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https://www.readbyqxmd.com/read/28743150/-anesthesiology-and-outcome-impact-of-the-perioperative-process
#1
Jörg Zieger, Helene A Häberle
In recent years, the role of the anesthesiologist has turned tremendously from the "anaesthesia doctor" into a perioperative physician and risk specialist. Patients are older, multimorbid, and are called up for more and more extensive surgery and interventions. Socioeconomic aspects have grown in importance. The anesthesiologist, paving the way for a good outcome, is involved in nearly all perioperative processes: preoperative evaluation, definition and optimization of preoperative and intraoperative conditions, management of modern intraoperative anesthesia as well as postoperative medically indicated, effective and efficient treatment of partially highly complex patients...
July 2017: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/28742911/targeted-temperature-management-for-48-vs-24-hours-and-neurologic-outcome-after-out-of-hospital-cardiac-arrest-a-randomized-clinical-trial
#2
Hans Kirkegaard, Eldar Søreide, Inge de Haas, Ville Pettilä, Fabio Silvio Taccone, Urmet Arus, Christian Storm, Christian Hassager, Jørgen Feldbæk Nielsen, Christina Ankjær Sørensen, Susanne Ilkjær, Anni Nørgaard Jeppesen, Anders Morten Grejs, Christophe Henri Valdemar Duez, Jakob Hjort, Alf Inge Larsen, Valdo Toome, Marjaana Tiainen, Johanna Hästbacka, Timo Laitio, Markus B Skrifvars
Importance: International resuscitation guidelines recommend targeted temperature management (TTM) at 33°C to 36°C in unconscious patients with out-of-hospital cardiac arrest for at least 24 hours, but the optimal duration of TTM is uncertain. Objective: To determine whether TTM at 33°C for 48 hours results in better neurologic outcomes compared with currently recommended, standard, 24-hour TTM. Design, Setting, and Participants: This was an international, investigator-initiated, blinded-outcome-assessor, parallel, pragmatic, multicenter, randomized clinical superiority trial in 10 intensive care units (ICUs) at 10 university hospitals in 6 European countries...
July 25, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28742719/pediatric-gastroenterologists-approach-to-venous-thromboembolism-prophylaxis-in-pediatric-inflammatory-bowel-disease
#3
Kimberley Ann Chien, Hoda T Hammad, Linda Gerber, Sujit Sheth, Robbyn Sockolow, Nicole Elena Kucine
The risk of venous thromboembolism (VTE) is significantly increased in inflammatory bowel disease (IBD) patients. For the adult population, prophylaxis guidelines exist to help guide physicians in their management of high-risk IBD patients. While it is known that children with IBD also experience increased rates of VTE, there is no clear consensus on how best to prevent these unwanted complications. We sought to better understand practicing pediatric gastroenterologists' awareness of this issue and practices surrounding prevention of VTE in their pediatric patients...
July 22, 2017: Journal of Pediatric Gastroenterology and Nutrition
https://www.readbyqxmd.com/read/28742682/ductal-carcinoma-in-situ-and-margins-2%C3%A2-mm-contemporary-outcomes-with-breast-conservation
#4
Audree B Tadros, Benjamin D Smith, Yu Shen, Heather Lin, Savitri Krishnamurthy, Anthony Lucci, Carlos H Barcenas, Rosa F Hwang, Gaiane Rauch, Lumarie Santiago, Eric A Strom, Sarah M DeSnyder, Wei T Yang, Dalliah M Black, Constance T Albarracin, Mariana Chavez-MacGregor, Kelly K Hunt, Henry M Kuerer
OBJECTIVE: To determine the relationship between negative margin width and locoregional recurrence (LRR) in a contemporary cohort of ductal carcinoma in situ (DCIS) patients. BACKGROUND: Recent national consensus guidelines recommend an optimal margin width of 2 mm or greater for the management of DCIS; however, controversy regarding re-excision remains when managing negative margins <2 mm. METHODS: One thousand four hundred ninety-one patients with DCIS who underwent breast-conserving surgery from 1996 to 2010 were identified from a prospectively managed cancer center database and analyzed using univariate and multivariate Cox proportional hazard models to determine the relationship between negative margin width and LRR with or without adjuvant radiation therapy (RT)...
