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https://www.readbyqxmd.com/read/28820404/responding-professionally-to-requests-for-cesarean-delivery
#1
F Chervenak, L McCullough
Patients' requests for non-indicated cesarean delivery challenge the professionalism of obstetricians. This is because physicians should not provide clinical management in the absence of an evidence-based indication for it. The ethics of responding professionally to requests for non-indicated cesarean delivery would appear to be simple: just say "No." This paper presents an ethically and clinically more nuanced approach, on the basis of the professional responsibility model of obstetric ethics, emphasizinga preventive ethics approach...
July 2017: Georgian Medical News
https://www.readbyqxmd.com/read/28817826/the-safety-and-efficacy-of-the-s1-temozolomide-regimen-in-patients-with-metastatic-neuroendocrine-tumors
#2
Jiuda Zhao, Hong Zhao, Yihebali Chi
<br><br>Purpose Both capecitabine alone and capecitabine in combination with temozolomide have activities against neuroendocrine tumors (NETs). However, the role of S-1 in NETs is still unknown. We performed a study to evaluate the safety and efficacy of the S-1 plus temozolomide (STEM) regimen in patients with locally advanced or metastatic NETs. Methods A retrospective review was conducted in 20 patients with locally advanced or metastatic NETs treated with the STEM regimen. Of the patients, 15 (75...
August 17, 2017: Neuroendocrinology
https://www.readbyqxmd.com/read/28811062/validation-of-the-prostate-health-index-in-a-predictive-model-of-prostate-cancer
#3
A Sanchís-Bonet, M Barrionuevo-González, A M Bajo-Chueca, L Pulido-Fonseca, L E Ortega-Polledo, J C Tamayo-Ruiz, M Sánchez-Chapado
OBJECTIVES: To validate and analyse the clinical usefulness of a predictive model of prostate cancer that incorporates the biomarker «[-2] pro prostate-specific antigen» using the prostate health index (PHI) in decision making for performing prostate biopsies. MATERIAL AND METHODS: We isolated serum from 197 men with an indication for prostate biopsy to determine the total prostate-specific antigen (tPSA), the free PSA fraction (fPSA) and the [-2] proPSA (p2PSA)...
August 12, 2017: Actas Urologicas Españolas
https://www.readbyqxmd.com/read/28809446/deferasirox-for-managing-iron-overload-in-people-with-thalassaemia
#4
REVIEW
Claudia Bollig, Lisa K Schell, Gerta Rücker, Roman Allert, Edith Motschall, Charlotte M Niemeyer, Dirk Bassler, Joerg J Meerpohl
BACKGROUND: Thalassaemia is a hereditary anaemia due to ineffective erythropoiesis. In particular, people with thalassaemia major develop secondary iron overload resulting from regular red blood cell transfusions. Iron chelation therapy is needed to prevent long-term complications.Both deferoxamine and deferiprone are effective; however, a review of the effectiveness and safety of the newer oral chelator deferasirox in people with thalassaemia is needed. OBJECTIVES: To assess the effectiveness and safety of oral deferasirox in people with thalassaemia and iron overload...
August 15, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28808888/has-time-come-for-the-use-of-direct-oral-anticoagulants-in-the-extended-prophylaxis-of-venous-thromboembolism-in-acutely-ill-medical-patients-yes
#5
Walter Ageno
Betrixaban is a direct factor Xa inhibitor with a renal excretion of only approximately 5-7%. On June 23rd 2017, it became the first direct oral anticoagulant to receive Food and Drug Administration approval for the prevention of venous thromboembolism in acutely ill medical patients, and the first anticoagulant agent to be approved for extended-duration thromboprophylaxis after hospital discharge in this setting. Approval followed the results of the APEX trial, a phase III clinical trial comparing betrixaban (80 mg) administered for 35-42 days with enoxaparin (40 mg) administered for 10 ± 4 days...
