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bedside rationing

Yiying Cai, Nathalie Grace Chua, Tze-Peng Lim, Jocelyn Qi-Min Teo, Winnie Lee, Asok Kurup, Tse-Hsien Koh, Thuan-Tong Tan, Andrea L Kwa
INTRODUCTION: Combination therapy is increasingly utilized against extensively-drug resistant (XDR) Gram negative bacteria (GNB). However, choosing a combination can be problematic as effective combinations are often strain-specific. An in vitro antibiotic combination testing (iACT) service, aimed to guide the selection of individualized and rationally optimized combination regimens within 48 hours, was developed. We described the role and feasibility of the iACT service in guiding individualized antibiotic combination selection in patients with XDR-GNB infections...
2016: PloS One
Pankaj Kumar Singh, Harpreet Singh, Om Silakari
Lung cancer still remains one of the major causes of cancer related mortality around the globe. Various different molecular targets have been discovered till date for targeting lung cancer. But not every new molecular target has a successfully designed inhibitor; moreover conventional chemotherapeutics have their own limitations such as toxicity and lack of selectivity. Thus, kinases still remain the most effective molecular target in lung cancer therapy. Also, once-shunned kinase inhibitors have recently acquired renewed interest after the development and approval of irreversible kinase inhibitors (such as afatinib) that form covalent bonds with cysteine (or other nucleophilic residues) in the ATP-binding pocket of the kinases...
August 2016: Biochimica et Biophysica Acta
Erik J Woods, Sreedhar Thirumala, Sandhya S Badhe-Buchanan, Dominic Clarke, Aby J Mathew
The field of cellular therapeutics has immense potential, affording an exciting array of applications in unmet medical needs. One of several key issues is an emphasis on getting these therapies from bench to bedside without compromising safety and efficacy. The successful commercialization of cellular therapeutics will require many to extend the shelf-life of these therapies beyond shipping "fresh" at ambient or chilled temperatures for "just in time" infusion. Cryopreservation is an attractive option and offers potential advantages, such as storing and retaining patient samples in case of a relapse, banking large quantities of allogeneic cells for broader distribution and use and retaining testing samples for leukocyte antigen typing and matching...
June 2016: Cytotherapy
F J Harries, P A Begg
OBJECTIVE: The use of non-rinse skin cleansers in the care of patients who are at risk of tissue breakdown is not new within the National Health Service (NHS). Back to the Floor Continence Care Rounds (introduced in 2012 to facilitate bedside continence care education) at University Hospitals Birmingham had identified that in the current climate of austerity and efficiency savings, the use of non-rinse cleanser was being randomly rationed. Our objective was to determine whether the introduction of a smaller tube of non-rinse cleanser with targeted education would improve usage and ultimately improve the skin of incontinent patients...
May 2016: Journal of Wound Care
Raja Atreya, Markus F Neurath
PURPOSE OF REVIEW: Standard structural imaging procedures such as endoscopy, ultrasonography, or MRI are an integral part of the rational management of patients with inflammatory bowel diseases (IBDs). There is nevertheless the need for further refined imaging approaches that are able to overcome the limitations of currently used formats. The advent of molecular imaging modalities that allow real-time visualization of cellular processes not only in the preclinical setting but also in clinical trials has demonstrated its ability to improve current therapeutic strategies...
July 2016: Current Opinion in Gastroenterology
Mei-Miao Zhan, Xue-Qin Hu, Xiu-Xiu Liu, Ban-Feng Ruan, Jun Xu, Chenzhong Liao
Cancer immunotherapy has made an extraordinary journey from bench to bedside. Blocking the interactions between programmed cell death protein 1 (PD-1) and its ligand, PD-L1, has emerged as a promising immunotherapy for treating cancer. Here, we review the development of drugs targeting the PD-1/PD-L1 pathway. We discuss the monoclonal antibodies (mAbs) approved or in clinical trials, peptides and patented small molecules developed against this pathway. Such compounds have the potential to treat cancer as well as chronic virological diseases...
