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https://www.readbyqxmd.com/read/29906514/pragmatic-clinical-trials-ethical-imperatives-and-opportunities
#1
EDITORIAL
Shona Kalkman, Ghislaine J M W van Thiel, Diederick E Grobbee, Johannes J M van Delden
Pragmatic clinical trials generate robust real-world evidence that holds great potential to better inform decision making regarding new medicines. For clinicians, patients and regulators, this evidence would preferably be available sooner rather than later. This means that, ideally, market authorization of any given medicine is accompanied by evidence obtained from a pragmatic trial. Given the operational and regulatory complexities of pragmatic trials in general, stakeholders tend to be hesitant to employ more pragmatism at the time of market approval...
June 12, 2018: Drug Discovery Today
https://www.readbyqxmd.com/read/29901487/a-core-set-of-outcome-measures-for-adults-with-neurologic-conditions-undergoing-rehabilitation-a-clinical-practice-guideline
#2
Jennifer L Moore, Kirsten Potter, Kathleen Blankshain, Sandra L Kaplan, Linda C OʼDwyer, Jane E Sullivan
BACKGROUND: Use of outcome measures (OMs) in adult neurologic physical therapy is essential for monitoring changes in a patient's status over time, quantifying observations and patient-reported function, enhancing communication, and increasing the efficiency of patient care. OMs also provide a mechanism to compare patient and organizational outcomes, examine intervention effectiveness, and generate new knowledge. This clinical practice guideline (CPG) examined the literature related to OMs of balance, gait, transfers, and patient-stated goals to identify a core set of OMs for use across adults with neurologic conditions and practice settings...
June 12, 2018: Journal of Neurologic Physical Therapy: JNPT
https://www.readbyqxmd.com/read/29891523/outcomes-from-a-patient-centered-interprofessional-palliative-consult-team-in-oncology
#3
Andrea Feldstain, Barry D Bultz, Janet de Groot, Amane Abdul-Razzak, Leonie Herx, Lyle Galloway, Srini Chary, Aynharan Sinnarajah
Background: Palliative care aims to improve suffering and quality of life for patients with life-limiting disease. This study evaluated an interdisciplinary palliative consultation team for outpatients with advanced cancer at the Tom Baker Cancer Centre. This team traditionally offered palliative medicine and recently integrated a specialized psychosocial clinician. Historic patient-reported clinical outcomes were reviewed. There were no a priori hypotheses. Methods: A total of 180 chart reviews were performed in 8 sample months in 2015 and 2016; 114 patients were included...
June 2018: Journal of the National Comprehensive Cancer Network: JNCCN
https://www.readbyqxmd.com/read/29886301/predictors-of-30-day-outcomes-in-octogenarians-with-traumatic-c2-fractures-undergoing-surgery
#4
John K Yue, Angel Ordaz, Ethan A Winkler, Hansen Deng, Catherine G Suen, John F Burke, Andrew K Chan, Geoffrey T Manley, Sanjay S Dhall, Phiroz E Tarapore
OBJECTIVE: Predictors of surgical outcomes following traumatic axis (C2) fractures in octogenarians remain undercharacterized. METHODS: Patients aged ≥80-years undergoing cervical spine surgery following traumatic C2 fractures were extracted from the National Sample Program of the National Trauma Data Bank (2003-2012). Outcomes include overall inpatient complications, individual complications >1% incidence, hospital length of stay (HLOS), discharge disposition, and mortality...
June 7, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29874142/new-agents-emerging-late-effects-and-the-development-of-precision-survivorship
#5
Eric J Chow, Zoltan Antal, Louis S Constine, Rebecca Gardner, W Hamish Wallace, Brent R Weil, Jennifer M Yeh, Elizabeth Fox
Incremental improvements in the treatment of children and adolescents with cancer have led to 5-year survival rates reaching nearly 85%. In the past decade, impressive progress has been made in understanding the biology of many pediatric cancers. With that understanding, multiple new agents have become available that offer the promise of more-effective and less-toxic treatment. These include agents that target various cell surface antigens and engage the adaptive immune system, as well as those that interfere with key signaling pathways involved in tumor development and growth...
June 6, 2018: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/29871725/comfort-as-a-multidimensional-construct-for-pain-management
#6
Tara Nichols
Pain is a multidimensional phenomenon which each person experiences in a different manner. However, practice stories delineate patterns in the lived pain experience that can broaden health care professionals' perspective of care needed in the moment. Intentional analysis of practice stories about pain and discomfort led to a theoretical model to guide clinical practice, interventions, and research. Recurring patterns and themes from the stories supported a central phenomenon: dimensions of comfort and relationships between comfort, pain, and internal and external predictors...
