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Managing uncertainty

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https://www.readbyqxmd.com/read/28652227/reducing-parental-uncertainty-around-childhood-cancer-implementation-decisions-and-design-trade-offs-in-developing-an-electronic-health-record-linked-mobile-app
#1
Keith Marsolo, William Shuman, Jeremy Nix, Caroline F Morrison, Larry L Mullins, Ahna Lh Pai
BACKGROUND: Parents of children newly diagnosed with cancer are confronted with multiple stressors that place them at risk for significant psychological distress. One strategy that has been shown to help reduce uncertainty is the provision of basic information; however, families of newly diagnosed cancer patients are often bombarded with educational material. Technology has the potential to help families manage their informational needs and move towards normalization. OBJECTIVE: The aim of this study was to create a mobile app that pulls together data from both the electronic health record (EHR) and vetted external information resources to provide tailored information to parents of newly diagnosed children as one method to reduce the uncertainty around their child's illness...
June 26, 2017: JMIR Research Protocols
https://www.readbyqxmd.com/read/28651866/life-cycle-assessment-to-compare-the-environmental-impact-of-seven-contemporary-food-waste-management-systems
#2
Joel Edwards, Maazuza Othman, Enda Crossin, Stewart Burn
Municipal food waste (FW) represents 35-45% of household residual waste in Australia, with the nation generating 1.6Tg annually. It is estimated that 91% of this FW ends up in landfill. This study used life cycle assessment to determine and compare the environmental impact of seven contemporary FW management systems for two real-life jurisdictions; incorporating the complete waste service and expanding the system to include inert and garden waste. Although, no system exhibited a best ranking across all impact categories, FW digestion based systems were all revealed to have a lower global warming potential than composting and landfilling systems...
June 16, 2017: Bioresource Technology
https://www.readbyqxmd.com/read/28650855/intermittent-vs-continuous-enteral-feeding-to-prevent-catabolism-in-acutely-ill-adult-and-pediatric-patients
#3
Filippo G Di Girolamo, Roberta Situlin, Nicola Fiotti, Gianni Biolo
PURPOSE OF REVIEW: In clinical management of acutely ill adults and children, continuous enteral feeding (CEF), being considered the most tolerable approach, in comparison to other temporal patterns of nutrient administration (i.e. intermittent, cyclic and bolus), is the most frequently applied method. However, uncertainties remain about the most efficient approach to counteract protein catabolism. RECENT FINDINGS: In critically ill adults, protein loss is mainly driven by increased protein breakdown whereas, in pediatric patients, acute illness is mainly characterized by blunted regulation of protein synthesis and stunted growth...
June 24, 2017: Current Opinion in Clinical Nutrition and Metabolic Care
https://www.readbyqxmd.com/read/28650738/recommendations-for-measuring-pulmonary-nodules-at-ct-a-statement-from-the-fleischner-society
#4
Alexander A Bankier, Heber MacMahon, Jin Mo Goo, Geoffrey D Rubin, Cornelia M Schaefer-Prokop, David P Naidich
These recommendations for measuring pulmonary nodules at computed tomography (CT) are a statement from the Fleischner Society and, as such, incorporate the opinions of a multidisciplinary international group of thoracic radiologists, pulmonologists, surgeons, pathologists, and other specialists. The recommendations address nodule size measurements at CT, which is a topic of importance, given that all available guidelines for nodule management are essentially based on nodule size or changes thereof. The recommendations are organized according to practical questions that commonly arise when nodules are measured in routine clinical practice and are, together with their answers, summarized in a table...
June 26, 2017: Radiology
https://www.readbyqxmd.com/read/28647705/revolution-in-acute-ischaemic-stroke-care-a-practical-guide-to-mechanical-thrombectomy
#5
REVIEW
Matthew Evans, Phil White, Peter Cowley, David Werring
Rapid, safe and effective arterial recanalisation to restore blood flow and improve functional outcome remains the primary goal of hyperacute ischaemic stroke management. The benefit of intravenous thrombolysis with recombinant tissue-type plasminogen activator for patients with severe stroke due to large artery occlusion is limited; early recanalisation is generally less than 30% for carotid, proximal middle cerebral artery or basilar artery occlusion. Since November 2014, nine positive randomised controlled trials of mechanical thrombectomy for large vessel occlusion in the anterior circulation have led to a revolution in the care of patients with acute ischaemic stroke...