July 24, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28742642/pathway-for-the-management-of-sleep-apnea-in-the-cardiac-patient
#5
Emad F Aziz, Allison Selby, Edgar Argulian, Joshua Aziz, Eyal Herzog
Sleep-disordered breathing is a highly prevalent medical condition, which if undiagnosed leads to increased morbidity and mortality, particularly related to increased incidence of cardiovascular events. It is therefore imperative that we identify patient population at high risk for sleep apnea and refer them to the appropriate therapy as early as possible. Up-to-date there is no management guideline specifically geared towards cardiac patients. Thus, we propose a (SAP) Sleep Apnea Pathway to correctly identify and triage these patients to the appropriate therapy...
September 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28742500/adverse-effects-of-androgen-deprivation-therapy-in-patients-with-prostate-cancer-focus-on-metabolic-complications
#6
REVIEW
Vasileios Tzortzis, Michael Samarinas, Ioannis Zachos, Athanasios Oeconomou, Louis L Pisters, Alexandra Bargiota
Prostate cancer is the most common cancer among men and androgen deprivation therapy (ADT) is the most effective treatment for this disease. The cornerstone of the treatment of prostate cancer is inhibition of testosterone production which interrupts testosterone-induced growth of the prostate tumor. The dramatic decrease in testosterone levels, however, has several undesirable effects on the metabolic profile and bone metabolism and can also lead to fatigue, loss of libido, gynecomastia, and anemia, provoke vasomotor flushing, and generally affect the quality of life...
April 2017: Hormones: International Journal of Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28742291/evaluating-the-effect-of-the-changes-in-fda-guidelines-for-clozapine-monitoring
#7
Ryan S Sultan, Mark Olfson, Christoph U Correll, Erica J Duncan
BACKGROUND: Concerns exist that clozapine is underutilized in the management of treatment-resistant schizophrenia. Although a 2015 change in the US Food and Drug Administration (FDA) monitoring recommendations lowered the threshold of the absolute neutrophil count for treatment interruption from 1,500/μL to 1,000/μL and removed white blood cell count thresholds from the monitoring algorithm, the implications of this policy change on clozapine interruptions remain unknown. METHODS: We analyzed outpatient prescribing records for antipsychotic medications in the Veterans Integrated Service Network 7 (VISN 7) database between 1999 and 2012 to assess the potential impact of the recent changes in FDA neutropenia monitoring recommendations on clozapine treatment discontinuation...
July 18, 2017: Journal of Clinical Psychiatry
https://www.readbyqxmd.com/read/28742255/weight-management-strategies-for-those-with-chronic-kidney-disease-a-consensus-report-from-the-asia-pacific-society-of-nephrology-and-australia-and-new-zealand-society-of-nephrology-2016-renal-dietitians-meeting
#8
Kelly Lambert, Jo Beer, Ruth Dumont, Katie Hewitt, Karen Manley, Anthony Meade, Karen Salamon, Katrina Campbell
AIM: Develop a consensus report to guide dietetic management of overweight or obese individuals with Chronic Kidney Disease (CKD). METHODS: Six statements relating weight management in CKD guided a comprehensive review of the literature. A summary of the evidence was then presented at the renal nutrition meeting of the 2016 Asia Pacific Society of Nephrology and Australia and New Zealand Society of Nephrology. Majority agreement was defined as group agreement on a statement of between 50-74%, and consensus was considered ≥ 75% agreement...
July 25, 2017: Nephrology
https://www.readbyqxmd.com/read/28741965/cost-effectiveness-of-dolutegravir-abacavir-lamivudine-in-hiv-1-treatment-na%C3%A3-ve-tn-patients-in-france
#9
Gilles Pialoux, Anne-Geneviève Marcelin, Hélène Cawston, Caroline Guilmet, Laurent Finkielsztejn, Audrey Laurisse, Céline Aubin
OBJECTIVES: To evaluate the cost-effectiveness of an integrase inhibitor (INI), dolutegravir (DTG), in combination with abacavir (ABC)/lamivudine (3TC) in France, in treatment-naïve (TN) HIV adult patients. METHODS: The ARAMIS microsimulation Markov model, evaluates costs and effects of DTG vs. first-line ARVs options including INIs (raltegravir, elvitegravir/c), protease inhibitors (PIs) (darunavir/r, atazanavir/r, lopinavir/r), non-nucleoside reverse transcriptase inhibitors (efavirenz and rilpivirine)...
