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Intervention thresholds

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https://www.readbyqxmd.com/read/28090729/notes-on-the-use-of-randomised-controlled-trials-to-evaluate-complex-interventions-community-treatment-orders-as-an-illustrative-case
#1
Feras Ali Mustafa
Over the past seven decades, randomised controlled trials (RCTs) have revolutionised clinical research and achieved a gold standard status. However, extending their use to evaluate complex interventions is problematic. In this paper we will demonstrate that complex intervention RCTs violate the necessary premises that govern the RCTs logic and underpin their rigour. The lack of blinding, heterogeneity of participants, as well as poor treatment standardisation and difficulty of controlling for confounders, which characterise complex intervention RCTs, can potentially be profoundly detrimental to their integrity...
January 16, 2017: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/28089777/bioresorbable-vascular-scaffold-to-treat-malignant-in-stent-restenosis-in-a-patient-with-nickel-allergy
#2
Alfonso Jurado-Román, María T López-Lluva, Ignacio Sánchez-Pérez, Jesús Piqueras-Flores, Ramón Maseda, Fernando Lozano-Ruíz-Poveda
Nickel is the most frequent allergen in patients with allergic contact dermatitis and nickel allergy has been associated with recurrent in-stent restenosis. However, it is often misdiagnosed because of a low suspicion threshold. It should be discarded in patients with recurrent in-stent restenosis, especially if their medical history reveals prior contact dermatitis. It is also noteworthy and rarely specified that even newer generation stents that use novel metal alloys also contain low amounts of nickel. To avoid the implantation of new stents containing this metal, when percutaneous coronary intervention is indicated, drug eluting balloons or bioresorbable vascular scaffolds associated with small doses of steroids could provide good alternatives of treatment...
January 2, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/28089295/inter-rater-reliability-of-distal-ureteral-diameter-ratio-compared-to-grade-of-vur
#3
A R Swanton, A M Arlen, S E Alexander, K Kieran, D W Storm, C S Cooper
INTRODUCTION AND OBJECTIVE: Management of vesicoureteral reflux (VUR) remains controversial, and reflux grade constitutes an important prognostic factor. Recent work has suggested that distal ureteral diameter ratio (UDR) is a predictive factor relative to clinical outcome independent of grade. Previous studies have noted significant inter-rater variability with grading of VUR. The present study compared inter-rater reliability of reflux grade and UDR in children with primary VUR. STUDY DESIGN: Four pediatric urologists independently reviewed, in a blinded fashion, voiding cystourethrograms...
December 1, 2016: Journal of Pediatric Urology
https://www.readbyqxmd.com/read/28088239/towards-interruption-of-schistosomiasis-transmission-in-sub-saharan-africa-developing-an-appropriate-environmental-surveillance-framework-to-guide-and-to-support-end-game-interventions
#4
REVIEW
J Russell Stothard, Suzy J Campbell, Mike Y Osei-Atweneboana, Timothy Durant, Michelle C Stanton, Nana-Kwadwo Biritwum, David Rollinson, Dieudonné R Eloundou Ombede, Louis-Albert Tchuem-Tchuenté
Schistosomiasis is a waterborne parasitic disease in sub-Saharan Africa, particularly common in rural populations living in impoverished conditions. With the scale-up of preventive chemotherapy, national campaigns will transition from morbidity- to transmission-focused interventions thus formal investigation of actual or expected declines in environmental transmission is needed as 'end game' scenarios arise. Surprisingly, there are no international or national guidelines to do so in sub-Saharan Africa. Our article therefore provides an introduction to key practicalities and pitfalls in the development of an appropriate environmental surveillance framework...
January 14, 2017: Infectious Diseases of Poverty
https://www.readbyqxmd.com/read/28086807/detection-of-critical-cerebral-desaturation-thresholds-by-three-regional-oximeters-during-hypoxia-a-pilot-study-in-healthy-volunteers
#5
Kerry L Tomlin, Anna-Maria Neitenbach, Ulf Borg
BACKGROUND: Regional oximetry is increasingly used to monitor post-extraction oxygen status of the brain during surgical procedures where hemodynamic fluctuations are expected. Particularly in cardiac surgery, clinicians employ an interventional algorithm to restore baseline regional oxygen saturation (rSO2) when a patient reaches a critical desaturation threshold. Evidence suggests that monitoring cardiac surgery patients and intervening to maintain rSO2 can improve postoperative outcomes; however, evidence generated with one manufacturer's device may not be applicable to others...