August 14, 2017: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/28808077/gps-knowledge-use-and-confidence-in-national-physical-activity-and-health-guidelines-and-tools-a-questionnaire-based-survey-of-general-practice-in-england
#6
Robin Chatterjee, Tim Chapman, Mike Gt Brannan, Justin Varney
BACKGROUND: Physical activity (PA) brief advice in health care is effective at getting individuals active. It has been suggested that one in four people would be more active if advised by a GP or nurse, but as many as 72% of GPs do not discuss the benefits of physical activity with patients. AIM: To assess the knowledge, use, and confidence in national PA and Chief Medical Officer (CMO) health guidelines and tools among GPs in England. DESIGN AND SETTING: Online questionnaire-based survey of selfselecting GPs in England that took place over a 10-day period in March 2016...
August 14, 2017: British Journal of General Practice: the Journal of the Royal College of General Practitioners
https://www.readbyqxmd.com/read/28801424/a-cost-effectiveness-comparison-of-the-nice-2015-and-who-2013-diagnostic-criteria-for-women-with-gestational-diabetes-with-and-without-risk-factors
#7
Paul Brian Jacklin, Michael Ja Maresh, Chris C Patterson, Katharine P Stanley, Anne Dornhorst, Shona Burman-Roy, Rudy W Bilous
OBJECTIVES: To compare the cost-effectiveness (CE) of the National Institute for Health and Care Excellence (NICE) 2015 and the WHO 2013 diagnostic thresholds for gestational diabetes mellitus (GDM). SETTING: The analysis was from the perspective of the National Health Service in England and Wales. PARTICIPANTS: 6221 patients from four of the Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO) study centres (two UK, two Australian), 6308 patients from the Atlantic Diabetes in Pregnancy study and 12 755 patients from UK clinical practice...
August 11, 2017: BMJ Open
https://www.readbyqxmd.com/read/28801396/the-sims-trial-adjustable-anchored-single-incision-mini-slings-versus-standard-tension-free-midurethral-slings-in-the-surgical-management-of-female-stress-urinary-incontinence-a-study-protocol-for-a-pragmatic-multicentre-non-inferiority-randomised-controlled
#8
Mohamed Abdel-Fattah, Graeme MacLennan, Mary Kilonzo, R Phil Assassa, Kirsty McCormick, Tracey Davidson, Alison McDonald, James N'Dow, Judith Wardle, John Norrie
INTRODUCTION: Single-incision mini-slings (SIMS) represent the third generation of midurethral slings. They have been developed with the aim of offering a true ambulatory procedure for treatment of female stress urinary incontinence (SUI) with reduced morbidity and earlier recovery while maintaining similar efficacy to standard midurethral slings (SMUS). The aim of this study is to determine the clinical and cost-effectiveness of adjustable anchored SIMS compared with tension-free SMUS in the surgical management of female SUI, with 3-year follow-up...
August 11, 2017: BMJ Open
https://www.readbyqxmd.com/read/28799620/long-term-bleeding-risk-prediction-in-real-world-patients-with-atrial-fibrillation-comparison-of-the-has-bled-and-abc-bleeding-risk-scores-the-murcia-atrial-fibrillation-project
#9
María Asunción Esteve-Pastor, José Miguel Rivera-Caravaca, Vanessa Roldan, Vicente Vicente, Mariano Valdés, Francisco Marín, Gregory Y H Lip
Risk scores in patients with atrial fibrillation (AF) based on clinical factors alone generally have only modest predictive value for predicting high risk patients that sustain events. Biomarkers might be an attractive prognostic tool to improve bleeding risk prediction. The new ABC-Bleeding score performed better than HAS-BLED score in a clinical trial cohort but has not been externally validated. It was the aim of this study to compare the predictive performance of the ABC-Bleeding score compared to HAS-BLED score in an independent "real-world" anticoagulated AF patients with long-term follow-up...
August 11, 2017: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/28777651/safety-net-academic-hospital-experience-in-following-up-noncritical-yet-potentially-significant-radiologist-recommendations
#10
Nadja Kadom, Gemma Doherty, Alexandra Solomon, Madison Close, Scott Friedman, Deborah Gregson, Bradley S Rostad, James M Moses, Alexander Norbash
OBJECTIVE: In this retrospective study, we identified the types of noncritical recommendations radiologists issued over a 15-day period, the percentage of noncritical radiology recommendations that were not acted on or acknowledged in the medical records, potential causes for recommendations not being acted on, and the potential risk of harm to patients. MATERIALS AND METHODS: We conducted a retrospective review of radiology reports and patient records from January 1, 2014, to January 15, 2014, at a large tertiary academic center and regional safety-net hospital...
