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Peter A Nigrovic, Timothy Beukelman, George Tomlinson, Brian M Feldman, Laura E Schanberg, Yukiko Kimura
BACKGROUND: Systemic juvenile idiopathic arthritis is a rare febrile arthritis of childhood characterized by a potentially severe course, including prolonged glucocorticoid exposure, growth failure, destructive arthritis, and life-threatening macrophage activation syndrome. Early cytokine-blocking biologic therapy may improve long-term outcomes, although some systemic juvenile idiopathic arthritis patients respond well to non-biologic treatment, leaving optimal management undefined. Consequently, treatment of new-onset systemic juvenile idiopathic arthritis by expert clinicians varies widely...
March 1, 2018: Clinical Trials: Journal of the Society for Clinical Trials
Paulino Alvarez, Alexandros Briasoulis
PURPOSE OF REVIEW: Immune system activation plays a central role in heart failure progression. Large-scale immune modulatory clinical trials targeting tumor necrosis factor-α and broad spectrum immune modulation have been negative. The objective of this review is to highlight past, present, and what is in the horizon for the immunomodulation in heart failure with a focus of biologics. RECENT FINDINGS: Strategies targeting interleukin-1 pathway are currently undergoing clinical evaluation and data from pilot studies are promising...
March 15, 2018: Current Treatment Options in Cardiovascular Medicine
Atul Ambekar, Monica Mongia
A number of research designs have been used to study the efficacy of psychosocial interventions in addictive disorders, including open label studies and randomised controlled trials. Only through a rigorously conducted research, evidence base for effectiveness of a psychosocial intervention can be established. However, research on these interventions are fraught with a number of challenges. It is imperative for researchers to ask appropriate research questions based on sound theoretical understanding of psychiatric disorders, psychosocial interventions and research designs...
February 2018: Indian Journal of Psychiatry
Sanjay Kalra
Insulin is a life saving medicine. Yet, diabetes care professionals encounter many barriers to its use, especially at the patient level. This is even more true in primary care, where patients tend to resist injectable therapy. This article uses the mnemonic,InfoCRIne, to highlight four important barriers to insulin, and proposes bridges to overcome them. The bridges include information, confidence building, resource husbandry and individualization of strategy. These help overcome the barriers of hearsay, perceived inability to use insulin, perceived lack of resources and intrusion into lifestyle...
March 2018: JPMA. the Journal of the Pakistan Medical Association
Regina Wing Shan Sit, Keith Kwok Wai Chan, Benjamin Hon Kei Yip, Daisy Dexing Zhang, Kenneth Dean Reeves, Ying Ho Chan, Vincent Chi Ho Chung, Samuel Yeung Shan Wong
INTRODUCTION: Knee osteoarthritis (KOA) is a common, disabling and costly medical condition. The patellofemoral joint is a critical source of pain in individuals with KOA, and coexistence of patellofemoral osteoarthritis (PFOA) and tibiofemoral osteoarthritis (TFOA) is sometimes observed. The identification of subgroups with PFOA and customised interventions to correct underlying pathomechanics is beneficial for individuals with KOA. This study aims to evaluate whether a clinic-based patella mobilisation therapy (PMT) leads to significant improvement in pain, physical function and quality of life of individuals with KOA...
March 14, 2018: BMJ Open
Marc-Etienne Parent, François Vézina, Nathalie Carrier, Ariel Masetto
OBJECTIVE: To analyze the indications for and clinical procedures resulting from knee magnetic resonance imaging (MRI) in older patients. DESIGN: We retrospectively analyzed 215 medical records of patients 50 years of age and older who had undergone a unilateral knee MRI in 2009. SETTING: Centre hospitalier universitaire de Sherbrooke in Quebec. PARTICIPANTS: Patients 50 years of age and older who underwent a knee MRI in 2009...
March 2018: Canadian Family Physician Médecin de Famille Canadien
Suzanne L K Stewart, Astrid Schepman, Matthew Haigh, Rhian McHugh, Andrew J Stewart
The recognition of emotional facial expressions is often subject to contextual influence, particularly when the face and the context convey similar emotions. We investigated whether spontaneous, incidental affective theory of mind inferences made while reading vignettes describing social situations would produce context effects on the identification of same-valenced emotions (Experiment 1) as well as differently-valenced emotions (Experiment 2) conveyed by subsequently presented faces. Crucially, we found an effect of context on reaction times in both experiments while, in line with previous work, we found evidence for a context effect on accuracy only in Experiment 1...
