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The rational clinical examination

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https://www.readbyqxmd.com/read/27931964/imaging-in-paediatric-rheumatology-is-it-time-for-imaging
#1
REVIEW
Paz Collado, Clara Malattia
Juvenile idiopathic arthritis (JIA) is a heterogeneous group of arthritides characterized by chronic synovial inflammation that can lead to structural damage. The main objective of JIA therapies is to induce disease control to avoid disability in childhood. The advances in therapeutic effectiveness have created a need to search for imaging tools that describe more precisely disease activity in children with JIA. Musculoskeletal ultrasound and magnetic resonance imaging have demonstrated to be more sensitive than clinical examination in early detection of synovitis...
August 2016: Best Practice & Research. Clinical Rheumatology
https://www.readbyqxmd.com/read/27928926/clinical-observation-of-adverse-drug-reactions-to-nonionic-iodinated-contrast-media-in-population-with-underlying-diseases-and-risk-factors
#2
Xue Li, Heng Liu, Li Zhao, Junling Liu, Li Cai, Lei Liu, Weiguo Zhang
OBJECTIVES: To determine the adverse drug reactions (ADRs) profile of nonionic iodinated contrast media (NICMs) in population with underlying diseases and risk factors, and to provide guidance for more safe and rational use of ICMs in clinic. METHODS: Data from 120,822 cases who underwent enhanced CT examination in our hospital from January 2014 to March 2016 were collected. A standardized case report form (CRF) was used for data collection and analysis. RESULTS: The incidence of ADRs was 0...
December 8, 2016: British Journal of Radiology
https://www.readbyqxmd.com/read/27911427/-modern-approach-to-early-diagnosis-and-pathogenetic-treatment-of-diabetic-retinopathy
#3
I V Vorob'eva
AIM: To improve the approach to pathogenetic treatment of diabetic retinopathy (DR) through early diagnosis and a new method for predicting disease progression. MATERIAL AND METHODS: The study enrolled 330 type 2 diabetes patients with DR (660 eyes), of whom women constituted 64.6%, men - 35.4%. The mean patient age was 62.3±2.3 years. Three groups were formed: the controls - 30 healthy volunteers (60 eyes) and 30 type 2 diabetes patients without ocular involvement (DR 0, 60 eyes); group 1 - 30 type 2 diabetes patients with DR I but no diabetic macular edema (DR I without DME, 60 eyes) that were treated with calcium dobesilate; group 2 - 240 type 2 diabetes patients, who had diabetic retinopathy of different stages (DR I, II, or III with DME, 480 eyes) and received laser retinal photocoagulation (LRP)...
2016: Vestnik Oftalmologii
https://www.readbyqxmd.com/read/27906721/preoperative-evaluation-and-preparation-of-the-morbidly-obese-patient
#4
Andreas B Böhmer, Frank Wappler
PURPOSE OF REVIEW: This review aims to familiarize with the most current findings regarding preoperative evaluation and preparation of morbidly obese patients prior to elective, noncardiac surgery. In the light of the increasing number of surgical patients being morbidly obese, the knowledge of evidence-based preoperative evaluation strategies is profound for a rational approach. RECENT FINDINGS: Preoperative evaluation should be carried out with sufficient time before the day of surgery to allow modification of the perioperative management...
November 30, 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27905110/distinct-molecular-landscapes-between-endometrioid-and-non-endometrioid-uterine-carcinomas
#5
Nathaniel L Jones, Joanne Xiu, Sudeshna Chatterjee-Paer, Alexandre Buckley de Meritens, William M Burke, Ana I Tergas, Jason D Wright, June Y Hou
Endometrial carcinoma (EC) is traditionally characterized as endometrioid and non-endometrioid based on histo-pathologic phenotypes. Molecular-based classifications have been proposed, but are not widely implemented. Herein we examine molecular profiles between EC histologic subtypes. 3133 ECs were submitted between March 2011 and July 2014: 1634 Type I and 1226 Type II. In situ hybridization and immunohistochemistry were used to assess copy number and protein expression of selected genes. Sequenced variants in 47 genes were analyzed using the Illumina TruSeq Amplicon Cancer Panel...