July 25, 2017: Expert Review of Pharmacoeconomics & Outcomes Research
https://www.readbyqxmd.com/read/28741848/pharmacologic-considerations-in-the-management-of-patients-receiving-left-ventricular-percutaneous-mechanical-circulatory-support
#10
J Erin Allender, Brent N Reed, Jenna L Foster, Jeremy D Moretz, Carrie S Oliphant, Douglas L Jennings, Robert J DiDomenico, James C Coons
Percutaneous mechanical circulatory support (MCS) devices, including the intra-aortic balloon pump, Impella, and TandemHeart, are often used for hemodynamic support in the setting of refractory cardiogenic shock. The thrombotic and bleeding complications associated with these devices is well recognized, and the Impella and TandemHeart devices have unique anticoagulation considerations that may influence patient outcomes. Both devices typically require use of a heparinized purge solution in combination with intravenous unfractionated heparin, thereby providing multiple sources of heparin exposure...
July 25, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28741723/analysis-of-the-incidence-and-factors-predictive-of-outcome-in-patients-with-head-and-neck-cancer-with-pulmonary-nodules
#11
Richard Green, Mark T Macmillan, Theofano Tikka, Lorna Bruce, John T Murchison, Iain J Nixon
BACKGROUND: The management of pulmonary nodules is challenging; unfortunately, little is known about the incidence and significance of pulmonary nodules in patients with head and neck cancer. METHODS: A review was conducted of 400 consecutive patients with head and neck cancer. Imaging was reviewed to identify the incidence of nodules and patient, tumor, and radiological factors associated with the risk of malignancy. RESULTS: Nodules were found in 58% of patients, with a malignant rate of 6%...
July 25, 2017: Head & Neck
https://www.readbyqxmd.com/read/28740999/advanced-cardiac-life-support-2016-singapore-guidelines
#12
Chi Keong Ching, Siew Hon Benjamin Leong, Siang Jin Terrance Chua, Swee Han Lim, Kenneth Heng, Sohil Pothiawala, Venkataraman Anantharaman
The main areas of emphasis in the Advanced Cardiac Life Support (ACLS) guidelines are: early recognition of cardiac arrest and call for help; good-quality chest compressions; early defibrillation when applicable; early administration of drugs; appropriate airway management ensuring normoventilation; and delivery of appropriate post-resuscitation care to enhance survival. Of note, it is important to monitor the quality of the various care procedures. The resuscitation team needs to reduce unnecessary interruptions to chest compressions in order to maintain adequate coronary perfusion pressure during the ACLS drill...
July 2017: Singapore Medical Journal
https://www.readbyqxmd.com/read/28740997/guidelines-for-bystander-first-aid-2016
#13
Jen Heng Pek
Cardiac life support is a form of first aid for cardiac emergencies. However, research and evidence in this field is lacking compared with other forms of first aid. Having identified the common emergencies that are encountered in the hospital, based on the available evidence, we have put together what could be an evidence-based approach to the first aid management of some of these common emergencies, viz. breathlessness, chest pain, allergies, stroke, heat injury, poisoning, unconsciousness, seizures, and trauma situations such as bleeding, wounds, contusions, head injury, burns and fractures...
July 2017: Singapore Medical Journal
https://www.readbyqxmd.com/read/28740942/anti-viral-effects-of-medicinal-plants-in-the-management-of-dengue-a-systematic-review
#14
Éric Heleno Freira Ferreira Frederico, André Luiz Bandeira Dionísio Cardoso, Eloá Moreira-Marconi, Danúbia da Cunha de Sá-Caputo, Carlos Alberto Sampaio Guimarães, Carla da Fontoura Dionello, Danielle Soares Morel, Laisa Liane Paineiras-Domingos, Patricia Lopes de Souza, Samuel Brandão-Sobrinho-Neto, Rafaelle Pacheco Carvalho-Lima, Eliane de Oliveira Guedes-Aguiar, Rebeca Graça Costa-Cavalcanti, Cristiane Ribeiro Kutter, Mario Bernardo-Filho
BACKGROUND: Dengue is considered as an important arboviral disease. Safe, low-cost, and effective drugs that possess inhibitory activity against dengue virus (DENV) are mostly needed to try to combat the dengue infection worldwide. Medicinal plants have been considered as an important alternative to manage several diseases, such as dengue. As authors have demonstrated the antiviral effect of medicinal plants against DENV, the aim of this study was to review systematically the published research concerning the use of medicinal plants in the management of dengue using the PubMed database...
