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https://www.readbyqxmd.com/read/28544750/unexpected-ethical-dilemmas-in-sex-assignment-in-46-xy-dsd-due-to-5-alpha-reductase-type-2-deficiency
#1
Heather M Byers, Lauren H Mohnach, Patricia Y Fechner, Ming Chen, Inas H Thomas, Linda A Ramsdell, Margarett Shnorhavorian, Elizabeth A McCauley, Anne-Marie E Amies Oelschlager, John M Park, David E Sandberg, Margaret P Adam, Catherine E Keegan
Sex assignment at birth remains one of the most clinically challenging and controversial topics in 46,XY disorders of sexual development (DSD). This is particularly challenging in deficiency of 5-alpha reductase type 2 given that external genitalia are typically undervirilized at birth but typically virilize at puberty to a variable degree. Historically, most individuals with 5-alpha reductase deficiency were raised females. However, reports that over half of patients who underwent a virilizing puberty adopted an adult male gender identity have challenged this practice...
May 25, 2017: American Journal of Medical Genetics. Part C, Seminars in Medical Genetics
https://www.readbyqxmd.com/read/28544474/breast-cancer-and-transplantation
#2
Germaine Wong, Eric Au, Sunil V Badve, Wai H Lim
Breast cancer is an important cancer among solid organ transplant recipients. While the incidence of breast cancer in solid organ transplant recipients is comparable to the age matched general population, the outcomes are generally poor. Interventions such as cancer screening which preclude the development of late stage disease through early detection are not well-studied, and clinical practice guidelines for cancer screening rely solely on recommendations from the general population. Among those with a prior breast cancer history, disease recurrence after transplantation is a rare but fearful event...
May 19, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28544273/use-of-clinical-guidelines-in-remote-australia-a-realist-evaluation
#3
Sandeep Reddy, Victoria Orpin, Sally Herring, Stephanie Mackie-Schneider, Janet Struber
AIM: The aim of this evaluation was to assess the acceptability, accessibility, and compliance with the 2014 editions of the Remote Primary Health Care Manuals (RPHCM) in health care centres across remote areas of Northern and Central Australia. METHOD: To undertake a comprehensive evaluation that considered context, the evaluation used a realist evaluation framework. The evaluation used a variety of methods including interviews and survey to develop and test a programme theory...
May 24, 2017: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/28544163/the-impact-of-clinical-practice-on-the-outcome-of-central-venous-access-devices-in-children-with-haemophilia
#4
K Khair, S Ranta, A Thomas, K Lindvall
INTRODUCTION: Central venous access devices facilitate home treatment in boys with haemophilia. These are usually fully implanted lines, referred to as ports. Caregivers are taught to manage the port using sterile techniques and maintaining patency by flushing with saline or heparin solution. National and international guidelines for the home care of ports are lacking. AIM: To evaluate if infection or occlusion rates differ between home care regimens used for ports in children with haemophilia...
May 24, 2017: Haemophilia: the Official Journal of the World Federation of Hemophilia
https://www.readbyqxmd.com/read/28544041/marked-variability-observed-in-inpatient-management-of-bronchiolitis-in-three-finnish-hospitals
#5
Varpu Elenius, Eija Bergroth, Petri Koponen, Sami Remes, Pedro A Piedra, Janice A Espinola, Matti Korppi, Carlos A Camargo, Tuomas Jartti
AIM: Infants hospitalised for bronchiolitis undergo examinations and treatments not supported by current research evidence and we investigated practice variations with regard to Finnish children under the age of two. METHODS: This prospective, multi-centre cohort study was conducted in paediatric units in three university hospitals in Finland from 2008-2010. Hospital medical records were reviewed to collect data on clinical course, testing and treatment. Data were analysed separately for children meeting our strict definition of bronchiolitis, aged under 12 months without a history of wheezing, and a loose definition, aged 12-23 months or with a history of wheezing...
