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Documentation of patients anticipated risks

G Jeanne, D Purper-Ouakil, H Rigole, N Franc
AIM: There have been significant changes in adolescent consumption habits over the past fifteen years. New molecules have been synthesized, new devices created and a number of products have increased in popularity; and as a result clinicians sometimes lack information. We chose to focus on this population because of its vulnerability, as adolescents show low sensitivity to long-term outcomes of their actions and may be easily influenced by peers as regards experimentation of new drugs...
October 6, 2016: L'Encéphale
D Leguay
This article attempts to identify and put into perspective the different approaches that could globally prevent the suffering induced by schizophrenia, from the detection of early psychosis to the impact on individual and family functioning and emotional health. Schizophrenia causes, at the community level, a number of difficult consequences and associated costs, which likely could be reduced if specific strategies, already known and documented internationally, were applied. Two areas not explored in this article: the role of medication and the issue of suicide prevention...
September 9, 2016: L'Encéphale
Daniel Urias, Jennifer Silvis, Lusine Mesropyan, Emma Oberlander, Thomas Simunich, James Tretter
BACKGROUND: Trauma patients are at increased risk for developing venous thromboembolic (VTE) disease. The EAST (Eastern Association for the Surgery of Trauma) practice management guidelines identified risk factors for VTE, as well as indications for prophylactic inferior vena cava filters (IVCF). In a 2009 study, our institution found a 26% retrieval rate for IVCF. Lack of retrieval was most consistently due to lack of follow-up. Our study is a follow-up analysis for retrieval rate of IVCF, since the formation of a geriatric trauma service...
July 15, 2016: Injury
Cristina Cezar, Garri Tchartchian, Matthias Korell, Nicole Ziegler, Kazuhisa Senshu, Maya Sophie De Wilde, Anja Herrmann, Angelika Larbig, Rudy Leon De Wilde
We conducted a prospective randomized single blind - subject study in the University Clinic of Gynecology of Pius-Hospital Oldenburg. The primary objective of the ADBEE study was to assess the safety and manageability of ADBLOCK when used as an adjunct to laparoscopic surgery for the primary of myomas in women wishing to improve pregnancy outcomes. The study population included 32 women aged between 18-45 years, in good general health condition, who have not completed their family planning and who are undergoing primary ('virgin') laparoscopic myomectomy with an aim to improve pregnancy outcomes...
August 2016: Best Practice & Research. Clinical Obstetrics & Gynaecology
Tjalf Ziemssen, Achim Gass, Jens Wuerfel, Antonios Bayas, Björn Tackenberg, Volker Limmroth, Ralf Linker, Mathias Mäurer, Judith Haas, Martin Stangel, Matthias Meergans, Olof Harlin, Hans-Peter Hartung
BACKGROUND: Natalizumab provides rapid and high-efficacy control of multiple sclerosis disease activity with long-term stabilization. However, the benefits of the drug are countered by a risk of developing progressive multifocal leukoencephalopathy in patients infected with the John Cunningham Virus. Close monitoring is required in patients with increased progressive multifocal leukoencephalopathy risk receiving natalizumab in the long-term for an optimal benefit-risk evaluation. Standardized high-quality monitoring procedures may provide a superior basis for individual benefit and risk evaluation and thus improve treatment decisions...
2016: BMC Neurology
Nghi B Ha, Katherine Yang, Sarah Hanigan, Brian Kurtz, Michael P Dorsch, Hannah Mak, Jerod Nagel
BACKGROUND: Drug-drug interactions (DDIs) with warfarin and antimicrobial agents are a common cause of international normalized ratio (INR) instability, which can affect the risk for bleeding and thrombotic events. OBJECTIVE: The purpose of this study was to assess the impact of a comprehensive guideline for the management of warfarin-antimicrobial DDIs across transitions of care. The guideline emphasizes improving identification of significant antimicrobial-warfarin DDIs during hospitalization, empirical warfarin dose modification based on DDI and baseline INR, patient education, documentation of the DDI, communication with outpatient providers regarding the DDI and anticipated antimicrobial stop date, and warfarin dose adjustment on discontinuation of antimicrobial...
September 2016: Annals of Pharmacotherapy
Roberto Caporale, Giovanna Geraci, Michele Massimo Gulizia, Mauro Borzi, Furio Colivicchi, Alberto Menozzi, Giuseppe Musumeci, Marino Scherillo, Antonietta Ledda, Giuseppe Tarantini, Piersilvio Gerometta, Giancarlo Casolo, Dario Formigli, Francesco Romeo, Roberto Di Bartolomeo
The wide availability of drugs effective in reducing cardiovascular events and the use of myocardial revascularization have greatly improved the prognosis of patients with coronary artery disease. However, the combination of antithrombotic drugs to be administered before the exact knowledge of the coronary anatomy and before the consequent therapeutic strategy can, on one hand, allow to anticipate an optimal treatment but, on the other hand, may expose the patient to a bleeding risk not always necessary. In patients with ST-elevation acute coronary syndrome with an indication to primary angioplasty, the administration of unfractionated heparin and aspirin is considered the pre-procedural standard treatment...