June 24, 2017: Practical Neurology
https://www.readbyqxmd.com/read/28647155/quantifying-trade-offs-between-future-yield-levels-food-availability-and-forest-and-woodland-conservation-in-benin
#6
Confidence Duku, Sander J Zwart, Lenny G J van Bussel, Lars Hein
Meeting the dual objectives of food security and ecosystem protection is a major challenge in sub-Saharan Africa (SSA). To this end agricultural intensification is considered desirable, yet, there remain uncertainties regarding the impact of climate change on opportunities for agricultural intensification and the adequacy of intensification options given the rapid population growth. We quantify trade-offs between levels of yield gap closure, food availability and forest and woodland conservation under different scenarios...
June 21, 2017: Science of the Total Environment
https://www.readbyqxmd.com/read/28645585/thrombocytopenia-and-neurosurgery-a-literature-review
#7
REVIEW
Daphne Li, Taylor Glor, G Alexander Jones
The absence of evidence-based guidelines for platelet transfusion surrounding invasive neurosurgical procedures leads to uncertainty in management. Multiple studies have illuminated this lack of high quality data, and subsequent reliance on expert opinion. The generally accepted threshold for platelet transfusion has hovered around 100,000/μl. We have conducted a review of available clinical literature, in order to identify any evidence that may support or refute these general guidelines, in an attempt to clarify the need for platelet transfusion in the patient requiring neurosurgical intervention...
June 20, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28644430/the-clinical-landscape-for-sma-in-a-new-therapeutic-era
#8
REVIEW
K Talbot, E F Tizzano
Despite significant advances in basic research, the treatment of degenerative diseases of the nervous system remains one of the greatest challenges for translational medicine. The childhood onset motor neuron disorder spinal muscular atrophy (SMA) has been viewed as one of the more tractable targets for molecular therapy, due to a detailed understanding of the molecular genetic basis of the disease. In SMA, inactivating mutations in the SMN1 gene can be partially compensated for by limited expression of SMN protein from a variable number of copies of the SMN2 gene, which provides both a molecular explanation for phenotypic severity and a target for therapy...
June 23, 2017: Gene Therapy
https://www.readbyqxmd.com/read/28643081/distraction-osteogenesis-reconstruction-of-large-segmental-bone-defects-after-primary-tumor-resection-pitfalls-and-benefits
#9
REVIEW
Jan Lesensky, Daniel E Prince
Successful cure is achieved in almost 70% of patients with primary bone sarcomas with currently available therapies. Some soft tissue sarcomas require wide bone resection in order to achieve appropriate margins for cure of disease, and patients undergoing these procedures need durable reconstruction. Biological reconstruction has been shown to provide patients with superior long-term results over other alternatives. Distraction osteogenesis is well studied in the correction of deformities as well as in addressing some congenital musculoskeletal pathologies...
June 22, 2017: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
https://www.readbyqxmd.com/read/28642213/development-of-a-web-based-intervention-for-addressing-distress-in-caregivers-of-patients-receiving-stem-cell-transplants-formative-evaluation-with-stakeholder-interviews-and-focus-groups
#10
Nicole Amoyal Pensak, Tanisha Joshi, Teresa Simoneau, Kristin Kilbourn, Alaina Carr, Jean Kutner, Mark L Laudenslager
BACKGROUND: Caregivers of cancer patients experience significant burden and distress including depression and anxiety. We previously demonstrated the efficacy of an eight session, in-person, one-on-one stress management intervention to reduce distress in caregivers of patients receiving allogeneic hematopoietic stem cell transplants (allo-HSCT). OBJECTIVE: The objective of this study was to adapt and enhance the in-person caregiver stress management intervention to a mobilized website (eg, tablet, smartphone, or computer-based) for self-delivery in order to enhance dissemination to caregiver populations most in need...