May 24, 2017: Acta Paediatrica
https://www.readbyqxmd.com/read/28543408/validation-and-cross-cultural-adaptation-of-the-arabic-version-of-the-nasal-obstruction-symptom-evaluation-scale
#6
Mohamed A Amer, Ibrahim A Kabbash, Ahmed A Yonis, Saad Elzayat, Mohamed O Tomoum
OBJECTIVES/HYPOTHESIS: Validation and cross-cultural adaptation of the Nasal Obstruction Symptom Evaluation (NOSE) scale into the Arabic language with studying of its psychometric properties. STUDY DESIGN: Prospective instrument-validation study. METHODS: Guidelines for the cross-cultural adaptation process from the original English language scale into the Arabic language version were followed. We assessed the psychometric properties of the Arabic version of the NOSE scale (A-NOSE) (feasibility, reproducibility, internal consistency, reliability, discriminatory validity, responsiveness to change) in 101 consecutive patients who underwent septal surgery (preoperatively and 3 months postoperatively) and 102 asymptomatic controls...
May 23, 2017: Laryngoscope
https://www.readbyqxmd.com/read/28541857/a-multidisciplinary-child-protection-team-improves-the-care-of-nonaccidental-trauma-patients
#7
John M Draus
We initiated a multidisciplinary Child Protection Team (CPT) as a subgroup of our pediatric multidisciplinary trauma peer review committee. Meetings are held monthly. Nonaccidental trauma (NAT) patients from the preceding month are reviewed. The meeting has two parts. During the open part, detectives and child protective services (CPS) workers are invited to discuss specific cases. The closed part focuses on improvement of specific processes and future outcomes. Attendance is recorded and minutes are kept. We sought to review accomplishments of this group...
May 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28540770/transdermal-estrogens-in-the-changing-landscape-of-hormone-replacement-therapy
#8
Keli L Beck, Michelle C Anderson, Julienne K Kirk
Views and clinical practice on hormone replacement therapy (HRT) for postmenopausal women have varied widely over the last several decades. The 1990s showed a dramatic decline in prescribing and only recently are prescription rates increasing again. Use of HRT is first line for women suffering from the symptoms of menopause. For a certain population of postmenopausal women, HRT is recommended for prevention of fracture. More consideration is being given to patient risk factors, side effects, and formulations available...
May 25, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28540672/communication-on-safety-of-medicines-in-europe-current-practices-and-general-practitioners-awareness-and-preferences
#9
Sieta T de Vries, Maartje J M van der Sar, Amelia Cupelli, Ilaria Baldelli, Anna Marie Coleman, Dolores Montero, Ivana Šipić, Adriana Andrić, Annika Wennberg, Jane Ahlqvist-Rastad, Petra Denig, Peter G M Mol
INTRODUCTION: National competent authorities (NCAs) for medicines coordinate communication relating to the safety of medicines in Europe. The effectiveness of current communication practices has been questioned, particularly with regard to reaching general practitioners (GPs). OBJECTIVE: The aim of this study was to assess current European NCA safety communication practices and to investigate European GPs' awareness of and preferences for safety communications on medicines...
May 24, 2017: Drug Safety: An International Journal of Medical Toxicology and Drug Experience
https://www.readbyqxmd.com/read/28540448/sensor-based-balance-measures-outperform-modified-balance-error-scoring-system-in-identifying-acute-concussion
#10
Laurie A King, Martina Mancini, Peter C Fino, James Chesnutt, Clayton W Swanson, Sheila Markwardt, Julie C Chapman
Balance assessment is an integral component of concussion evaluation and management. Although the modified balance error scoring system (mBESS) is the conventional clinical tool, objective metrics derived from wearable inertial sensors during the mBESS may increase sensitivity in detecting subtle balance deficits post-concussion. The aim of this study was to identify which stance condition and postural sway metrics obtained from an inertial sensor placed on the lumbar spine during the mBESS best discriminate athletes with acute concussion...