August 4, 2017: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/28772094/pharmacovigilance-in-hospice-palliative-care-net-effect-of-haloperidol-for-nausea-or-vomiting
#11
Madeline Digges, Akram Hussein, Andrew Wilcock, Gregory B Crawford, Jason W Boland, Meera R Agar, Aynharan Sinnarajah, David C Currow, Miriam J Johnson
BACKGROUND: Haloperidol is widely prescribed as an antiemetic in patients receiving palliative care, but there is limited evidence to support and refine its use. OBJECTIVE: To explore the immediate and short-term net clinical effects of haloperidol when treating nausea and/or vomiting in palliative care patients. DESIGN: A prospective, multicenter, consecutive case series. SETTING/SUBJECTS: Twenty-two sites, five countries: consultative, ambulatory, and inpatient services...
August 3, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28762617/effect-of-extended-duration-thromboprophylaxis-on-venous-thromboembolism-and-major-bleeding-among-acutely-ill-hospitalized-medical-patients-a-bivariate-analysis
#12
Gerald Chi, Samuel Z Goldhaber, John M Kittelson, Alexander G G Turpie, Adrian F Hernandez, Russell D Hull, Alex Gold, John T Curnutte, Alexander T Cohen, Robert A Harrington, C Michael Gibson
BACKGROUND: Among acutely ill hospitalized medical patients, extended-duration thromboprophylaxis reduces venous thromboembolism (VTE), but some pharmacologic strategies have been associated with greater risks of major bleeding, thereby offsetting the net clinical benefit (NCB). METHODS: To assess the risk-benefit profile of anticoagulation regimens, a previously described bivariate method that does not assume a linear risk-benefit tradeoff and can accommodate different margins for efficacy and safety was performed to simultaneously assess efficacy (symptomatic VTE) and safety (major bleeding) based on data from four randomized controlled trials of extended-duration (30 to 46 days) versus standard-duration (6 to 14 days) thromboprophylaxis among 28,227 patients (EXCLAIM, ADOPT, MAGELLAN, and APEX trials)...
August 1, 2017: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/28761758/the-european-society-for-medical-oncology-magnitude-of-clinical-benefit-scale-field-tested-in-infrequent-tumour-entities-an-extended-analysis-of-its-feasibility-at-the-medical-university-of-vienna
#13
Barbara Kiesewetter, Markus Raderer, Gerald W Prager, Thorsten Fuereder, Christine Marosi, Matthias Preusser, Michael Krainer, Gottfried J Locker, Thomas Brodowicz, Christoph C Zielinski
BACKGROUND: The European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS) is a new tool to quantify the clinical benefit that may be anticipated from a novel anticancer treatment. We present here an analysis on the feasibility of the ESMO-MCBS in less frequent tumour entities. METHODS: This study evaluates the practicability of the ESMO-MCBS for metastatic neuroendocrine tumours (NETs), soft tissue sarcomas, glioblastoma, thyroid cancer, pancreatic cancer, head/neck cancer, urothelial cancer and ovarian cancer at the Medical University Vienna...
2017: ESMO Open
https://www.readbyqxmd.com/read/28753781/prediction-of-prostate-cancer-external-validation-of-the-erspc-risk-calculator-in-a-contemporary-dutch-clinical-cohort
#14
Maudy Gayet, Christophe K Mannaerts, Daan Nieboer, Harrie P Beerlage, Hessel Wijkstra, Peter F A Mulders, Monique J Roobol
BACKGROUND: The validity of prediction models needs external validation to assess their value beyond the original development setting. OBJECTIVE: To report the diagnostic accuracy of the European Randomized Study of Screening for Prostate Cancer (ERSPC) risk calculator (RC)3 and RC4 in a contemporary Dutch clinical cohort. DESIGN, SETTING, AND PARTICIPANTS: We retrospectively identified all men who underwent prostate biopsy (PBx) in the Jeroen Bosch Hospital, The Netherlands, between 2007 and 2016...