December 1, 2016: International Journal of Cancer. Journal International du Cancer
https://www.readbyqxmd.com/read/27903150/addressing-the-role-of-obesity-in-endometrial-cancer-risk-prevention-and-treatment
#6
Michaela A Onstad, Rosemarie E Schmandt, Karen H Lu
In sharp contrast to many other cancer types, the incidence and mortality of endometrial cancer continue to grow. This unfortunate trend is, in no small part, a result of the worldwide obesity epidemic. More than half of endometrial cancers are currently attributable to obesity, which is recognized as an independent risk factor for this disease. In this review, we identify the molecular mechanisms by which obesity and adipose tissue contribute to the pathogenesis of endometrial cancer. We further discuss the impact of obesity on the clinical management of the disease and examine the development of rational behavioral and pharmaceutical interventions aimed at reducing endometrial cancer risk, improving cancer outcomes, and preserving fertility in an increasingly younger population of patients with endometrial cancer...
December 10, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/27874840/an-integrated-narrative-nursing-model-towards-a-new-healthcare-paradigm
#7
Giovanna Artioli, Chiara Foà, Chiara Taffurelli
In the traditional biomedical model of clinical practice, which assumes a medicine focused on disease, diseases are considered as biological or psycho-physiological universal entities. This explanation, although necessary, is not enough. Several authors have recently become interested in the use of narrative practices in the medical care setting, underlining the increasing importance of "a patient-centered approach", a "relationship -centered care" and "narrative medicine". Even in Nursing, the challenge was to combine two models that seemed incompatible: the Evidence-Based Nursing Model and the Narrative-Based Nursing Model...
November 22, 2016: Acta Bio-medica: Atenei Parmensis
https://www.readbyqxmd.com/read/27852277/right-hepatectomy-for-a-detoured-left-hepatic-artery-in-hilar-cholangiocarcinoma-report-of-a-rare-but-rational-resection
#8
Chun-Yi Tsai, Nobuyuki Watanabe, Tomoki Ebata, Takashi Mizuno, Yuzuru Kamei, Masato Nagino
BACKGROUND: Curative hepatectomy with bile duct resection is the treatment for perihilar cholangiocarcinoma. A locally advanced tumor necessitates hepatectomy with simultaneous vascular resection, and reconstruction remains an obstacle for surgeons. Studies have focused on the variations of hepatic arteries. Nevertheless, the anatomical alignment of the portal veins, bile ducts, and hepatic arteries are equally critical in surgical planning of curative resection for advanced tumors. We have reported promising outcomes of hepatectomy with simultaneous resection and reconstruction of the hepatic artery...
November 16, 2016: World Journal of Surgical Oncology
https://www.readbyqxmd.com/read/27842620/contested-evidence-a-dutch-reimbursement-decision-taken-to-court
#9
Floortje Moes, Eddy Houwaart, Diana Delnoij, Klasien Horstman
This paper examines a remarkable lawsuit in health care rationing. The Patients Association for Interstitial Cystitis sued the Dutch National Health Care Institute for alleged misconduct against Interstitial Cystitis patients, as the Institute decided that bladder instillations with chondroitin sulphate or hyaluronic acid are no longer covered by the basic health insurance. The patients' organisation challenged the Institute for basing its standpoint on scientific evidence; overruling clinical expertise and patients' experiences...
November 15, 2016: Health Economics, Policy, and Law
https://www.readbyqxmd.com/read/27836999/quality-of-child-healthcare-at-primary-healthcare-facilities-a-national-assessment-of-the-integrated-management-of-childhood-illnesses-in-afghanistan
#10
Ghulam Farooq Mansoor, Paata Chikvaidze, Sherin Varkey, Ariel Higgins-Steele, Najibullah Safi, Adela Mubasher, Khaksar Yusufi, Sayed Alisha Alawi
OBJECTIVE: To assess quality of the national Integrated Management of Childhood Illness (IMCI) program services provided for sick children at primary health facilities in Afghanistan. DESIGN: Mixed methods including cross-sectional study. SETTING: Thirteen (of thirty-four) provinces in Afghanistan. PARTICIPANTS: Observation of case management and re-examination of 177 sick children, exit interviews with caretakers and review of equipment/supplies at 44 health facilities...
