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https://www.readbyqxmd.com/read/28546778/good-intentions-getting-out-of-hand-is-there-a-future-for-health-care-guidelines
#1
Louise Hk Blume, Nico Jhw van Weert, Jamiu O Busari, Diana Mj Delnoij
To date, the focus of research on guidelines has been directed toward professionals, and hospitals have merely served as the context. Little research has been performed on the dilemmas of guideline adherence in hospitals, as a setting in which multiple professional guidelines have to be implemented simultaneously; also, it is still unclear which clinical guidelines have to be aligned with other external demands, such as rules, regulations, standards, indicators, norms, and so on. Hence, different ways of studying the issue of guideline implementation are called for...
2017: Risk Management and Healthcare Policy
https://www.readbyqxmd.com/read/28546705/sinonasal-mass-a-recent-study-of-its-clinicopathological-profile
#2
P Agarwal, R Panigrahi
A variety of non-neoplastic and neoplastic conditions involving the nasal cavity, paranasal sinuses (PNS), and nasopharynx are commonly encountered in clinical practice. The objectives of the study were to identify various pathological conditions that present with sinus or nasal mass, to understand their varied clinical behavior, to know the distribution of various lesions among the different age and sex groups, and to study the management of sinonasal masses and its outcome on follow-up. A prospective study was carried out from September 2013 to August 2015, in the Otorhinolaryngology Department of Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha...
June 2017: Indian Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28546660/can-we-deliver-better
#3
REVIEW
Ajay Rane, Jay Iyer, Harsha Ananthram, Thomas Currie
Human childbirth has been described as an "obstetrical dilemma". Evolution favours enlargement of the foetal brain, whilst bipedal locomotion demands a reduction in pelvic breadth for improvements in biomechanical efficiency. The result of this conflict is a human pelvis incongruous with the dynamics of childbirth. Acute genital distortion at delivery can inflict lasting damage to female pelvic function. Pelvic organ prolapse, urinary, faecal incontinence and sexual dysfunction are long-term sequelae rarely discussed at antenatal care, impacting upon the expectant mother's ability to make an informed decision...
June 2017: Journal of Obstetrics and Gynaecology of India
https://www.readbyqxmd.com/read/28545884/a-diagnostic-dilemma-in-a-patient-with-polyarthritis
#4
Prashant Rao, Nathan Coffman, Joao Paulo Ferreira
No abstract text is available yet for this article.
May 22, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28544799/fine-needle-aspiration-cytology-of-primary-cutaneous-mucinous-carcinoma-of-axilla-report-of-a-rare-case
#5
Subrata Pal, Palash Kr Mondal, Rajashre Pradhan, Abhishek Sharma, Biswajit Biswas, Subodh Bhattacharyya
Primary mucinous eccrine carcinoma is a rare malignant adnexal tumor of older patients. The histopathological features of this tumor are well-established but the cytomorphology of this neoplasm has only been documented in a few cases. The cytology and histology of this tumor may mimic metastatic mucinous carcinoma and may cause a diagnostic dilemma, especially when the tumor is located at axilla. A correct diagnosis is important because the prognosis is better than that of a metastatic mucinous carcinoma. Here we report the cytological and histological features of a case of primary cutaneous mucinous carcinoma of axilla in an elderly male patient...
May 24, 2017: Diagnostic Cytopathology
https://www.readbyqxmd.com/read/28544750/unexpected-ethical-dilemmas-in-sex-assignment-in-46-xy-dsd-due-to-5-alpha-reductase-type-2-deficiency
#6
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/28544184/did-some-red-alga-derived-plastids-evolve-via-kleptoplastidy-a-hypothesis
#7
Andrzej Bodył
The evolution of plastids has a complex and still unresolved history. These organelles originated from a cyanobacterium via primary endosymbiosis, resulting in three eukaryotic lineages: glaucophytes, red algae, and green plants. The red and green algal plastids then spread via eukaryote-eukaryote endosymbioses, known as secondary and tertiary symbioses, to numerous heterotrophic protist lineages. The number of these horizontal plastid transfers, especially in the case of red alga-derived plastids, remains controversial...
May 23, 2017: Biological Reviews of the Cambridge Philosophical Society
https://www.readbyqxmd.com/read/28543656/international-capacity-building-initiatives-for-national-bioethics-committees
#8
Eugenijus Gefenas, Vilma Lukaseviciene
During the last two decades, national bioethics committees have been established in many countries all over the world. They vary with respect to their structure, composition, and working methods, but the main functions are similar. They are supposed to facilitate public debate on controversial bioethical issues and produce opinions and recommendations that can help inform the public and policy-makers. The dialogue among national bioethics committees is also increasingly important in the globalized world, where biomedical technologies raise ethical dilemmas that traverse national borders...