June 2016: Giornale Italiano di Cardiologia
Michael Malandra, Sunpreet Kaur, Ashish Chogle
INTRODUCTION: Benign juvenile hamartomatous polyps are common in pediatric gastrointestinal practice. We hypothesize that in the absence of gross mucosal abnormalities, the likelihood of histologic abnormalities from routine random colonic biopsies is low. METHODS: We performed a retrospective chart review identifying patients aged 1 to 18 years who underwent complete colonoscopy and polypectomy for suspected colorectal polyps from January 1, 2004 to July 1, 2014...
June 13, 2016: Journal of Pediatric Gastroenterology and Nutrition
Sigall K Bell, Roanne Mejilla, Melissa Anselmo, Jonathan D Darer, Joann G Elmore, Suzanne Leveille, Long Ngo, James D Ralston, Tom Delbanco, Jan Walker
BACKGROUND: Patient advocates and safety experts encourage adoption of transparent health records, but sceptics worry that shared notes may offend patients, erode trust or promote defensive medicine. As electronic health records disseminate, such disparate views fuel policy debates about risks and benefits of sharing visit notes with patients through portals. METHODS: Presurveys and postsurveys from 99 volunteer doctors at three US sites who participated in OpenNotes and postsurveys from 4592 patients who read at least one note and submitted a survey...
May 18, 2016: BMJ Quality & Safety
Gerasimos Siasos, George Lazaros, Evangelos Oikonomou, Theodoros Zografos, Dimitris Athanasiou, Manolis Vavuranakis, Alexis Antonopoulos, Vasiliki Tsigkou, Christodoulos Stefanadis, Athanasios G Papavassiliou, Dimitris Tousoulis
OBJECTIVES: Non-ST elevation myocardial infarction (NSTEMI) is one of the most common manifestations of acute coronary syndromes (ACS). We evaluated the prognostic role of cardiac troponin I (cTnI) at presentation and peak cardiac troponin I in patients with NSTEMI. METHODS: We consecutively enrolled 215 subjects presenting with NSTEMI. Subjects were followed up for 1 year. cTnI at presentation and the peak value of cTnI were measured. The primary end point was defined as cardiovascular death, readmission to hospital with heart failure and new ACS...
2016: Cardiology
Yehuda Handelsman, Robert R Henry, Zachary T Bloomgarden, Sam Dagogo-Jack, Ralph A DeFronzo, Daniel Einhorn, Ele Ferrannini, Vivian A Fonseca, Alan J Garber, George Grunberger, Derek LeRoith, Guillermo E Umpierrez, Matthew R Weir
AACE = American Association of Clinical Endocrinologists ACE = American College of Endocrinology DKA = diabetic ketoacidosis EMA = European Medicines Agency FDA = U.S. Food and Drug Administration SGLT-2 = sodium glucosecotransporter 2 T1D = type 1 diabetes T2D = type 2 diabetes.
June 2016: Endocrine Practice
Michael Eddleston, Adam F Cohen, David J Webb
Over the past 10 years, thousands of first-into-human (FIH) clinical trials have been performed in Europe, with few severe adverse events (SAEs). Each has received detailed prior safety review at both the local clinical research facility and at national drug regulatory authority level. The recent fatal SAE in the BIA-102474-101 clinical trial shows the limitations of this process. Although criticized for not sequentially dosing subjects both within and between cohorts - as recommended by the European Medicines Agency for high-risk compounds after the TeGenero clinical trial disaster in 2006 - BIA-102474-101 was not considered to be high risk...
April 2016: British Journal of Clinical Pharmacology
Samuel M Brown, Hanan J Aboumatar, Leslie Francis, John Halamka, Ronen Rozenblum, Eileen Rubin, Barbara Sarnoff Lee, Jeremy Sugarman, Kathleen Turner, Micah Vorwaller, Dominick L Frosch
Patients in intensive care units (ICUs) may lack decisional capacity and may depend on proxy decision makers (PDMs) to make medical decisions on their behalf. High-quality information-sharing with PDMs, including through such means as health information technology, could improve communication and decision making and could potentially minimize the psychological consequences of an ICU stay for both patients and their family members. However, alongside these anticipated benefits of information-sharing are risks of unwanted disclosure of sensitive information...
September 2016: Journal of the American Medical Informatics Association: JAMIA
Ulrike Nimptsch, Christian Krautz, Georg F Weber, Thomas Mansky, Robert Grützmann
OBJECTIVE: We aimed to determine the unbiased mortality rates for pancreatic surgery procedures at the national level through a comprehensive analysis of every inpatient case in Germany. SUMMARY OF BACKGROUND DATA: Several studies have proclaimed a general improvement of perioperative outcomes following pancreatic surgery. These results are challenged by recent analyses of large US databases that found strong volume-outcome relationships, with high mortality in low-volume facilities...