May 24, 2017: Annals of Biomedical Engineering
https://www.readbyqxmd.com/read/28540395/management-of-atherosclerosis-risk-factors-for-patients-at-high-cardiovascular-risk-in-the-real-world-practice-a-multicentre-study
#11
Arintaya Phrommintikul, Rungroj Krittayaphong, Wanwarang Wongcharoen, Sukit Yamwong, Smonporn Boonyaratavej, Rapeephon Kunjara-Na-Ayudhya, Pyatat Tatsanavivat, Piyamitr Sritara
INTRODUCTION: Atherosclerotic cardiovascular disease is a global health burden. However, there are heterogeneities among countries or regions regarding the risk factors and clinical manifestations of atherosclerotic diseases as well as their management patterns. METHODS: We collected data from 25 centres in Thailand. Patients with documented coronary artery disease or cerebrovascular disease or peripheral arterial disease, or with at least three atherosclerosis risk factors were enrolled between April 2011 and March 2014...
May 25, 2017: Singapore Medical Journal
https://www.readbyqxmd.com/read/28540231/use-of-botulinum-toxin-for-voiding-dysfunction
#12
REVIEW
David Eldred-Evans, Prokar Dasgupta
The use of botulinum toxin A (BoNT-A) has expanded across a range of lower urinary tract conditions. This review provides an overview of the current indications for BoNT-A in the lower urinary tract and critically evaluates the published evidence within each area. The classic application of BoNT-A has been in the management of refractory neurogenic detrusor overactivity (NDO) and overactive bladder (OAB). There is a large volume of high-quality evidence, including numerous randomized placebo-controlled trials, which demonstrate the efficacy of BoNT-A over a long follow-up period...
April 2017: Translational Andrology and Urology
https://www.readbyqxmd.com/read/28540058/trends-in-the-management-of-patients-with-kidney-failure-in-alberta-canada-2004-2013
#13
Christy C Chong, Helen Tam-Tham, Brenda R Hemmelgarn, Robert G Weaver, Nairne Scott-Douglas, Marcello Tonelli, Robert R Quinn, Liam Manns, Braden J Manns
BACKGROUND: Based on clinical practice guidelines, specific quality indicators are examined to assess the performance of a health care system for patients with end-stage renal disease (ESRD). We examined trends in the proportion of patients with ESRD referred late to nephrology, timing of dialysis initiation in those with chronic kidney disease, and proportion of patients with ESRD treated with pre-emptive kidney transplantation or peritoneal dialysis (PD). Design:: This was a retrospective cohort study...
2017: Canadian Journal of Kidney Health and Disease
https://www.readbyqxmd.com/read/28540025/erratum-clinical-practice-guidelines-for-prevention-diagnosis-and-management-of-early-and-delayed-onset-ocular-injuries-due-to-mustard-gas-exposure
#14
(no author information available yet)
[This corrects the article on p. 65 in vol. 12, PMID: 28299009.].
April 2017: Journal of Ophthalmic & Vision Research
https://www.readbyqxmd.com/read/28539693/quality-based-procedures-for-knee-replacement-hip-replacement-and-hip-fracture-physiotherapists-perceptions-of-adherence-barriers-and-facilitators
#15
Kirsti J E Reinikka, Denise Taylor, Sylvia Daniel, Stacey Burns-Hogan, Brittany DePass, Laura McGill, Michael McLeod, Susan Safadi, Sandy Veit
Purpose: This mixed-methods study examined the perceived barriers to and facilitators of implementing best-practice guidelines (BPGs) and adhering to provincial Quality-Based Procedures (QBPs) by Ontario physiotherapists working with patients after total knee replacement (TKR), total hip replacement (THR), and hip fracture (HF). Method: Using snowball sampling, 93 hospital and home care physiotherapists working with patients after TKR, THR, or HF completed a Web-based survey. A subset of these participated in follow-up semi-structured telephone interviews...