June 22, 2017: JMIR Research Protocols
https://www.readbyqxmd.com/read/28641997/uterine-artery-embolization-and-surgical-methods-for-the-treatment-of-symptomatic-uterine-leiomyomas-a-systemic-review-and-meta-analysis-followed-by-indirect-treatment-comparison
#11
REVIEW
Marcelo C M Fonseca, Rodrigo Castro, Marcio Machado, Tania Conte, Manoel J B C Girao
PURPOSE: There is significant discussion and uncertainty about the optimal management of symptomatic uterine leiomyomas (SULs). Nonsurgical procedures such as uterine artery embolization (UAE) have been developed. The goal of this study was to conduct a meta-analysis and an indirect treatment comparison to examine the comparative efficacy and safety of the surgical procedures to treat SULs compared with UAE. METHODS: MEDLINE, EMBASE, Lilacs, and the Cochrane Central Register of Controlled Trials databases were searched from inception to February 2016...
June 19, 2017: Clinical Therapeutics
https://www.readbyqxmd.com/read/28641166/care-coordination-at-a-pediatric-accountable-care-organization-aco-a-qualitative-analysis
#12
Baria Hafeez, Sophia Miller, Anup D Patel, Zachary M Grinspan
OBJECTIVE: Care coordinators may help manage care for children with chronic illness. Their role in pediatric epilepsy care is understudied. We aimed to qualitatively describe the content of a care coordination intervention for children with epilepsy. METHODS: We conducted nine semi-structured interviews and one focus group with care coordinators at a pediatric accountable care organization (ACO) in Ohio. The care coordinators used a modified version of a published care coordination checklist for children with epilepsy (Patel AD, 2014)...
June 19, 2017: Epilepsy & Behavior: E&B
https://www.readbyqxmd.com/read/28640487/a-qualitative-study-exploring-the-difficulties-influencing-decision-making-at-the-end-of-life-for-people-with-dementia
#13
Kethakie Lamahewa, Rammya Mathew, Steve Iliffe, Jane Wilcock, Jill Manthorpe, Elizabeth L Sampson, Nathan Davies
BACKGROUND: Dementia is a progressive neurodegenerative condition characterized by declining functional and cognitive abilities. The quality of end of life care for people with dementia in the UK can be poor. Several difficult decisions may arise at the end of life, relating to the care of the person with dementia, for example management of comorbidities. OBJECTIVE: To explore difficulties in decision making for practitioners and family carers at the end of life for people with dementia...
June 22, 2017: Health Expectations: An International Journal of Public Participation in Health Care and Health Policy
https://www.readbyqxmd.com/read/28639967/ras-positive-thyroid-nodules
#14
Trevor E Angell
PURPOSE OF REVIEW: The current review focuses on the uncertainty regarding the management of rat sarcoma viral oncogene homolog RAS-positive thyroid nodules. The application of oncogene testing has been heralded for improving risk assessment for indeterminate cytology thyroid nodules and has grown in clinical use. RAS mutations are historically considered oncogenic. However, RAS mutation detection in thyroid nodules has proven problematic, as these mutations are found in benign and malignant lesions...
July 20, 2017: Current Opinion in Endocrinology, Diabetes, and Obesity
https://www.readbyqxmd.com/read/28639329/estimating-abundance-without-recaptures-of-marked-pallid-sturgeon-in-the-mississippi-river
#15
Nicholas A Friedenberg, Jan J Hoover, Krista Boysen, K Jack Killgore
Abundance estimates are essential for estimating the viability of populations and the risks posed by alternative management actions. An effort to estimate abundance via a repeated mark-recapture experiment may fail to recapture marked individuals. We present a framework for obtaining lower bounds on abundance in the absence of recaptures for both panmictic and spatially-structured populations. We applied this nil-recapture method to data from a 12-year survey of pallid sturgeon (Scaphirhynchus albus) in the lower and middle Mississippi River; none of the 241 individuals marked were recaptured in the survey...