January 13, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28081162/beyond-pressure-gradients-the-effects-of-intervention-on-heart-power-in-aortic-coarctation
#6
Joao Filipe Fernandes, Leonid Goubergrits, Jan Brüning, Florian Hellmeier, Sarah Nordmeyer, Tiago Ferreira da Silva, Stephan Schubert, Felix Berger, Titus Kuehne, Marcus Kelm
BACKGROUND: In aortic coarctation, current guidelines recommend reducing pressure gradients that exceed given thresholds. From a physiological standpoint this should ideally improve the energy expenditure of the heart and thus prevent long term organ damage. OBJECTIVES: The aim was to assess the effects of interventional treatment on external and internal heart power (EHP, IHP) in patients with aortic coarctation and to explore the correlation of these parameters to pressure gradients obtained from heart catheterization...
2017: PloS One
https://www.readbyqxmd.com/read/28079724/explaining-how-cognitive-behavioural-approaches-work-for-low-back-pain-mediation-analysis-of-the-back-skills-training-trial
#7
Bethany Fordham, Chen Ji, Zara Hansen, Ranjit Lall, Sarah E Lamb
STUDY DESIGN: .: This is secondary research examining the longitudinal mediation effect within a structural equation model. OBJECTIVE: .: To identify possible mechanisms which mediate the effects of a cognitive behavioural approach upon disability and pain in low back pain patients. SUMMARY OF BACKGROUND DATA: .: Cognitive behavioural interventions (CBIs) can improve pain and disability in low back pain (LBP) but the mechanisms of action are unclear...
January 10, 2017: Spine
https://www.readbyqxmd.com/read/28079681/internal-jugular-vein-compression-a-novel-approach-to-mitigate-blast-induced-hearing-injury
#8
Brian Sindelar, Michael Shinners, Sydney Sherman, Kevin Novak, Kristine Erickson, Vimal Patel, Paul Kubilis, David Smith, John Finan, Julian E Bailes
HYPOTHESIS: Internal jugular vein (IJV) compression before blast injury will lead to reduced risk of traumatic hearing injury following exposure to a blast injury. BACKGROUND: IJV compression and its effects on not only intracranial, but also intracochlear pressure may potentiate blast induced hearing injury, therefore, precluding its use as a prophylactic therapy for blast induced traumatic brain injury. METHODS: Twenty Sprague Dawley rats were exposed to a 17...
January 10, 2017: Otology & Neurotology
https://www.readbyqxmd.com/read/28076926/yoga-treatment-for-chronic-non-specific-low-back-pain
#9
REVIEW
L Susan Wieland, Nicole Skoetz, Karen Pilkington, Ramaprabhu Vempati, Christopher R D'Adamo, Brian M Berman
BACKGROUND: Non-specific low back pain is a common, potentially disabling condition usually treated with self-care and non-prescription medication. For chronic low back pain, current guidelines state that exercise therapy may be beneficial. Yoga is a mind-body exercise sometimes used for non-specific low back pain. OBJECTIVES: To assess the effects of yoga for treating chronic non-specific low back pain, compared to no specific treatment, a minimal intervention (e...
January 12, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28075104/esophageal-cancer
#10
Matthew W Short, Kristina G Burgers, Vincent T Fry
Esophageal cancer has a poor prognosis and high mortality rate, with an estimated 16,910 new cases and 15,910 deaths projected in 2016 in the United States. Squamous cell carcinoma and adenocarcinoma account for more than 95% of esophageal cancers. Squamous cell carcinoma is more common in nonindustrialized countries, and important risk factors include smoking, alcohol use, and achalasia. Adenocarcinoma is the predominant esophageal cancer in developed nations, and important risk factors include chronic gastroesophageal reflux disease, obesity, and smoking...