March 14, 2016: Annals of Surgery
Caroline Pixberg, Raphael Koch, Hans Theodor Eich, Ulla Martinsson, Ingrid Kristensen, Christiane Matuschek, Rolf-Dieter Kortmann, Fabian Pohl, Khaled Elsayad, Hans Christiansen, Normann Willich, Jack Lindh, Diana Steinmann
PURPOSE: In the context of oncologic therapy for children, radiation therapy is frequently indicated. This study identified the frequency of and reasons for the development of high-grade acute toxicity and possible sequelae. MATERIALS AND METHODS: Irradiated children have been prospectively documented since 2001 in the Registry for the Evaluation of Side Effects After Radiation in Childhood and Adolescence (RiSK) database in Germany and since 2008 in the registry for radiation therapy toxicity (RADTOX) in Sweden...
March 15, 2016: International Journal of Radiation Oncology, Biology, Physics
Frank J Senatore, Shruti Murali, Constantin A Dasanu
BACKGROUND: Cancer survivors are known to be at increased risk for second primary cancers. In addition, immunosuppression and previous cancer treatments such as radiotherapy and systemic chemotherapy are linked with increased risk of both colonic adenomas and adenocarcinomas. AIM: We performed a systematic review searching for manuscripts discussing second colon cancers, accelerated polyposis, immunosuppression, radiation, and chemotherapy. We sought to identify a link between immunosuppression and increased risks specific to premalignant polyposis and second colon cancers...
June 2016: Journal of Gastrointestinal Cancer
Nay M Htun, John G Webb
Transcatheter aortic valve replacement is a viable alternative to surgical aortic valve replacement in patients with severe aortic stenosis. The SAPIEN 3 is the latest generation of balloon-expandable transcatheter heart valve, designed to address some of the shortcomings of earlier versions of transcatheter heart valves. It has a lower device profile to reduce access-related vascular injury, an improved delivery catheter to facilitate accurate implantation, and incorporates an additional outer sealing cuff to minimize paravalvular leakage...
2016: Expert Review of Medical Devices
Nirada Siriyakorn, Pornvimol Leethong, Terapong Tantawichien, Saowalak Sripakdee, Anusak Kerdsin, Surang Dejsirilert, Leilani Paitoonpong
BACKGROUND: Although pertussis has been considered a disease of childhood, it is also recognized as an important respiratory tract infection in adolescents and adults. However, in countries with routine vaccination against pertussis with high coverage, pertussis is not usually taken into consideration for the etiology of prolonged cough in adults. Previous studies in a variety of populations in developed countries have documented that pertussis is quite common, ranging from 2.9 to 32% of adolescents and adults with prolonged cough...
2016: BMC Infectious Diseases
Nicholas D James, Melissa R Spears, Noel W Clarke, David P Dearnaley, Malcolm D Mason, Christopher C Parker, Alastair W S Ritchie, J Martin Russell, Francesca Schiavone, Gerhardt Attard, Johann S de Bono, Alison Birtle, Daniel S Engeler, Tony Elliott, David Matheson, Joe O'Sullivan, Delia Pudney, Narayanan Srihari, Jan Wallace, Jim Barber, Isabel Syndikus, Mahesh K B Parmar, Matthew R Sydes
IMPORTANCE: The natural history of patients with newly diagnosed high-risk nonmetastatic (M0) prostate cancer receiving hormone therapy (HT) either alone or with standard-of-care radiotherapy (RT) is not well documented. Furthermore, no clinical trial has assessed the role of RT in patients with node-positive (N+) M0 disease. The STAMPEDE Trial includes such individuals, allowing an exploratory multivariate analysis of the impact of radical RT. OBJECTIVE: To describe survival and the impact on failure-free survival of RT by nodal involvement in these patients...
March 2016: JAMA Oncology
Melanie J Engels, Bruce W Chaffee, John S Clark
PURPOSE: An academic medical center's strategic goals were compared and aligned with the 2015 ASHP Health-System Pharmacy Initiative and the Pharmacy Practice Model Initiative (PPMI). METHODS: The department's pharmacy practice model steering committee identified potential solutions to narrow prioritized gaps using a modified nominal group technique and a multivoting dot technique. RESULTS: Five priority solutions were identified and assigned to work groups to develop business plans, which included admission medication history and reconciliation for high-risk patients and those with complex medication regimens, pharmacist provision of discharge counseling to high-risk patients and those with complex medication regimens, improved measurement and reporting of the impact of PPMI programs on patient outcomes, implementation of a departmentwide formalized peer review and evaluation process, and the greeting of every patient at some time during his or her visit by a pharmacy team member...
December 1, 2015: American Journal of Health-system Pharmacy: AJHP
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