November 10, 2016: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/27821554/assessment-of-drug-sensitivity-in-hematopoietic-stem-and-progenitor-cells-from-acute-myelogenous-leukemia-and-myelodysplastic-syndrome-ex-vivo
#11
Katherine L B Knorr, Laura E Finn, B Douglas Smith, Allan D Hess, James M Foran, Judith E Karp, Scott H Kaufmann
: : Current understanding suggests that malignant stem and progenitor cells must be reduced or eliminated for prolonged remissions in myeloid neoplasms such as acute myelogenous leukemia (AML) or myelodysplastic syndrome (MDS). Multicolor flow cytometry has been widely used to distinguish stem and myeloid progenitor cells from other populations in normal and malignant bone marrow. In this study, we present a method for assessing drug sensitivity in MDS and AML patient hematopoietic stem and myeloid progenitor cell populations ex vivo using the investigational Nedd8-activating enzyme inhibitor MLN4924 and standard-of-care agent cytarabine as examples...
November 7, 2016: Stem Cells Translational Medicine
https://www.readbyqxmd.com/read/27747629/temperature-rise-during-removal-of-fractured-components-out-of-the-implant-body-an-in-vitro-study-comparing-two-ultrasonic-devices-and-five-implant-types
#12
Eric W Meisberger, Sjoerd J G Bakker, Marco S Cune
BACKGROUND: Ultrasonic instrumentation under magnification may facilitate mobilization of screw remnants but may induce heat trauma to surrounding bone. An increase of 5°C is considered detrimental to osseointegration. The objective of this investigation was to examine the rise in temperature of the outer implant body after 30 s of ultrasonic instrumentation to the inner part, in relation to implant type, type of ultrasonic equipment, and the use of coolants in vitro. METHODS: Two ultrasonic devices (Satelec Suprasson T Max and Electro Medical Systems (EMS) miniMaster) were used on five different implant types that were provided with a thermo couple (Astra 3...
December 2015: International Journal of Implant Dentistry
https://www.readbyqxmd.com/read/27732120/serous-tubal-intraepithelial-carcinoma-stic-clinical-impact-and-management
#13
Vit Weinberger, Marketa Bednarikova, David Cibula, Michal Zikan
Introduction Serous tubal intraepithelial carcinoma (STIC) is most likely precursor lesion of the most part of high-grade serous pelvis carcinomas, carcinosarcoma and undifferentiated carcinoma with incidence of 0.6% to 7% in BRCA carriers or women with strong family history of breast or ovarian carcinoma. STIC is a pathomorphologically and immunohistochemically detectable lesion which biological significance and clinical relevance is unknown. Areas covered We investigate methods of STIC diagnostics and we present an overview of recent studies and available knowledge on surgical management, adjuvant chemotherapy and subsequent follow-up procedure in women with an isolated STIC...
October 12, 2016: Expert Review of Anticancer Therapy
https://www.readbyqxmd.com/read/27697136/childhood-depressive-disorders
#14
Rikke Thaarup Wesselhöft
Major depressive disorder (MDD) is a frequent and painful mental disorder considered among the five leading causes of disability in Western countries by the World Health Organization. MDD occurs at all ages, but childhood onset MDD has a more severe course with longer depressive episodes, more suicidality, and more frequent hospitalization, than later onset MDD. Childhood seems to be a window of opportunity for prevention of mental disorders, and subsequently prevention of MDD onset in childhood is recommended...
October 2016: Danish Medical Journal
https://www.readbyqxmd.com/read/27666547/-clinical-assessment-of-chemosensitivity-test-in-xeno-free-culture-of-autologous-%C3%A2-malignant-effusion-cells-from-patients-with-advanced-lung-adenocarcinoma
#15
Liang Chen, Shunfang Yang, Jinqi Jiang, Ying Zhang, Hui Feng, Jie Cao, Xinyue Ge, Wenhui Xie
BACKGROUND: A great individual differences to chemotherapeutic effects existed in the patient with advanced lung cancer. How to choose the optimum regimens to achieve the individuation and maximum effect of chemotherapy for lung cancer is worth exploring. The study was designed to examine the effect of ex vitro chemo-sensitivity assay in xeno-free culture of autologous malignant effusion cells from patients with advanced lung adenocarcinoma. METHODS: The 50 treatment-naive patients with lung adenocarcinoma complicated with malignant pleural or pericardial effusions were enrolled...