January 1, 2017: American Family Physician
https://www.readbyqxmd.com/read/28073798/effectiveness-of-a-lumbopelvic-monitor-and-feedback-device-to-change-postural-behaviour-a-protocol-for-the-elf-cluster-randomised-controlled-trial
#11
Daniel Cury Ribeiro, Stephan Milosavljevic, J Haxby Abbott
INTRODUCTION: Low back pain (LBP) is the most common, costly and disabling musculoskeletal disorder worldwide, and is prevalent in healthcare workers. Posture is a modifiable risk factor for LBP shown to reduce the prevalence of LBP. Our feasibility research suggests that postural feedback might help healthcare workers avoid hazardous postures. The Effectiveness of Lumbopelvic Feedback (ELF) trial will investigate the extent to which postural monitor and feedback (PMF) can reduce exposure to hazardous posture associated with LBP...
January 10, 2017: BMJ Open
https://www.readbyqxmd.com/read/28073749/cost-effectiveness-of-a-government-supported-policy-strategy-to-decrease-sodium-intake-global-analysis-across-183-nations
#12
Michael Webb, Saman Fahimi, Gitanjali M Singh, Shahab Khatibzadeh, Renata Micha, John Powles, Dariush Mozaffarian
OBJECTIVE:  To quantify the cost effectiveness of a government policy combining targeted industry agreements and public education to reduce sodium intake in 183 countries worldwide. DESIGN:  Global modeling study. SETTING:  183 countries. POPULATION:  Full adult population in each country. INTERVENTION:  A "soft regulation" national policy that combines targeted industry agreements, government monitoring, and public education to reduce population sodium intake, modeled on the recent successful UK program...
January 10, 2017: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/28072793/merit-based-incentive-payment-system-meaningful-changes-in-the-final-rule-brings-cautious-optimism
#13
Laxmaiah Manchikanti, Standiford Helm Ii, Aaron K Calodney, Joshua A Hirsch
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) eliminated the flawed Sustainable Growth Rate (SGR) act formula - a longstanding crucial issue of concern for health care providers and Medicare beneficiaries. MACRA also included a quality improvement program entitled, "The Merit-Based Incentive Payment System, or MIPS." The proposed rule of MIPS sought to streamline existing federal quality efforts and therefore linked 4 distinct programs into one. Three existing programs, meaningful use (MU), Physician Quality Reporting System (PQRS), value-based payment (VBP) system were merged with the addition of Clinical Improvement Activity category...
January 2017: Pain Physician
https://www.readbyqxmd.com/read/28072761/immediate-chest-x-ray-for-patients-at-risk-of-lung-cancer-presenting-in-primary-care-randomised-controlled-feasibility-trial
#14
Richard D Neal, Allan Barham, Emily Bongard, Rhiannon Tudor Edwards, Jim Fitzgibbon, Gareth Griffiths, Willie Hamilton, Kerenza Hood, Annmarie Nelson, David Parker, Cath Porter, Hayley Prout, Kirsty Roberts, Trevor Rogers, Emma Thomas-Jones, Angela Tod, Seow Tien Yeo, Chris N Hurt
BACKGROUND: Achieving earlier stage diagnosis is one option for improving lung cancer outcomes in the United Kingdom. Patients with lung cancer typically present with symptoms to general practitioners several times before referral or investigation. METHODS: We undertook a mixed methods feasibility individually randomised controlled trial (the ELCID trial) to assess the feasibility and inform the design of a definitive, fully powered, UK-wide, Phase III trial of lowering the threshold for urgent investigation of suspected lung cancer...
January 10, 2017: British Journal of Cancer
https://www.readbyqxmd.com/read/28069915/increasing-incidence-of-chronic-subdural-haematoma-in-the-elderly
#15
Vedamurthy Adhiyaman, Indrajit Chattopadhyay, Fahd Irshad, David Curran, Samuel Abraham
BackgroundChronic subdural haematoma (CSDH) is a condition predominantly affecting the elderly. We reported an incidence of 8.2 per 100,000 per year in people above the age of 65 in 2002.AimSince recent studies have demonstrated a higher incidence, we repeated our study to estimate the current incidence of CSDH amongst people above the age of 65 in North Wales.DesignWe used radiological reports to identify patients with CSDH over a one-year period.MethodsWe collected data on demographics, clinical presentations, indications for brain imaging, drug history and 30-day outcome from the case notes and electronic records...