May 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28543651/the-past-present-and-future-of-mexico-s-national-bioethics-commission
#9
Manuel Ruiz de Chavez, Aidee Orozco, Gustavo Olaiz
The establishment of Mexico's National Bioethics Commission (Comisión Nacional de Bioética), in 1992, was conceived within the context of a global movement aimed at raising awareness of the ethical implications of technological and scientific development, especially in biomedicine. In 2005, a new decree put the commission under the scope of the Secretariat of Health and granted it technical and operational autonomy, allowing it to become a regulatory agency aimed at promoting a culture of bioethics, encouraging reflection on human health, and developing guidelines for health care, research, and education, through a global, secular, and democratic perspective...
May 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28542407/the-influence-of-persistent-organic-pollutants-in-the-traditional-inuit-diet-on-markers-of-inflammation
#10
L K Schæbel, E C Bonefeld-Jørgensen, H Vestergaard, S Andersen
Concentrations of persistent organic pollutants (POPs) are high in Inuit living predominately on the traditional marine diet. Adverse effects of POPs include disruption of the immune system and cardiovascular diseases that are frequent in Greenland Inuit. We aimed to assess the association between exposure to POPs from the marine diet and inflammation, taking into account other factors such as vitamin D. We invited Inuit and non-Inuit living in settlements or the town in rural East Greenland or in the capital city Nuuk...
2017: PloS One
https://www.readbyqxmd.com/read/28541274/cerebrospinal-fluid-procalcitonin-as-a-biomarker-of-bacterial-meningitis-in-neonates
#11
Z Reshi, M Nazir, W Wani, M Malik, J Iqbal, S Wajid
OBJECTIVE: The objective of the study was to study the performance of cerebrospinal fluid (CSF) procalcitonin as a marker for bacterial meningitis in neonates, and to determine its optimal 'cutoff' in CSF that can be called significant for the diagnosis. STUDY DESIGN: Neonates qualifying for lumbar puncture were prospectively studied. Procalcitonin and established CSF parameters were recorded. RESULTS: At a cut-off value of 0.33 ng ml(-1), CSF procalcitonin had a sensitivity of 0...
May 25, 2017: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/28539541/sleep-disordered-breathing-in-heart-failure%C3%A3-a-therapeutic-dilemma
#12
Nobuhiko Haruki, John S Floras
Sleep-disordered breathing (SDB) occurs in approximately 50% of patients with reduced left ventricular ejection fraction receiving contemporary heart failure (HF) therapies. Obstructive (OSA) and central sleep apneas (CSA) interrupt breathing by different mechanisms but impose qualitatively similar autonomic, chemical, mechanical, and inflammatory burdens on the heart and circulation. Because contemporary evidence-based drug and device HF therapies have little or no mitigating effect on the acute or long-term consequences of such stimuli, there is a sound mechanistic rationale for targeting SDB to reduce cardiovascular event rates and prolong life...
May 23, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/28539256/anorexia-nervosa-in-cystic-fibrosis
#13
REVIEW
Lynette Linkson, Patricia Macedo, Felicity M R Perrin, Caroline M Elston
This article explores the challenges associated with diagnosing and managing eating disorders such as anorexia nervosa amongst adolescents and adults with cystic fibrosis. It reviews the known risk factors, generic verses disease specific eating disorder risk screening tools and considers the ethical dilemmas associated with critically low body mass indices. A case review is included to illustrate the complexities of managing both conditions in the context of declining respiratory function.
March 23, 2017: Paediatric Respiratory Reviews
https://www.readbyqxmd.com/read/28539069/real-world-challenges-for-hepatitis-c-virus-medications-a-critical-overview
#14
Imran Shahid, Waleed Hassan AlMalki, Sajida Hassan, Muhammad Hassan Hafeez
From 2010, the landscape of hepatitis C therapeutics has been changed rapidly, and today we are standing at a cusp of a pharmacological revolution where highly effective and interferon (IFN)-free direct acting antivirals (DAAs) are already on the market. Such treatment paradigms attain 90-95% sustained virologic response (SVR; undetectable viral load at week 12 or 24 at the end of therapy) rates in treated individuals compared to 50-70% with treatment completion of dual-therapy-pegylated interferon (PEG-IFN) and ribavirin (RBV)...