2017: African Journal of Traditional, Complementary, and Alternative Medicines: AJTCAM
https://www.readbyqxmd.com/read/28740686/whole-lung-lavage-technical-details-challenges-and-management-of-complications
#15
REVIEW
Ahmed Awab, Muhammad S Khan, Houssein A Youness
Pulmonary alveolar proteinosis (PAP) is a rare disease characterized by alveolar accumulation of surfactant material with resulting hypoxemia and reduced lung function. Whole lung lavage (WLL) to physically remove the proteinaceous material from the affected lung is the standard treatment. Since its original description in 1964, there have been increasing numbers of WLL procedures done worldwide and the technique has been variously refined and modified. When done in experienced centers, WLL provides long lasting benefit in the majority of patients...
June 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28740661/south-african-guideline-for-the-management-of-community-acquired-pneumonia-in-adults
#16
REVIEW
Tom H Boyles, Adrian Brink, Greg L Calligaro, Cheryl Cohen, Keertan Dheda, Gary Maartens, Guy A Richards, Richard van Zyl Smit, Clifford Smith, Sean Wasserman, Andrew C Whitelaw, Charles Feldman
No abstract text is available yet for this article.
June 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28740389/methylphenidate-dose-optimization-for-adhd-treatment-review-of-safety-efficacy-and-clinical-necessity
#17
REVIEW
Michael Huss, Praveen Duhan, Preetam Gandhi, Chien-Wei Chen, Carsten Spannhuth, Vinod Kumar
Attention-deficit/hyperactivity disorder (ADHD) is a chronic psychiatric disorder characterized by hyperactivity and/or inattention and is often associated with a substantial impact on psychosocial functioning. Methylphenidate (MPH), a central nervous system stimulant, is commonly used for pharmacological treatment of adults and children with ADHD. Current practice guidelines recommend optimizing MPH dosage to individual patient needs; however, the clinical benefits of individual dose optimization compared with fixed-dose regimens remain unclear...
2017: Neuropsychiatric Disease and Treatment
https://www.readbyqxmd.com/read/28739655/critical-issues-in-food-allergy-a-national-academies-consensus-report
#18
Scott H Sicherer, Katrina Allen, Gideon Lack, Steve L Taylor, Sharon M Donovan, Maria Oria
The National Academies of Sciences, Engineering, and Medicine convened an expert, ad hoc committee to examine critical issues related to food allergy. The authors of the resulting report, "Finding a Path to Safety in Food Allergy: Assessment of the Global Burden, Causes, Prevention, Management, and Public Policy," evaluated the scientific evidence on the prevalence, diagnosis, prevention, and management of food allergy and made recommendations to bring about a safe environment for those affected. The committee recommended approaches to monitor prevalence, explore risk factors, improve diagnosis, and provide evidence-based health care...
July 24, 2017: Pediatrics
https://www.readbyqxmd.com/read/28739478/an-overview-of-clinical-guidelines-for-the-management-of-vertebral-compression-fracture-a-systematic-review
#19
REVIEW
Patrícia Parreira, Chris G Maher, Rodrigo Z Megale, Lyn March, Manuela L Ferreira
BACKGROUND CONTEXT: Vertebral compression fractures are the most common type of osteoporotic fracture comprising approximately 1.4 million cases worldwide. Clinical practice guidelines can be powerful tools for promoting evidence-based practice, as they integrate research findings in order to support decision-making. However, currently available clinical guidelines and recommendations, established by different medical societies, are sometimes contradictory. PURPOSE: The aim of this study was to appraise the recommendations and methodological quality of international clinical guidelines for the management of VCFs...
July 21, 2017: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/28739433/pain-management-the-rising-role-of-interventional-oncology
#20
D Filippiadis, S Tutton, A Kelekis
Patients with early or metastatic cancer may suffer from pain of different origins. The vast majority of these patients are not adequately treated by means of systemic analgesia and radiotherapy. Percutaneous neurolysis is performed using chemical agents or thermal energy upon sympathetic nervous system plexus for pain reduction and life quality improvement. Ablation and vertebral augmentation are included in clinical guidelines for metastatic disease. As far as the peripheral skeleton is concerned bone augmentation and stabilization can be performed by means of cement injection either solely performed or in combination to cannulated screws or other metallic or peek implants...
July 21, 2017: Diagnostic and Interventional Imaging
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