March 14, 2018: Cognition & Emotion
Mafalda Pardal
BACKGROUND: In Belgium, Cannabis Social Clubs (CSCs) collectively organize the cultivation and distribution of cannabis for the personal use of their members. In this paper we seek to improve understanding of the motivations and practices of cannabis growers operating within CSCs, shedding light on the cultivation process. METHODS: We draw on data gathered through face-to-face semi-structured interviews with the directors of seven active Belgian CSCs (n = 21) and CSC growers (n = 23)...
March 11, 2018: International Journal on Drug Policy
M Cheetham, A Wiseman, B Khazaeli, E Gibson, P Gray, P Van der Graaf, R Rushmer
Background: Embedded research (ER) is recognized as one way to strengthen the integration of evidence into public health (PH) practice. In this paper, we outline a promising example of the co-production of research evidence between Fuse, the UKCRC Centre for Translational Research in Public Health and a local authority (LA) in north east England. Methods: We critically examine attempts to share and use research findings to influence decision-making in a LA setting, drawing on insights from PH practitioners, managers, commissioners and academic partners involved in this organizational case study...
March 1, 2018: Journal of Public Health
Peter D Ehrenkranz, Jesus Mg Calleja, Wafaa El-Sadr, Ade O Fakoya, Nathan Ford, Anna Grimsrud, Kate L Harris, Suzanne L Jed, Daniel Low-Beer, Sadhna V Patel, Miriam Rabkin, William John Reidy, Annette Reinisch, George K Siberry, Leigh A Tally, Isaac Zulu, Irum Zaidi
INTRODUCTION: The World Health Organization's (WHO) recommendation of "Treat All" has accelerated the call for differentiated antiretroviral therapy (ART) delivery, a method of care that efficiently uses limited resources to increase access to HIV treatment. WHO has further recommended that stable individuals on ART receive refills every 3 to 6 months and attend clinical visits every 3 to 6 months. However, there is not yet consensus on how to ensure that the quality of services is maintained as countries strive to meet these standards...
March 2018: Journal of the International AIDS Society
Sanjay Kalra
This communication reviews available high concentration insulins and their basic as well as clinical pharmacology. It classifies all high concentration insulins, and describes their pharmacokinetic and pharmacodynamic properties. The article discusses the utility of high concentrations insulins, lists indications for these preparations, highlights caveats for their safe use, and proposes pragmatic contraindications to their prescription.
January 2018: Indian Journal of Endocrinology and Metabolism
Matthew P Smeltzer, Fedoria E Rugless, Bianca M Jackson, Courtney L Berryman, Nicholas R Faris, Meredith A Ray, Meghan Meadows, Anita A Patel, Kristina S Roark, Satish K Kedia, Margaret M DeBon, Fayre J Crossley, Georgia Oliver, Laura M McHugh, Willeen Hastings, Orion Osborne, Jackie Osborne, Toni Ill, Mark Ill, Wynett Jones, Hyo K Lee, Raymond S Signore, Roy C Fox, Jingshan Li, Edward T Robbins, Kenneth D Ward, Lisa M Klesges, Raymond U Osarogiagbon
Background: Responsible for 25% of all US cancer deaths, lung cancer presents complex care-delivery challenges. Adoption of the highly recommended multidisciplinary care model suffers from a dearth of good quality evidence. Leading up to a prospective comparative-effectiveness study of multidisciplinary vs. serial care, we studied the implementation of a rigorously benchmarked multidisciplinary lung cancer clinic. Methods: We used a mixed-methods approach to conduct a patient-centered, combined implementation and effectiveness study of a multidisciplinary model of lung cancer care...
February 2018: Translational Lung Cancer Research
Scott A Mosley, J Kevin Hicks, Diane G Portman, Kristine A Donovan, Priya Gopalan, Jessica Schmit, Jason Starr, Natalie Silver, Yan Gong, Taimour Langaee, Mike Clare-Salzler, Petr Starostik, Young D Chang, Sahana Rajasekhara, Joshua E Smith, Heloisa P Soares, Thomas J George, Howard L McLeod, Larisa H Cavallari
INTRODUCTION: Pain is one of the most burdensome symptoms associated with cancer and its treatment, and opioids are the cornerstone of pain management. Opioid therapy is empirically selected, and patients often require adjustments in therapy to effectively alleviate pain or ameliorate adverse drug effects that interfere with quality of life. There are data suggesting CYP2D6 genotype may contribute to inter-patient variability in response to opioids through its effects on opioid metabolism...