May 25, 2017: Critical Reviews in Microbiology
https://www.readbyqxmd.com/read/28538466/increasing-research-capacity-in-a-safety-net-setting-through-an-academic-clinical-partnership
#15
J Margo Brooks Carthon, Sara Holland, Kerry Gamble, Helyn Rothwell, Darcy Pancir, Jim Ballinghoff, Linda Aiken
Safety net settings care for a disproportionate share of low-resource patients often have fewer resources to invest in nursing research. To address this dilemma, an academic-clinical partnership was formed in an effort to increase nursing research capacity at a safety net setting. Penn Presbyterian Medical Center and the Center for Health Outcomes and Policy Research located at the University of Pennsylvania partnered researchers and baccalaureate-prepared nurses in an 18-month research skill development program...
June 2017: Journal of Nursing Administration
https://www.readbyqxmd.com/read/28537991/treatment-and-outcomes-of-primary-urethra-cancer
#16
Tony Y Eng, Tiffany W Chen, Abhilasha J Patel, Jill N Vincent, Chul S Ha
BACKGROUND: Urethral cancer is a rare malignancy, representing <1% of all malignancies. Optimal management, due to its rarity, presents as a treatment dilemma for physicians. There is a lack of consensus regarding treatment as large randomized trials cannot be performed; thus, optimal management decisions rely on study of retrospective cases. This is a review of our institutional experience with urethral cancer treated with various treatment modalities. METHODS: A retrospective chart review was performed on 31 patients treated for primary cancer of the urethra from 1958 to 2008...
May 23, 2017: American Journal of Clinical Oncology
https://www.readbyqxmd.com/read/28537025/prediction-of-dissolved-oxygen-concentration-in-hypoxic-river-systems-using-support-vector-machine-a-case-study-of-wen-rui-tang-river-china
#17
Xiaoliang Ji, Xu Shang, Randy A Dahlgren, Minghua Zhang
Accurate quantification of dissolved oxygen (DO) is critically important for managing water resources and controlling pollution. Artificial intelligence (AI) models have been successfully applied for modeling DO content in aquatic ecosystems with limited data. However, the efficacy of these AI models in predicting DO levels in the hypoxic river systems having multiple pollution sources and complicated pollutants behaviors is unclear. Given this dilemma, we developed a promising AI model, known as support vector machine (SVM), to predict the DO concentration in a hypoxic river in southeastern China...
May 23, 2017: Environmental Science and Pollution Research International
https://www.readbyqxmd.com/read/28536728/neonatologist-performed-point-of-care-functional-echocardiography-in-the-neonatal-intensive-care-unit
#18
Woei Bing Poon, Keng Yean Wong
Functional echocardiography (fECHO) refers to a bedside, limited assessment of the ductus arteriosus, myocardial performance and pulmonary or systemic haemodynamics that is brief in nature and addresses a specific clinical question or management dilemma. This point-of-care ultrasonography is increasingly used internationally and locally among neonatal units to assist with management of neonatal haemodynamic conditions. This article intends to explain the modality, its indications, interpretation and implications for management, and how it impacts long-term outcomes, particularly in chronic lung disease for premature infants born before 32 weeks of gestation...
May 2017: Singapore Medical Journal
https://www.readbyqxmd.com/read/28536726/anaemia-with-laugier-hunziker-syndrome-a-diagnostic-dilemma
#19
Muhammad Bilal Abid, Paras Mughal, Muhammad Abbas Abid
No abstract text is available yet for this article.
May 2017: Singapore Medical Journal
https://www.readbyqxmd.com/read/28536227/back-pain-and-oedematous-schmorl-node-a-diagnostic-dilemma
#20
Aakriti Pandita, Nikhil Madhuripan, Rocio M Hurtado, Amit Dhamoon
A 26-year-old female from India presented with progressive, unremitting low back pain for over 1 year. She had been treated unsuccessfully for left-sided sacroiliitis, pelvic floor dysfunction, ankylosing spondylitis and seronegative spondyloarthritis. MRI lumbar spine showed a Schmorl node with surrounding marrow oedema at L4, the relevance of which is not clear in literature. One year after initial presentation, a biopsy of this lesion revealed culture positive diagnosis of spinal tuberculosis. Despite advances in imaging, delayed diagnosis is not uncommon in spinal tuberculosis (TB)...
May 22, 2017: BMJ Case Reports
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