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https://www.readbyqxmd.com/read/28734560/deciding-on-breast-cancer-risk-reduction-the-role-of-counseling-in-individual-decision-making-a-qualitative-study
#1
Sarah B Blakeslee, Worta McCaskill-Stevens, Patricia A Parker, Christine M Gunn, Hanna Bandos, Therese B Bevers, Tracy A Battaglia, Angela Fagerlin, Jacqueline Müller-Nordhorn, Christine Holmberg
OBJECTIVES: The presentation of risks and benefits in clinical practice is common particularly in situations in which treatment recommendations involve trade-offs. The treatment of breast cancer risk with selective estrogen receptor modulators (SERMs) is such a decision. We investigated the influence of health care provider (HCP) counseling on women's decision-making. METHODS: Thirty breast cancer risk counseling sessions were recorded from April 2012-August 2013 at a comprehensive cancer center and at a safety-net, community hospital in the US...
June 27, 2017: Patient Education and Counseling
https://www.readbyqxmd.com/read/28728094/modelling-a-budgetary-impact-analysis-for-funding-drug-based-smoking-cessation-therapies-for-patients-with-major-depressive-disorder-in-spain
#2
J Rejas-Gutiérrez, E Bruguera, S Cedillo
BACKGROUND: Smoking is associated with high healthcare resource utilisation and cost to society. Patients with major depressive disorder (MDD) exhibit high susceptibility to nicotine dependence. Varenicline, bupropion and nicotine replacement therapy are all indicated for smoking cessation; however funding by the Spanish national health system (SNHS) is limited. We modelled a budgetary impact analysis (BIA) to estimate the impact of the SNHS funding drug-based therapies for smoking cessation in smokers with MDD...
June 3, 2017: European Psychiatry: the Journal of the Association of European Psychiatrists
https://www.readbyqxmd.com/read/28726530/incremental-net-monetary-benefit-of-ocrelizumab-relative-to-subcutaneous-interferon-%C3%AE-1a
#3
Melissa A Frasco, Tiffany Shih, Devin Incerti, Oliver Diaz Espinosa, Diana K Vania, Nina Thomas
AIM: Disease-modifying therapies (DMTs) impact the natural history of relapsing forms of multiple sclerosis (RRMS) by reducing annual relapse rates and slowing disability progression. The effect of DMTs on indirect costs has not been consistently explored in cost-effectiveness studies thus far. The value to patients of an emerging DMT, ocrelizumab, was quantified in comparison to subcutaneous interferon beta-1a (IFNβSC) for the prevalent RRMS population with mild to moderate disability in the United States based on two Phase 3 trials, OPERA I and OPERA II, of ocrelizumab versus IFNβSC in RRMS...
July 20, 2017: Journal of Medical Economics
https://www.readbyqxmd.com/read/28724590/long-term-antithrombotic-treatment-in-intracranial-hemorrhage-survivors-with-atrial-fibrillation
#4
Eleni Korompoki, Filippos T Filippidis, Peter B Nielsen, Angela Del Giudice, Gregory Y H Lip, Joji B Kuramatsu, Hagen B Huttner, Jiming Fang, Sam Schulman, Joan Martí-Fàbregas, Celine S Gathier, Anand Viswanathan, Alessandro Biffi, Daniela Poli, Christian Weimar, Uwe Malzahn, Peter Heuschmann, Roland Veltkamp
OBJECTIVE: To perform a systematic review and meta-analysis of studies reporting recurrent intracranial hemorrhage (ICH) and ischemic stroke (IS) in ICH survivors with atrial fibrillation (AF) during long-term follow-up. METHODS: A comprehensive literature search including MEDLINE, EMBASE, Cochrane library, clinical trials registry was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We considered studies capturing outcome events (ICH recurrence and IS) for ≥3 months and treatment exposure to vitamin K antagonists (VKAs), antiplatelet agents (APAs), or no antithrombotic medication (no-ATM)...
July 19, 2017: Neurology
https://www.readbyqxmd.com/read/28723416/unravelling-the-pharmacologic-opportunities-and-future-directions-for-targeted-therapies-in-gastro-intestinal-cancers-part-2-neuroendocrine-tumours-hepatocellular-carcinoma-and-gastro-intestinal-stromal-tumours
#5
REVIEW
Cindy Neuzillet, Louis de Mestier, Benoît Rousseau, Olivier Mir, Mohamed Hebbar, Hemant M Kocher, Philippe Ruszniewski, Christophe Tournigand
Until the 1990s, cytotoxic chemotherapy has been the cornerstone of medical therapy for gastrointestinal (GI) cancers. Better understanding of the cancer cell molecular biology has led to the therapeutic revolution of targeted therapies, i.e. monoclonal antibodies or small molecule inhibitors directed against proteins that are specifically overexpressed or mutated in cancer cells. These agents, being more specific to cancer cells, were expected to be less toxic than conventional cytotoxic agents. However, their effects have sometimes been disappointing, due to intrinsic or acquired resistance mechanisms, or to an activity restricted to some tumour settings, illustrating the importance of patient selection and early identification of predictive biomarkers of response to these therapies...