June 2016: Drug Discovery Today
C Saillard, D Blaise, D Mokart
The outcome of allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients has significantly improved over the past decade. Still, a significant number of patients require intensive care unit (ICU) management because of life-threatening complications. Literature from the 1990s reported extremely poor prognosis for critically ill allo-HSCT patients requiring ICU management. Recent data justify the use of ICU resources in hematologic patients. Yet, allo-HSCT remains an independent variable associated with mortality...
August 2016: Bone Marrow Transplantation
Luise I M Pernar, Lindsay L Wolf, Anupamaa Seshadri, Vihas Patel
BACKGROUND: Peripherally inserted central venous catheters (PICCs) are popular for a broad range of indications. As with other forms of central access, PICC use can be associated with serious and potentially costly complications. In 2000, in response to the rising popularity of PICC use, a surgeon-led team was created to steward their placement. All requests were screened rigorously to ensure rational use. Our hypothesis was that creation of a dedicated PICC team would decrease inappropriate PICC placement, overall complication rates, and cost...
June 2016: Surgical Infections
Tiantian He, Elie Hatem, Laurence Vernis, Ming Lei, Meng-Er Huang
BACKGROUND: Many promising anticancer molecules are abandoned during the course from bench to bedside due to lack of clear-cut efficiency and/or severe side effects. Vitamin K3 (vitK3) is a synthetic naphthoquinone exhibiting significant in vitro and in vivo anticancer activity against multiple human cancers, and has therapeutic potential when combined with other anticancer molecules. The major mechanism for the anticancer activity of vitK3 is the generation of cytotoxic reactive oxygen species (ROS)...
2015: Journal of Experimental & Clinical Cancer Research: CR
Dominique Barbolosi, Joseph Ciccolini, Bruno Lacarelle, Fabrice Barlési, Nicolas André
Computational oncology is a generic term that encompasses any form of computer-based modelling relating to tumour biology and cancer therapy. Mathematical modelling can be used to probe the pharmacokinetics and pharmacodynamics relationships of the available anticancer agents in order to improve treatment. As a result of the ever-growing numbers of druggable molecular targets and possible drug combinations, obtaining an optimal toxicity-efficacy balance is an increasingly complex task. Consequently, standard empirical approaches to optimizing drug dosing and scheduling in patients are now of limited utility; mathematical modelling can substantially advance this practice through improved rationalization of therapeutic strategies...
April 2016: Nature Reviews. Clinical Oncology
Frehiwot Berhane Defaye, Dawit Desalegn, Marion Danis, Samia Hurst, Yemane Berhane, Ole Frithjof Norheim, Ingrid Miljeteig
BACKGROUND: Resource scarcity in health care is a universal challenge. In high-income settings, bedside rationing is commonly discussed and debated as a means to addressing scarcity. However, little is known about physicians' experiences in resource-limited contexts in low- income countries. Here we describe physicians' experiences regarding scarcity of resources, bedside rationing, use of various strategies to save resources, and perceptions of the consequences of rationing in Ethiopia...
2015: BMC Health Services Research
Matthew Weinstock, David F McDermott
Therapies that augment the antitumor immune response have been an established treatment modality for metastatic renal cell carcinoma (mRCC) since the 1980s. An improved understanding of the factors that limit the immune response to cancer have led to the development of novel therapeutic agents. Most notably, monoclonal antibodies that block the programmed death (PD)-1 immune checkpoint pathway have demonstrated encouraging antitumor activity against mRCC in phase I and II clinical trials. However, as monotherapy these agents are unlikely to offer substantial clinical benefit for the majority of patients with mRCC...
2015: American Society of Clinical Oncology Educational Book
Andrea Vannucci, Laura F Cavallone
BACKGROUND: Unanticipated difficult intubation is associated with unwanted patient outcomes. The capability of predicting difficult airways may contribute to patient safety, efficient patient flow and rational use of limited resources. We evaluated current literature on performance of bedside airway tests in predicting difficult tracheal intubation. METHODS: Eligibility criteria were: prospective clinical studies; adult population of least 100 subjects; accepted definition of difficult intubation; direct laryngoscopy approach; true positive, false negative, false positive and true negative either reported or inferred...