September 20, 2016: Zhongguo Fei Ai za Zhi, Chinese Journal of Lung Cancer
https://www.readbyqxmd.com/read/27647967/evaluation-of-rational-extent-lymphadenectomy-for-local-advanced-gastric-cancer
#16
Han Liang, Jingyu Deng
Based upon studies from randomized clinical trials, the extended (D2) lymph node dissection is now recommended as a standard procedure for local advanced gastric cancer worldwide. However, the rational extent lymphadenectomy for local advanced gastric cancer has remained a topic of debate in the past decades. Due to the limitation of low metastatic rate in para-aortic nodes (PAN) in JCOG9501, the clinical benefit of D2+ para-aortic nodal dissection (PAND) for patients with stage T4 and/or stage N3 disease, which is very common in China and other countries except Japan and Korea, cannot be determined...
August 2016: Chinese Journal of Cancer Research, Chung-kuo Yen Cheng Yen Chiu
https://www.readbyqxmd.com/read/27619354/an-educational-and-administrative-intervention-to-promote-rational-laboratory-test-ordering-on-an-academic-general-medicine-service
#17
Bradley M Wertheim, Andrew J Aguirre, Roby P Bhattacharyya, John Chorba, Ashutosh P Jadhav, Vanessa B Kerry, Eric A Macklin, Gabriela Motyckova, Shveta Raju, Kent Lewandrowski, Daniel P Hunt, Douglas E Wright
BACKGROUND: Overutilization of clinical laboratory testing in the inpatient setting is a common problem. The objective of this project was to develop an inexpensive and easily-implemented intervention to promote rational laboratory utilization without compromising resident education or patient care. METHODS: The study comprised of a cluster-randomized, controlled trial to assess the impact of a multifaceted intervention of education, guideline development, elimination of recurring lab orders, unbundling of laboratory panels, and redesign of the daily progress note on laboratory test ordering...
September 9, 2016: American Journal of Medicine
https://www.readbyqxmd.com/read/27612948/secreted-trophic-factors-of-mesenchymal-stem-cells-support-neurovascular-and-musculoskeletal-therapies
#18
REVIEW
Heidi R Hofer, Rocky S Tuan
Adult mesenchymal stem cells (MSCs) represent a subject of intense experimental and biomedical interest. Recently, trophic activities of MSCs have become the topic of a number of revealing studies that span both basic and clinical fields. In this review, we focus on recent investigations that have elucidated trophic mechanisms and shed light on MSC clinical efficacy relevant to musculoskeletal applications. Innate differences due to MSC sourcing may play a role in the clinical utility of isolated MSCs. Pain management, osteochondral, nerve, or blood vessel support by MSCs derived from both autologous and allogeneic sources have been examined...
September 9, 2016: Stem Cell Research & Therapy
https://www.readbyqxmd.com/read/27600642/type-ii-diabetes-patients-with-proteinuria-and-the-recovery-of-their-metabolic-parameters
#19
Ya Z Liu, Keqi Wang, Xiang Li, Bin Chen
BACKGROUND: The aim of this study was to provide reasonable guidelines for type II diabetes patients with proteinuria to recover their metabolic parameters. METHODS: A cross-sectional study was conducted in selected groups of type 2 diabetic patients. Hypoglycemic and antihypertensive drug use was recorded. Certain physical examinations were conducted including routine urine test, urinary albumin/creatinine ratio (ACR), metabolic parameters of blood glucose and lipid, and other biochemical indicators...
December 2016: Minerva Endocrinologica
https://www.readbyqxmd.com/read/27600117/if-you-build-it-they-will-come-unintended-future-uses-of-organised-health-data-collections
#20
REVIEW
Kieran C O'Doherty, Emily Christofides, Jeffery Yen, Heidi Beate Bentzen, Wylie Burke, Nina Hallowell, Barbara A Koenig, Donald J Willison
BACKGROUND: Health research increasingly relies on organized collections of health data and biological samples. There are many types of sample and data collections that are used for health research, though these are collected for many purposes, not all of which are health-related. These collections exist under different jurisdictional and regulatory arrangements and include: 1) Population biobanks, cohort studies, and genome databases 2) Clinical and public health data 3) Direct-to-consumer genetic testing 4) Social media 5) Fitness trackers, health apps, and biometric data sensors Ethical, legal, and social challenges of such collections are well recognized, but there has been limited attention to the broader societal implications of the existence of these collections...
2016: BMC Medical Ethics
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