March 10, 2018: Contemporary Clinical Trials
Ellen McCreedy, Lacey Loomer, Jennifer A Palmer, Susan L Mitchell, Angelo Volandes, Vincent Mor
OBJECTIVES: Federally mandated assessments of nursing home (NH) residents drive individualized care planning. Residents with cognitive impairment may not be able to meaningfully communicate their care needs and preferences during this process-a gap that may be partially addressed by involving surrogates. We describe the prevalence of family participation in the care planning process for long-stay NH residents with varying degrees of cognitive impairment. DESIGN: Retrospective study using administrative data made available as part of an ongoing pragmatic cluster randomized controlled trial...
March 10, 2018: Journal of the American Medical Directors Association
Jane M Garbutt, Sherry Dodd, Emily Walling, Amanda A Lee, Katharine Kulka, Rebecca Lobb
BACKGROUND: The national guideline for use of the vaccine targeting oncogenic strains of the human papillomavirus (HPV) is an evidence-based practice that is poorly implemented in primary care. Recommendations include completion of the vaccine series before the 13th birthday for girls and boys, giving the first dose at the 11- to 12-year-old check-up visit, concurrent with other recommended vaccines. Interventions to increase implementation of this guideline have had little impact, and opportunities to prevent cancer continue to be missed...
March 13, 2018: Implementation Science: IS
Laura Coll-Planas, Sergi Blancafort, Xavier Rojano, Marta Roqué, Rosa Monteserín
BACKGROUND: Older people living in socio-economic deprived urban areas especially suffer the effects of health inequalities but have been insufficiently targeted. Strategies promoted by local primary health care agents might influence health and social behaviours as intermediate social determinants that are modifiable and thus can potentially mitigate health inequalities. Therefore, we aim to develop and assess the effectiveness of a complex intervention based on a community programme that promotes self-management, health literacy and social capital targeting older people from urban socioeconomically disadvantaged areas in order to improve their self-perceived health as an indicator of health inequality reduction...
March 13, 2018: BMC Public Health
N T de Siqueira Filha, M de Fatima Pessoa Militao de Albuquerque, R Legood, L Rodrigues, A C Santos
OBJECTIVE: The objective of this study was to evaluate the direct and indirect costs of tuberculosis (TB) (active and latent TB [LTB]) and HIV co-infection from the patient perspective. STUDY DESIGN: Costing study conducted alongside a pragmatic clinical trial. METHODS: The study was conducted in Brazil in a referral service for HIV/AIDS. We applied a standardised questionnaire to collect data about out-of-pocket expenses and indirect cost...
March 10, 2018: Public Health
James Winters, Simon Kirby, Kenny Smith
Aligning on a shared system of communication requires senders and receivers reach a balance between simplicity, where there is a pressure for compressed representations, and informativeness, where there is a pressure to be communicatively functional. We investigate the extent to which these two pressures are governed by contextual predictability: the amount of contextual information that a sender can estimate, and therefore exploit, in conveying their intended meaning. In particular, we test the claim that contextual predictability is causally related to signal autonomy: the degree to which a signal can be interpreted in isolation, without recourse to contextual information...
March 10, 2018: Cognition
David Ulrich Seidel, Jonas Jae-Hyun Park, Andreas M Sesterhenn, Karel Kostev
AIM: The aim of this study was to analyze the prevalence of dizziness- and vertigo-related diagnoses in ear, nose, and throat (ENT) practices in Germany and the associated demographic characteristics based on data from a representative nationwide practice database. METHOD: The study sample included patients from 138 ENT practices in Germany who received dizziness- and vertigorelated diagnoses (ICD-10 code) between January 2012 and December 2015. Collected parameters included age, sex, insurance status, prescribed medication (anatomical therapeutic chemical [ATC] class), and referrals to other specialists and hospitals...
April 2018: Otology & Neurotology
Douglas Zatzick, Joan Russo, Peter Thomas, Doyanne Darnell, Harry Teter, Leah Ingraham, Lauren K Whiteside, Jin Wang, Roxanne Guiney, Lea Parker, Kirsten Sandgren, Margot Kelly Hedrick, Erik G Van Eaton, Gregory Jurkovich
OBJECTIVE: The investigation aimed to compare two approaches to the delivery of care for hospitalized injury survivors, a patient-centered care transition intervention versus enhanced usual care. METHOD: This pragmatic comparative effectiveness trial randomized 171 acutely injured trauma survivors with three or more early postinjury concerns and high levels of emotional distress to intervention (I; n = 85) and enhanced usual care control (C; n = 86) conditions...
March 13, 2018: Psychiatry
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