June 22, 2017: Conservation Biology: the Journal of the Society for Conservation Biology
https://www.readbyqxmd.com/read/28639023/uncertainties-in-vegetated-buffer-strip-function-in-controlling-phosphorus-export-from-agricultural-land-in-the-canadian-prairies
#16
Reza Habibiandehkordi, David A Lobb, Steve C Sheppard, Don N Flaten, Philip N Owens
Vegetated buffer strips (VBSs) are widely encouraged as a cost-effective strategy to address phosphorus (P) pollution associated with agricultural production. However, there is a lack of evidence in the effectiveness of these measures for tackling diffuse P pollution in cold-climate regions under concentrated runoff flow conditions. This research aimed to investigate the effects of VBSs on reducing P concentrations in surface runoff at three different watersheds in Manitoba, Canada. Surface runoff samples were collected in four sub-catchments from each watershed by installing paired weirs at 0...
June 22, 2017: Environmental Science and Pollution Research International
https://www.readbyqxmd.com/read/28638298/uncertainty-of-myocardial-perfusion-imaging-in-chest-pain-risk-stratification
#17
Htoo Kyaw, Sivacharan Buddhavarapu, Joseph Abboud, Deepika Misra
BACKGROUND: Chest pain is a common presenting symptom in the emergency department (ED). Although the diagnostic workup for chest pain is well established, the best time to perform invasive cardiac catheterization in patients with low to moderate risk of coronary artery disease is still unclear, particularly if noninvasive tests such as the electrocardiogram (ECG) and nuclear myocardial perfusion scan show nonsignificant findings. CASE REPORT: We present the case of a 52-year-old female who presented to the ED with acute-onset chest pain that had started early in the morning while she was sleeping...
2017: Ochsner Journal
https://www.readbyqxmd.com/read/28637128/maximizing-gait-and-balance-behaviors-and-decision-making-processes-of-persons-with-multiple-sclerosis-and-physical-therapists
#18
Elissa Held Bradford, Marcia Finlayson, Andrea White Gorman, Joanne Wagner
PURPOSE: To describe the behavioral decisions used by persons with multiple sclerosis (MS) and physical therapists to maximize gait and balance following outpatient physical therapy. METHODS: A multi-method case series with seven matched pairs (persons with MS-physical therapists). Quota sampling maximized variability among persons with MS (disease steps score range 3-6). Three of the four physical therapists were MS or neurology certified. Persons with MS completed a phone survey, follow-up interview, and standardized questionnaires...
February 7, 2017: Disability and Rehabilitation
https://www.readbyqxmd.com/read/28632247/antecedents-and-outcomes-of-uncertainty-in-older-adults-with-cancer-a-scoping-review-of-the-literature
#19
Vida Ghodraty Jabloo, Shabbir M H Alibhai, Margaret Fitch, Ann E Tourangeau, Ana Patricia Ayala, Martine T E Puts
PROBLEM IDENTIFICATION: Uncertainty is a major source of distress for cancer survivors. Because cancer is primarily a disease of older adults, a comprehensive understanding of the antecedents and outcomes of uncertainty in older adults with cancer is essential. 
. LITERATURE SEARCH: MEDLINE®, PsycINFO®, Scopus, and CINAHL® were searched from inception to December 2015. Medical Subject Headings (MeSH) terms and free text words were used for the search concepts, including neoplasms, uncertainty, and aging...
July 1, 2017: Oncology Nursing Forum
https://www.readbyqxmd.com/read/28631247/choice-of-reserve-capacity-by-hospitals-a-problem-for-prospective-payment
#20
Philippe K Widmer, Maria Trottmann, Peter Zweifel
This contribution analyzes the impact of prospective payment on hospital decisions with regard to reserve capacity, using Swiss hospital data covering the years 2004-2009. This data set is unique because it permits distinguishing of institutional characteristics (e.g., ownership status) from the mode of payment as determinants of hospital efficiency, due to the fact that some Swiss cantons introduced prospective payment early while others waited for federal legislation to be enacted in 2012. Since a hospital's choice of reserve capacity depends also on the risk preferences of management while affecting the cost function, heterogeneity is predicted even in the presence of identical technology and factor prices...
June 19, 2017: European Journal of Health Economics: HEPAC: Health Economics in Prevention and Care
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