January 9, 2017: QJM: Monthly Journal of the Association of Physicians
https://www.readbyqxmd.com/read/28069663/cybercycling-effects-on-classroom-behavior-in-children-with-behavioral-health-disorders-an-rct
#16
April Bowling, James Slavet, Daniel P Miller, Sebastien Haneuse, William Beardslee, Kirsten Davison
BACKGROUND AND OBJECTIVES: Exercise is linked with improved cognition and behavior in children in clinical and experimental settings. This translational study examined if an aerobic cybercycling intervention integrated into physical education (PE) resulted in improvements in behavioral self-regulation and classroom functioning among children with mental health disabilities attending a therapeutic day school. METHODS: Using a 14-week crossover design, students (N = 103) were randomly assigned by classroom (k = 14) to receive the 7-week aerobic cybercycling PE curriculum during fall 2014 or spring 2015...
January 9, 2017: Pediatrics
https://www.readbyqxmd.com/read/28069625/cost-effectiveness-of-a-pragmatic-structured-education-intervention-for-the-prevention-of-type-2-diabetes-economic-evaluation-of-data-from-the-let-s-prevent-diabetes-cluster-randomised-controlled-trial
#17
J Leal, D Ahrabian, M J Davies, L J Gray, K Khunti, T Yates, A M Gray
OBJECTIVES: Prevention of type 2 diabetes mellitus (TD2M) is a priority for healthcare systems. We estimated the cost-effectiveness compared with standard care of a structured education programme (Let's Prevent) targeting lifestyle and behaviour change to prevent progression to T2DM in people with prediabetes. DESIGN: Cost-effectiveness analysis alongside randomised controlled trial. SETTING: 44 general practices in Leicestershire, England...
January 9, 2017: BMJ Open
https://www.readbyqxmd.com/read/28066851/analysis-of-smartphone-interruptions-on-academic-general-internal-medicine-wards-frequent-interruptions-may-cause-a-crisis-mode-work-climate
#18
Alon Vaisman, Robert C Wu
INTRODUCTION: Hospital-based medical services are increasingly utilizing team-based pagers and smartphones to streamline communications. However, an unintended consequence may be higher volumes of interruptions potentially leading to medical error. There is likely a level at which interruptions are excessive and cause a 'crisis mode' climate. METHODS: We retrospectively collected phone, text messaging, and email interruptions directed to hospital-assigned smartphones on eight General Internal Medicine (GIM) teams at two tertiary care centres in Toronto, Ontario from April 2013 to September 2014...
January 4, 2017: Applied Clinical Informatics
https://www.readbyqxmd.com/read/28065839/cardiovascular-function-in-long-term-hematopoietic-cell-transplantation-survivors
#19
Saro H Armenian, David Horak, Jessica M Scott, George Mills, Aida Siyahian, Jennifer Berano Teh, Pamela S Douglas, Stephen J Forman, Smita Bhatia, Lee W Jones
Peak oxygen consumption (VO2peak), as measured by cardiopulmonary exercise testing (CPET), is a powerful independent predictor of cardiovascular disease (CVD) and all-cause mortality in a broad range of populations. We assessed the safety and feasibility of CPET in aging long-term HCT survivors, a population at high risk for premature-onset of CVD. Next we examined how organ-specific impairments (e.g. cardiac, pulmonary, hematologic) impact VO2peak after HCT. Twenty consecutive HCT survivors underwent a comprehensive assessment of cardiopulmonary health that included CPET, echocardiography with strain, pulmonary function testing, six-minute walk test, and timed-up and go...
January 5, 2017: Biology of Blood and Marrow Transplantation
https://www.readbyqxmd.com/read/28063396/cold-pressor-pain-in-skin-picking-disorder
#20
Jon E Grant, Sarah A Redden, Samuel R Chamberlain
Excoriation (skin-picking) disorder (SPD) is a disabling, under-recognized condition in which individuals repeatedly pick at their skin, leading to noticeable tissue damage. There has been no examination as to whether individuals with SPD have different pain thresholds or pain tolerances compared to healthy counterparts. Adults with SPD were examined on a variety of clinical measures including symptom severity and functioning. All participants underwent the cold pressor test. Heart rate, blood pressure, and self-reported pain were compared between SPD participants (n=14) and healthy controls (n=14)...
December 31, 2016: Psychiatry Research
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