July 16, 2017: Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28716797/a-pragmatic-phase-iii-multisite-double-blind-placebo-controlled-parallel-arm-dose-increment-randomised-trial-of-regular-low-dose-extended-release-morphine-for-chronic-breathlessness-breathlessness-exertion-and-morphine-sulfate-beams-study-protocol
#6
David Currow, Gareth John Watts, Miriam Johnson, Christine F McDonald, John O Miners, Andrew A Somogyi, Linda Denehy, Nicola McCaffrey, Danny J Eckert, Philip McCloud, Sandra Louw, Lawrence Lam, Aine Greene, Belinda Fazekas, Katherine C Clark, Kwun Fong, Meera R Agar, Rohit Joshi, Sharon Kilbreath, Diana Ferreira, Magnus Ekström
INTRODUCTION: Chronic breathlessness is highly prevalent and distressing to patients and families. No medication is registered for its symptomatic reduction. The strongest evidence is for regular, low-dose, extended- release (ER) oral morphine. A recent large phase III study suggests the subgroup most likely to benefit have chronic obstructive pulmonary disease (COPD) and modified Medical Research Council breathlessness scores of 3 or 4. This protocol is for an adequately powered, parallel-arm, placebo-controlled, multisite, factorial, block-randomised study evaluating regular ER morphine for chronic breathlessness in people with COPD...
July 17, 2017: BMJ Open
https://www.readbyqxmd.com/read/28711725/the-cost-effectiveness-of-a-patient-centred-pressure-ulcer-prevention-care-bundle-findings-from-the-intact-cluster-randomised-trial
#7
Jennifer A Whitty, Elizabeth McInnes, Tracey Bucknall, Joan Webster, Brigid M Gillespie, Merrilyn Banks, Lukman Thalib, Marianne Wallis, Jose Cumsille, Shelley Roberts, Wendy Chaboyer
BACKGROUND: Pressure ulcers are serious, avoidable, costly and common adverse outcomes of healthcare. OBJECTIVES: To evaluate the cost-effectiveness of a patient-centred pressure ulcer prevention care bundle compared to standard care. DESIGN: Cost-effectiveness and cost-benefit analyses of pressure ulcer prevention performed from the health system perspective using data collected alongside a cluster-randomised trial. SETTINGS: Eight tertiary hospitals in Australia...
June 27, 2017: International Journal of Nursing Studies
https://www.readbyqxmd.com/read/28707449/individualizing-dual-antiplatelet-therapy-duration-prediction-tools-genomics-and-clinical-judgment
#8
EDITORIAL
Arka Chatterjee, William B Hillegass
Prolonged dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) on average reduces the risk of subsequent myocardial infarction (MI) but increases major bleeds. Individualizing duration of DAPT based on the DAPT trial's net benefit prediction tool would likely optimize outcome beyond population average recommendations. Individualizing agent selection and duration of therapy based on genomic data may further improve outcomes. Clinical judgment remains the most important tool to tailor DAPT duration based on a large array of additional relevant factors not captured by predition rules or genomics...
July 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28704383/predicting-in-hospital-death-during-acute-presentation-with-pulmonary-embolism-to-facilitate-early-discharge-and-outpatient-management
#9
Jerrett K Lau, Vincent Chow, Alex Brown, Leonard Kritharides, Austin C C Ng
BACKGROUND: Pulmonary embolism continues to be a significant cause of death. The aim was to derive and validate a risk prediction model for in-hospital death after acute pulmonary embolism to identify low risk patients suitable for outpatient management. METHODS: A confirmed acute pulmonary embolism database of 1,426 consecutive patients admitted to a tertiary-center (2000-2012) was analyzed, with odd and even years as derivation and validation cohorts respectively...