May 1, 2018: Creative Nursing
https://www.readbyqxmd.com/read/29866585/a-qualitative-study-of-nuisance-bleeding-and-medication-related-beliefs-with-dual-antiplatelet-drug-therapy
#7
Laura P Kimble, Kathryn M Momary, Modupe Adewuyi
OBJECTIVES: The purpose of this qualitative study was to explore perceptions of nuisance bleeding and medication-related beliefs among adults taking dual antiplatelet drug therapy. METHODS: We conducted qualitative telephone interviews with 34 community-dwelling adults with cardiovascular disease. RESULTS: Using qualitative content analysis, we identified 4 dominant themes: nuisance bruising, nuisance bleeding, importance of medication adherence, and duration of therapy...
June 1, 2018: Heart & Lung: the Journal of Critical Care
https://www.readbyqxmd.com/read/29862328/risk-assessment-of-the-hospital-discharge-process-of-high-risk-patients-with-diabetes
#8
Teresa A Pollack, Vidhya Illuri, Rebeca Khorzad, Grazia Aleppo, Diana Johnson Oakes, Jane L Holl, Amisha Wallia
Objectives: Describe the application of a risk assessment to identify failures in the hospital discharge process of a high-risk patient group, liver transplant (LT) recipients with diabetes mellitus (DM) and/or hyperglycaemia who require high-risk medications. Design: A Failure Modes, Effects and Criticality Analysis (FMECA) of the hospital discharge process of LT recipients with DM and/or hyperglycaemia who required DM education and training before discharge was conducted using information from clinicians, patients and data extraction from the electronic health records (EHR)...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29806896/change-without-change-assessing-medicare-reimbursement-for-advance-care-planning
#9
Megan S Wright
In January 2016, Medicare began reimbursing clinicians for time spent engaging in advance care planning with their patients or patients' surrogates. Such planning involves discussions of the care an individual would want to receive should he or she one day lose the capacity to make health care decisions or have conversations with a surrogate about, for example, end-of-life wishes. Clinicians can be reimbursed for face-to-face explanation and discussion of care and advance directives and for the completion of advance care planning forms...
May 2018: Hastings Center Report
https://www.readbyqxmd.com/read/29791243/amcp-partnership-forum-managing-care-in-the-wave-of-precision-medicine
#10
(no author information available yet)
Precision medicine, the customization of health care to an individual's genetic profile while accounting for biomarkers and lifestyle, has increasingly been adopted by health care stakeholders to guide the development of treatment options, improve treatment decision making, provide more patient-centered care, and better inform coverage and reimbursement decisions. Despite these benefits, key challenges prevent its broader use and adoption. On December 7-8, 2017, the Academy of Managed Care Pharmacy convened a group of stakeholders to discuss these challenges and provide recommendations to facilitate broader adoption and use of precision medicine across health care settings...
May 23, 2018: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/29788313/defining-value-of-cancer-therapeutics-a-health-system-perspective
#11
Christine Leopold, Jeffrey M Peppercorn, S Yousuf Zafar, Anita K Wagner
Because of the rising costs of cancer care and ongoing challenges in ensuring access to quality care, there is an increasing need to prioritize spending and define the benefits of therapy in proportion to costs. The term "value" has gained favor as means to define the relative utility of a medical intervention in terms of benefits, risks, and financial costs, which in turn can help clinicians, patients, and policy makers prioritize "high-value" care. While numerous value concepts have been proposed, a comprehensive discussion of value initiatives along the care continuum is missing...
May 18, 2018: Journal of the National Cancer Institute
https://www.readbyqxmd.com/read/29781890/complexities-of-the-diagnostic-process
#12
Barbara Schildkrout
The diagnostic process is a highly complex, problem-solving enterprise. Yet, traditional case reports have not focused directly on this endeavor. Physicians could use the case format to present actual experiences of getting to a diagnosis. This approach would allow for modeling of nonjudgmental, self-reflective practices and also provide information to aid in studying the diagnostic endeavor. Given that diagnostic errors in medicine are widespread and constitute a serious public health problem, it is crucial for physicians to understand the diagnostic process as one step toward improving error rates...
May 17, 2018: Journal of Nervous and Mental Disease
https://www.readbyqxmd.com/read/29779601/noninvasive-ventilation-for-neuromuscular-disease
#13
REVIEW
Dean R Hess
Noninvasive ventilation (NIV) is standard practice for patients with neuromuscular respiratory failure. The interface distinguishes noninvasive from invasive ventilation. Interfaces are commercially available in a variety of styles and sizes. There are now available portable ventilators with good leak compensation and with a variety of modes. Although much has been written about the technical aspects of interfaces and ventilators, the initiation of NIV is an art. Selection of an appropriate interface and ventilator settings requires a close working relationship between clinicians, patients, and families...
June 2018: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29779182/locator%C3%A2-versus-ceramic-electroplated-double-crown-attachments-a-prospective-study-on-the-intraindividual-comparison-of-implant-supported-mandibular-prostheses
#14
Silvia Brandt, Jan Brandt, Ali-Reza Ketabi, Hans-Christoph Lauer, Anna Kunzmann
OBJECTIVES: Implant-supported overdentures are an established dental treatment mode. The aim of this prospective study was and interindividual comparison of patient satisfaction with restorations retained by a prefabricated and thus inexpensive attachment system (Locator®) or with a technologically complex and thus expensive attachment system (ceramic/electroplated double crowns) with similar retentive performance. MATERIALS AND METHODS: Twelve patients received a Locator and a double-crown prosthesis in a crossover study for test periods of 3 months each...