August 4, 2016: European Urology Focus
https://www.readbyqxmd.com/read/28746214/external-validation-of-non-invasive-prediction-models-for-identifying-ultrasonography-diagnosed-fatty-liver-disease-in-a-chinese-population
#15
COMPARATIVE STUDY
Ya-Nan Shen, Ming-Xing Yu, Qian Gao, Yan-Yan Li, Jian-Jun Huang, Chen-Ming Sun, Nan Qiao, Hai-Xia Zhang, Hui Wang, Qing Lu, Tong Wang
Several prediction models for fatty liver disease (FLD) are available with limited externally validation and less comprehensive evaluation. The aim was to perform external validation and direct comparison of 4 prediction models (the Fatty Liver Index, the Hepatic Steatosis Index, the ZJU index, and the Framingham Steatosis Index) for FLD both in the overall population and the obese subpopulation.This cross-sectional study included 4247 subjects aged 20 to 65 years recruited from the north of Shanxi Province in China...
July 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28743299/the-public-health-value-of-vaccines-beyond-efficacy-methods-measures-and-outcomes
#16
A Wilder-Smith, I Longini, P L Zuber, T Bärnighausen, W J Edmunds, N Dean, V Masserey Spicher, M R Benissa, B D Gessner
BACKGROUND: Assessments of vaccine efficacy and safety capture only the minimum information needed for regulatory approval, rather than the full public health value of vaccines. Vaccine efficacy provides a measure of proportionate disease reduction, is usually limited to etiologically confirmed disease, and focuses on the direct protection of the vaccinated individual. Herein, we propose a broader scope of methods, measures and outcomes to evaluate the effectiveness and public health impact to be considered for evidence-informed policymaking in both pre- and post-licensure stages...
July 26, 2017: BMC Medicine
https://www.readbyqxmd.com/read/28741420/outreach-syncope-clinic-managed-by-a-nurse-practitioner-outcome-and-cost-effectiveness
#17
Mohamed H Hamdan, Kathleen E Walsh, Michele Brignole, Jamie Key
Introduction The purpose of this study was to assess the clinical and financial outcomes of a novel outreach syncope clinic. Methods We compared the clinical outcome of the Faint and Fall Clinic at the American Center (January-June 2016) with that of the University of Wisconsin Health and Clinics Faint and Fall Clinic (January 2013-December 2014). The American Center-Faint and Fall Clinic is run solely by a nurse practitioner, assisted by online faint-decision software and consultancy of a faint specialist through video-conferencing...
January 1, 2017: Journal of Telemedicine and Telecare
https://www.readbyqxmd.com/read/28736385/thromboembolic-risk-bleeding-outcomes-and-effect-of-different-antithrombotic-strategies-in-very-elderly-patients-with-atrial-fibrillation-a-sub-analysis-from-the-prefer-in-af-prevention-of-thromboembolic-events-european-registry-in-atrial-fibrillation
#18
Giuseppe Patti, Markus Lucerna, Ladislav Pecen, Jolanta M Siller-Matula, Ilaria Cavallari, Paulus Kirchhof, Raffaele De Caterina
BACKGROUND: Increasing age predisposes to both thromboembolic and bleeding events in patients with atrial fibrillation; therefore, balancing risks and benefits of antithrombotic strategies in older populations is crucial. We investigated 1-year outcome with different antithrombotic approaches in very elderly atrial fibrillation patients (age ≥85 years) compared with younger patients. METHODS AND RESULTS: We accessed individual patients' data from the prospective PREFER in AF (PREvention oF thromboembolic events-European Registry in Atrial Fibrillation), compared outcomes with and without oral anticoagulation (OAC), and estimated weighed net clinical benefit in different age groups...
July 23, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28734560/deciding-on-breast-cancer-risk-reduction-the-role-of-counseling-in-individual-decision-making-a-qualitative-study
#19
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
#20
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
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