2017: PloS One
https://www.readbyqxmd.com/read/28697289/bariatric-metabolic-surgery-a-guide-for-the-primary-care-physician
#10
Phong Ching Lee, John Dixon
BACKGROUND: Bariatric-metabolic surgery has emerged as an attractive option that offers significant and durable weight loss in the treatment of clinically severe obesity. Given the high prevalence of obesity, and growing numbers of bariatric-metabolic surgeries performed, primary care physicians increasingly encounter patients who have had, or are considering, bariatric-metabolic surgery. OBJECTIVE: The aim of this article is to provide guidance on common issues pertaining to bariatric-metabolic surgery that general practitioners (GPs) face, including patient selection, preoperative work-up, acute and long-term complications following the surgery, and long-term lifestyle and nutritional support...
2017: Australian Family Physician
https://www.readbyqxmd.com/read/28689048/the-impact-of-hypothermia-on-serum-potassium-concentration-a-systematic-review
#11
REVIEW
Sarah Buse, Marc Blancher, Damien Viglino, Mathieu Pasquier, Maxime Maignan, Pierre Bouzat, Thorsten Annecke, Guillaume Debaty
BACKGROUND: Blood potassium is the main prognostic biomarker used for triage in hypothermic cardiac arrest. The aim of this review was to assess the impact of hypothermia on blood potassium levels and compare the underlying pathophysiological theories. METHODS: The Medline electronic database was searched via PubMed for articles published from January 1970 to December 2016. The search strategy included studies related to hypothermia and potassium levels. The relevant literature on clinical studies and experimental studies was reviewed by the authors...
July 5, 2017: Resuscitation
https://www.readbyqxmd.com/read/28684922/emerging-use-of-everolimus-in-the-treatment-of-neuroendocrine-tumors
#12
REVIEW
Pablo Gajate, Olga Martínez-Sáez, Teresa Alonso-Gordoa, Enrique Grande
Neuroendocrine tumors (NETs) consist of a diverse family of malignancies, which are derived from neuroendocrine cells, most commonly originating from the gastroenteropancreatic (GEP) tract or the bronchopulmonary system. In general, NETs are more indolent than epithelial tumors, with median survival rates of longer than 30 months. The upregulation of mTOR pathway has been shown to play a pivotal role in NET pathogenesis. Inhibition of mTOR protein with everolimus represents a progress in the treatment of advanced NETs...
2017: Cancer Management and Research
https://www.readbyqxmd.com/read/28683900/derivation-and-validation-of-a-novel-prediction-model-to-identify-low-risk-patients-with-acute-pulmonary-embolism
#13
Muthiah Subramanian, Sowmya Gopalan, Srinivasan Ramadurai, Preetam Arthur, Mukund A Prabhu, Rajesh Thachathodiyl, Kumaraswamy Natarajan
Accurate identification of low-risk patients with acute pulmonary embolism (PE) who may be eligible for outpatient treatment or early discharge can have substantial cost-saving benefit. The purpose of this study was to derive and validate a prediction model to effectively identify patients with PE at low risk of short-term mortality, right ventricular dysfunction, and other nonfatal outcomes. This study analyzed data from 400 consecutive patients with acute PE. We derived and internally validated our prediction rule based on clinically significant variables that are routinely available at initial examination and that were categorized and weighted using coefficients in the multivariate logistic regression...
May 30, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28682442/covariate-adjusted-response-adaptive-randomization-for-multi-arm-clinical-trials-using-a-modified-forward-looking-gittins-index-rule
#14
Sofía S Villar, William F Rosenberger
We introduce a non-myopic, covariate-adjusted response adaptive (CARA) allocation design for multi-armed clinical trials. The allocation scheme is a computationally tractable procedure based on the Gittins index solution to the classic multi-armed bandit problem and extends the procedure recently proposed in Villar et al. (2015). Our proposed CARA randomization procedure is defined by reformulating the bandit problem with covariates into a classic bandit problem in which there are multiple combination arms, considering every arm per each covariate category as a distinct treatment arm...
July 6, 2017: Biometrics
https://www.readbyqxmd.com/read/28676065/prior-balloon-valvuloplasty-versus-direct-transcatheter-aortic-valve-implantation-directavi-study-protocol-for-a-randomized-controlled-trial
#15
Florence Leclercq, Pierre Robert, Jessica Labour, Benoit Lattuca, Mariama Akodad, Jean-Christophe Macia, Richard Gervasoni, Francois Roubille, Thomas Gandet, Laurent Schmutz, Erika Nogue, Nicolas Nagot, Bernard Albat, Guillaume Cayla
BACKGROUND: Balloon predilatation of the aortic valve has been regarded as an essential step during the transcatheter aortic valve implantation (TAVI) procedure. However, recent evidence has suggested that aortic valvuloplasty may cause complications and that high success rates may be obtained without prior dilatation of the valve. We hypothesize that TAVI performed without predilatation of the aortic valve and using new-generation balloon-expandable transcatheter heart valves is associated with a better net clinical benefit than TAVI performed with predilatation...