May 19, 2018: Clinical Oral Investigations
https://www.readbyqxmd.com/read/29754644/cushing-s-syndrome-in-pediatrics-an-update
#15
REVIEW
Maya B Lodish, Margaret F Keil, Constantine A Stratakis
Cushing syndrome (CS) is a multisystem disorder resulting from the prolonged exposure to excess glucocorticoids. In children, CS most commonly results from the exogenous administration of steroids and the typical presentation is height deceleration concomitant with weight gain. Endogenous and ectopic causes are rare. CS in children may be associated with distinct germline and somatic mutations. Clinical practice guidelines are available assist clinicians. Patients should be referred to multidisciplinary centers of excellence with experience in endocrinology and surgery...
June 2018: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/29750922/legal-aspects-of-sleep-medicine-in-the-21-st-century
#16
REVIEW
Saiprakash B Venkateshiah, Romy Hoque, Nancy A Collop
Multiple manifestations of sleep disorders may interact with the law making it important to increase awareness of such interactions among clinicians. Patients with excessive sleepiness may have civil (and in some states criminal) liability if they fall asleep while driving and cause a motor vehicle accident. Employers may be held vicariously liable due to the actions of sleepy employees. Hence awareness of causes of excessive sleepiness such as sleep deprivation and OSA is increasing among trucking, railroad, and other safety sensitive occupations...
May 8, 2018: Chest
https://www.readbyqxmd.com/read/29741160/adaptive-deep-brain-stimulation-for-parkinson-s-disease-using-motor-cortex-sensing
#17
Nicole C Swann, Coralie de Hemptinne, Margaret C Thompson, Svjetlana Miocinovic, Andrew M Miller, Ro'ee Gilron, Jill L Ostrem, Howard J Chizeck, Philip A Starr
OBJECTIVE: Contemporary deep brain stimulation (DBS) for Parkinson's disease is delivered continuously, and adjustments based on patient's changing symptoms must be made manually by a trained clinician. Patients may be subjected to energy intensive settings at times when they are not needed, possibly resulting in stimulation-induced adverse effects, such as dyskinesia. One solution is 'adaptive' DBS, in which stimulation is modified in real time based on neural signals that co-vary with the severity of motor signs or of stimulation-induced adverse effects...
May 9, 2018: Journal of Neural Engineering
https://www.readbyqxmd.com/read/29737197/inflammatory-bowel-disease-related-fatigue-is-correlated-with-depression-and-gender
#18
Philip Keightley, Rebecca E Reay, Paul Pavli, Jeffrey Cl Looi
OBJECTIVES: Fatigue is a common and disabling problem in inflammatory bowel disease. We sought to explore the possible determinants of inflammatory bowel disease-associated fatigue including demographic, psychological and disease variables. METHODS: Surveys were distributed to 100 patients undergoing infliximab infusion for inflammatory bowel disease in an infusion lounge, assessing attachment style (Experiences in Close Relationships Revised scale), fatigue (Functional Assessment of Chronic Illness Therapy Fatigue - Fatigue Subscore), and depression and anxiety (Hospital Anxiety and Depression Scale)...
May 1, 2018: Australasian Psychiatry: Bulletin of Royal Australian and New Zealand College of Psychiatrists
https://www.readbyqxmd.com/read/29735477/finding-meaning-in-medication-reconciliation-using-electronic-health-records-qualitative-analysis-in-safety-net-primary-and-specialty-care
#19
George Yaccoub Matta, Elaine C Khoong, Courtney R Lyles, Dean Schillinger, Neda Ratanawongsa
BACKGROUND: Safety net health systems face barriers to effective ambulatory medication reconciliation for vulnerable populations. Although some electronic health record (EHR) systems offer safety advantages, EHR use may affect the quality of patient-provider communication. OBJECTIVE: This mixed-methods observational study aimed to develop a conceptual framework of how clinicians balance the demands and risks of EHR and communication tasks during medication reconciliation discussions in a safety net system...
May 7, 2018: JMIR Medical Informatics
https://www.readbyqxmd.com/read/29733840/clinical-opinion-doing-something-about-the-cesarean-delivery-rate
#20
S L Clark, T J Garite, E J Hamilton, M A Belfort, G D Hankins
There is a general consensus that the cesarean delivery rate in the U.S. is too high, and that practice patterns of obstetricians are largely to blame for this situation. In reality, the U.S. cesarean delivery rate is the result of 3 forces largely beyond the control of the practicing clinician: patient expectations and misconceptions regarding the safety of labor, the medical-legal system, and limitations in technology. Efforts to "do something" about the cesarean delivery rate by promulgating practice directives which are marginally evidence-based or influenced by social pressures are both ineffective and potentially harmful...
May 4, 2018: American Journal of Obstetrics and Gynecology
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