2017: Physiotherapy Canada. Physiothérapie Canada
https://www.readbyqxmd.com/read/28538794/gender-differences-and-psychotropic-polypharmacy-in-psychiatric-patients-in-brazil-a-cross-sectional-analysis-of-the-pessoas-project
#16
Juliana de Oliveira Costa, Maria das Graças Braga Ceccato, Ana Paula Souto Melo, Francisco de Assis Acurcio, Mark Drew Crosland Guimarães
We aimed to estimate the prevalence and correlates of psychotropic polypharmacy in Brazilian psychiatric patients by gender. Sociodemographic, behavioral and clinical data were obtained through face-to-face interviews and medical charts of 2,475 patients. Psychotropic polypharmacy was defined as the use of two or more psychotropic drugs and occurred in 85.7% of men (95%CI: 83.6%-87.6%) and 84.9% of women (95%CI: 82.8%-86.8%; p > 0.05). The mean number of psychotropic drugs/patient was 2.98 ± 1.23 and most common combinations included antipsychotics...
May 18, 2017: Cadernos de Saúde Pública
https://www.readbyqxmd.com/read/28538532/identification-and-management-of-obese-patients-in-a-pediatric-orthopaedic-clinic
#17
Natalia Davila, Joy Vess, Emily E Johnson
BACKGROUND: Childhood obesity is a complex healthcare problem that affects all aspects of a child's health. The American Academy of Pediatrics and the Expert Committee recommends that all children be evaluated for current medical conditions including the risk for obesity by identifying elevated body mass index (BMI), physical activity habits, and diet. Childhood obesity is defined as a BMI of 95th percentile or greater on standardized age-based growth charts. Abdominal and visceral fat mass has a negative effect on bone formation during childhood and adolescence...
May 2017: Orthopaedic Nursing
https://www.readbyqxmd.com/read/28538493/committee-opinion-no-703-summary-asymptomatic-microscopic-hematuria-in-women
#18
(no author information available yet)
Asymptomatic microscopic hematuria is an important clinical sign of urinary tract malignancy. Asymptomatic microscopic hematuria has been variably defined over the years. In addition, the evidence primarily is based on data from male patients. However, whether the patient is a man or a woman influences the differential diagnosis of asymptomatic microscopic hematuria, and the risk of urinary tract malignancy (bladder, ureter, and kidney) is significantly less in women than in men. Among women, being older than 60 years, having a history of smoking, and having gross hematuria are the strongest predictors of urologic cancer...
June 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28537834/when-respecting-autonomy-is-harmful-a-clinically-useful-approach-to-the-nocebo-effect
#19
John T Fortunato, Jason Adam Wasserman, Daniel Londyn Menkes
Nocebo effects occur when an adverse effect on the patient arises from the patient's own negative expectations. In accordance with informed consent, providers often disclose information that results in unintended adverse outcomes for the patient. While this may adhere to the principle of autonomy, it violates the doctrine of "primum non nocere," given that side-effect disclosure may cause those side effects. In this article we build off previous work, particularly by Wells and Kaptchuk ( 2012 ) and by Cohen ( 2013 ), to suggest ethical guidelines that permit nondisclosure in the case when a nocebo effect is likely to occur on of the basis of nonmaleficence...
June 2017: American Journal of Bioethics: AJOB
https://www.readbyqxmd.com/read/28537808/dose-intense-dose-dense-and-tailored-dose-adjuvant-chemotherapy-for-early-breast-cancer-an-evolution-of-concepts
#20
Alexios Matikas, Theodoros Foukakis, Jonas Bergh
BACKGROUND: The introduction of adjuvant chemotherapy following surgery for early breast cancer (BC) and its integration into routine clinical practice has consistently improved clinical outcomes. Since the addition of other agents to the contemporary standard of care containing an anthracycline, cyclophosphamide and a taxane has not lead to further prolongation of survival, subsequent efforts concentrated on escalating the administered doses and reducing the time interval between chemotherapy cycles...
May 24, 2017: Acta Oncologica
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