July 4, 2017: Trials
https://www.readbyqxmd.com/read/28674136/a-systematic-review-of-the-cost-and-cost-effectiveness-of-electronic-discharge-communications
#16
Laura K Sevick, Rosmin Esmail, Karen Tang, Diane L Lorenzetti, Paul Ronksley, Matthew James, Maria Santana, William A Ghali, Fiona Clement
BACKGROUND: The transition between acute care and community care can be a vulnerable period in a patients' treatment due to the potential for postdischarge adverse events. The vulnerability of this period has been attributed to factors related to the miscommunication between hospital-based and community-based physicians. Electronic discharge communication has been proposed as one solution to bridge this communication gap. Prior to widespread implementation of these tools, the costs and benefits should be considered...
July 2, 2017: BMJ Open
https://www.readbyqxmd.com/read/28669288/incremental-benefit-cost-of-momcare-collaborative-care-for-perinatal-depression-among-economically-disadvantaged-women
#17
Nancy K Grote, Gregory E Simon, Joan Russo, Mary Jane Lohr, Kathy Carson, Wayne Katon
OBJECTIVE: Effectiveness of collaborative care for perinatal depression has been demonstrated for MOMCare, from early pregnancy up to 15 months postpartum, for Medicaid enrollees in a public health system. MOMCare had a greater impact on reducing depression and improving functioning for women with comorbid posttraumatic stress disorder (PTSD) than for those without PTSD. This study estimated the incremental benefit and cost and the net benefit of MOMCare for women with major depression and PTSD...
July 3, 2017: Psychiatric Services: a Journal of the American Psychiatric Association
https://www.readbyqxmd.com/read/28652016/overall-effectiveness-of-rivaroxaban-in-patients-with-pulmonary-embolism
#18
Li Wang, Onur Baser, Phil Wells, W Frank Peacock, Craig I Coleman, Gregory J Fermann, Jeff Schein, Concetta Crivera
PURPOSE: Due to limited evidence on the impact of rivaroxaban in clinical practice, we compared the effectiveness of rivaroxaban versus standard of care (SOC) among patients in the Veterans Health Administration. METHODS: Adult patients with continuous enrollment in a health plan with medical and pharmacy benefits for ≥12 months before and ≥3 months after an inpatient diagnosis of pulmonary embolism (PE) between October 1, 2011, and June 30, 2015, and a prescription claim for an anticoagulant during the index hospitalization, were included...
June 23, 2017: Clinical Therapeutics
https://www.readbyqxmd.com/read/28645935/liver-cirrhosis-in-patients-with-atrial-fibrillation-would-oral-anticoagulation-have-a-net-clinical-benefit-for-stroke-prevention
#19
Ling Kuo, Tze-Fan Chao, Chia-Jen Liu, Yenn-Jiang Lin, Shih-Lin Chang, Li-Wei Lo, Yu-Feng Hu, Ta-Chuan Tuan, Jo-Nan Liao, Fa-Po Chung, Tzeng-Ji Chen, Gregory Y H Lip, Shih-Ann Chen
BACKGROUND: Patients with liver cirrhosis have been excluded from randomized clinical trials of oral anticoagulation therapy for stroke prevention in atrial fibrillation. We hypothesized that patients with liver cirrhosis would have a positive net clinical benefit for oral anticoagulation when used for stroke prevention in atrial fibrillation. METHODS AND RESULTS: This study used the National Health Insurance Research Database in Taiwan. Among 289 559 atrial fibrillation patients aged ≥20 years, there were 10 336 with liver cirrhosis, and 9056 of them having a CHA2DS2-VASc score ≥2 were divided into 3 groups, that is, no treatment, antiplatelet therapy, and warfarin...
June 23, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28644772/risk-stratification-for-second-primary-lung-cancer
#20
Summer S Han, Gabriel A Rivera, Martin C Tammemägi, Sylvia K Plevritis, Scarlett L Gomez, Iona Cheng, Heather A Wakelee
Purpose This study estimated the 10-year risk of developing second primary lung cancer (SPLC) among survivors of initial primary lung cancer (IPLC) and evaluated the clinical utility of the risk prediction model for selecting eligibility criteria for screening. Methods SEER data were used to identify a population-based cohort of 20,032 participants diagnosed with IPLC between 1988 and 2003 and who survived ≥ 5 years after the initial diagnosis. We used a proportional subdistribution hazards model to estimate the 10-year risk of developing SPLC among survivors of lung cancer LC in the presence of competing risks...
June 23, 2017: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
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