspective is to appraise synthetic access to complex peptides, particularly those containing unnatural α-amino amides...
October 14, 2016: Journal of the American Chemical Society
Fernanda Campos, Rodrigo Oa Souza, Marco A Bottino, Mutlu Özcan
The required connector dimension for zirconia fixed dental prostheses (FDPs) may be a clinical limitation due to limited space in the occlusogingival direction. Using no veneering in the gingival regions of the pontics and connectors may solve this problem. This study evaluated the mechanical durability of zirconia FDPs with and without veneering in the gingival area of the connectors and pontics and subsequent air abrasion of this region with different protocols. Models were made of resin abutments (diameter = 6 or 8 mm, height = 6 mm, 6 degrees convergence) and embedded in polyurethane resin (distance = 11 mm)...
November 2016: International Journal of Periodontics & Restorative Dentistry
Fu Yang, Shu Zaiyue, Gu Mingmin
According to previous reports, nearly one in 10 genetic diseases are caused by nonsense mutations around the world. Nonsense mutations lead to premature transcription terminations in cells, which in turn generate non-functional, truncated proteins. In recent years, read-through drugs are playing increasing prominent roles in the researches related to genetic diseases caused by nonsense mutations. However, due to the fact that the mechanisms lying behind translation termination still remain to be elucidated, the mechanistic research and clinical application of read-through drugs are facing new challenges...
July 20, 2016: Yi Chuan, Hereditas
Hana Alsobayel
BACKGROUND: Social media can be used in health care settings to enhance professional networking and education; patient communication, care, and education; public health programs; organizational promotion; and research. OBJECTIVE: The aim of this study was to explore the use of social media networks for the purpose of professional development among health care professionals in Saudi Arabia using a purpose-designed Web-based survey. METHODS: A cross-sectional web-based survey was undertaken...
September 12, 2016: JMIR Med Educ
Neeraj Nagpal
Physicians and Internists in India have tended to brush under the carpet legal issues affecting their profession. Of concern to all Physicians is the judgment in a recent case where the NCDRC has stated that if MD Medicine Physicians write Physician & Cardiologist on their letterhead it is Quackery. What is MD Medicine degree holder in India qualified and trained to treat ? These are issues which need debate and that can only be initiated once we recognize that there is a problem. Either an MD Medicine is a cardiologist or he is not...
February 2016: Journal of the Association of Physicians of India
Eric W Leppink, Samuel R Chamberlain, Sarah A Redden, Jon E Grant
A notable number of young adults struggle to control impulsive behavior, resulting in impairment and distress. Assessments of problematic sexual behavior (PSB) have noted clinical differences relative to other populations, but neurocognitive findings have varied. This analysis assesses the clinical presentation and neurocognitive profile of patients with PSB relative to participants without PSB symptoms. A total of 492 participants (18-29) were recruited for a study on impulsivity in young adults. Participants completed diagnostic, self-report, and neurocognitive measures which assessed several cognitive domains...
September 26, 2016: Psychiatry Research
Wenchao Gao, Wenyu Liang, Kok Kiong Tan
To treat a worldwide common ear disease (OME), a device allowing fast grommet tube insertion has been designed in our earlier works (Gao et al., 2015 [1] and Liang et al., 2013 [2]). However, the instrument has to be manually placed as close as to the Tympanic Membrane before the insertion procedures. To realize a fully automated surgical process, the instrument shall be automatically manipulated to align to the axial direction of ear canal and proceed to complete the surgery. A vision-based servomechanism is proposed to solve the path planning problem...
October 5, 2016: ISA Transactions
Rick A Stephan, Omar M Alhassoon, Kenneth E Allen, Scott C Wollman, Matt Hall, William J Thomas, Julia M Gamboa, Chrissy Kimmel, Mark Stern, Celina Sari, Constance J Dalenberg, Scott F Sorg, Igor Grant
BACKGROUND: Promising models for cognitive rehabilitation in alcohol treatment rest on a more nuanced understanding of the associated impairments in the multifaceted domains of executive functioning (EF) and impulsivity. OBJECTIVES: This meta-analysis examined the effects of alcohol on the individual subcomponents of EF and impulsivity in recently detoxified participants, including 1) Inhibition & Self-Regulation, 2) Flexibility & Set Shifting, 3) Planning & Problem Solving, 4) Reasoning & Abstraction, and 5) Verbal Fluency...
August 12, 2016: American Journal of Drug and Alcohol Abuse
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