January 2016: Minerva Anestesiologica
David S Liebeskind
The recent culmination of imaging-endowed endovascular stroke trials has decisively proven the utility of clinically relevant neuroimaging in improving the outcome of patients with potentially debilitating neurological disorders. These large multicenter trials conducted across several continents notably utilized a variety of multimodal CT/MRI modalities to rapidly identify a favorable collateral profile that presages clinically beneficial revascularization. The modern clinical neuroimager may accelerate complex decision-making through the rational use of a variety of imaging modalities and an active feedback loop of imaging at the bedside...
July 2015: Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging
Dimitrios C Mastellos, Despina Yancopoulou, Petros Kokkinos, Markus Huber-Lang, George Hajishengallis, Ali R Biglarnia, Florea Lupu, Bo Nilsson, Antonio M Risitano, Daniel Ricklin, John D Lambris
There is a growing awareness that complement plays an integral role in human physiology and disease, transcending its traditional perception as an accessory system for pathogen clearance and opsonic cell killing. As the list of pathologies linked to dysregulated complement activation grows longer, it has become clear that targeted modulation of this innate immune system opens new windows of therapeutic opportunity for anti-inflammatory drug design. Indeed, the introduction of the first complement-targeting drugs has reignited a vibrant interest in the clinical translation of complement-based inhibitors...
April 2015: European Journal of Clinical Investigation
Anka C Roehr, Otto R Frey, Andreas Koeberer, Thomas Fuchs, Jason A Roberts, Alexander Brinkmann
PURPOSE: The main objective of this study was to investigate the clearance of 11 selected anti-infectives in an in vitro model of continuous veno-venous hemodialysis (CVVHD), in order to suggest rational dosing strategies for clinical practice. METHODS: Ceftazidime, ciprofloxacin, flucloxacillin, gentamicin, linezolid, meropenem, metronidazole, piperacillin, rifampicin, vancomycin and voriconazole were studied in two different solvents (sodium chloride 0.9% and HSA 5%) using a multifiltrate dialysis device by Fresenius Medical Care (Bad Homburg, Germany)...
January 2015: International Journal of Artificial Organs
F Ferraro, T L Di Gennaro, A Torino, J Petruzzi, A d'Elia, P Fusco, R Marfella, B Lettieri
AIM: To evaluate the effectiveness of a caval vein filter (CVF) peri-implant monitoring protocol in order to reduce pulmonary embolism (PE) mortality and CVF-related morbidity. BACKGROUND: The reduction in mortality from PE associated with the use of CVF is affected by the risk of increase in morbidity. Therefore, CVF implant is a challenging prophylactic or therapeutic option. Nowadays, we have many different devices whose rational use, by applying a strict peri-implant monitoring protocol, could be safe and effective...
2014: Drug Design, Development and Therapy
Gustavo A Patino, Jack Parent
No abstract text is available yet for this article.
September 2014: Epilepsy Currents
Brian Wan-Chi Tse, Lidija Jovanovic, Colleen Coyne Nelson, Paul de Souza, Carl Andrew Power, Pamela Joan Russell
The mainstay therapeutic strategy for metastatic castrate-resistant prostate cancer (CRPC) continues to be androgen deprivation therapy usually in combination with chemotherapy or androgen receptor targeting therapy in either sequence, or recently approved novel agents such as Radium 223. However, immunotherapy has also emerged as an option for the treatment of this disease following the approval of sipuleucel-T by the FDA in 2010. Immunotherapy is a rational approach for prostate cancer based on a body of evidence suggesting these cancers are inherently immunogenic and, most importantly, that immunological interventions can induce protective antitumour responses...
2014: BioMed Research International
Kanchan Gupta, Shalini Arora, Sandeep Kaushal
OBJECTIVE: The undergraduate teaching in pharmacology has always been a challenging task for medical teachers. Traditional lecture format is monotonous and a passive way of learning. There is a need to shift the educational focus from content centered to case based. In an effort to create interest and further improve the student learning, we have introduced simulated bedside teaching sessions as case based learning (CBL) module (modified CBL-[mCBL]) for 2(nd) professional MBBS students...
July 2014: International Journal of Applied and Basic Medical Research
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