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Yun-Kyeong Cho, Chang-Wook Nam
Multi-vessel coronary artery disease (MVD) frequently features ambiguous or intermediate lesions that may be both serial and complex, suggesting that multiple regions require revascularization. Percutaneous coronary intervention (PCI) is associated with various challenges such as appropriate identification of lesions that should be treated, the choice of an optimum revascularization method, and limitations of long-term outcomes. Optimal patient selection and careful targeting of lesions are key when planning treatment...
March 21, 2018: Korean Journal of Internal Medicine
Yvonne Stallard
PURPOSE: The purpose of this Evidence-Based Report Card was to examine current best evidence related to when and how to perform cultures on chronic wounds to guide clinicians in determining the appropriate treatment. QUESTION: (1) When should cultures be performed on chronic wounds? and (2) What is the best method or technique to perform a culture on a chronic wound? SEARCH STRATEGY: A search of the literature was performed, resulting in 45 publications relevant to the topic...
March 2018: Journal of Wound, Ostomy, and Continence Nursing
Tridib Das, Zhongli Chen, Rudi W Hendriks, Mirjam Kool
Immune cell activation is a stringently regulated process, as exaggerated innate and adaptive immune responses can lead to autoinflammatory and autoimmune diseases. Perhaps the best-characterized molecular pathway promoting cell activation is the nuclear factor-κB (NF-κB) signaling pathway. Stimulation of this pathway leads to transcription of numerous pro-inflammatory and cell-survival genes. Several mechanisms tightly control NF-κB activity, including the key regulatory zinc finger (de)ubiquitinating enzyme A20/tumor necrosis factor α-induced protein 3 (TNFAIP3)...
2018: Frontiers in Immunology
M Uccello, M Moschetta, G Mak, T Alam, C Murias Henriquez, H-T Arkenau
Chemotherapy remains the mainstay of treatment for advanced pancreatic ductal adenocarcinoma (pda). Two randomized trials have demonstrated superiority of the combination regimens folfirinox (5-fluorouracil, leucovorin, oxaliplatin, and irinotecan) and gemcitabine plus nab-paclitaxel over gemcitabine monotherapy as a first-line treatment in adequately fit subjects. Selected pda patients progressing to first-line therapy can receive secondline treatment with moderate clinical benefit. Nevertheless, the optimal algorithm and the role of combination therapy in second-line are still unclear...
February 2018: Current Oncology
Philipp Vormittag, Rebecca Gunn, Sara Ghorashian, Farlan S Veraitch
In recent years, chimeric antigen receptor (CAR) modified T cells have been used as a treatment for haematological malignancies in several phase I and II trials and with Kymriah of Novartis and Yescarta of KITE Pharma, the first CAR T cell therapy products have been approved. Promising clinical outcomes have yet been tempered by the fact that many therapies may be prohibitively expensive to manufacture. The process is not yet defined, far from being standardised and often requires extensive manual handling steps...
February 17, 2018: Current Opinion in Biotechnology
Getnet M Kassie, Teklu Belay, Anjali Sharma, Getachew Feleke
Introduction: Focus on improving access and quality of HIV care and treatment gained acceptance in Ethiopia through the work of the International Training and Education Center for Health. The initiative deployed mobile field-based teams and capacity building teams to mentor health care providers on clinical services and program delivery in three regions, namely Tigray, Amhara, and Afar. Transitioning of the clinical mentoring program (CMP) began in 2012 through capacity building and transfer of skills and knowledge to local health care providers and management...
2018: Frontiers in Public Health
Zhi-Dong Zhao, Peng-Cui Li, Xiao-Chun Wei
Up to now, surgical treatment of recurrent lateral patellar dislocation mainly includes: medial patellofemoral ligament reconstruction, tibial tubercle osteotomy, trochleoplasty, lateral retinacular release, derotation osteotomy and so on . Clinical reports show that: the use of a single or combined with several methods have achieved ideal short to mid-term clinical outcomes. However, there is no consolidate criterion concerning the choices of different kinds of surgical ways for the treatment of individual recurrent lateral patellar dislocation...
November 25, 2017: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
Tara Packham, Janet Holly
STUDY DESIGN: Narrative review. INTRODUCTION: There are a variety of treatments with demonstrated effectiveness for the management of complex regional pain syndrome (CRPS). However given the variability in symptom presentation in this population, therapists may be unsure what treatments would be most effective for individual clients. PURPOSE OF THE STUDY: To present a brief synthesis of the literature and propose a rehabilitation version of a mechanism-specific management algorithm to guide personalized treatment of CRPS...
February 13, 2018: Journal of Hand Therapy: Official Journal of the American Society of Hand Therapists
Robyn L Shepardson, Laura J Buchholz, Risa B Weisberg, Jennifer S Funderburk
Anxiety symptoms are prevalent in primary care, yet treatment rates are low. The integration of behavioral health providers into primary care via the Primary Care Behavioral Health (PCBH) model offers a promising way to improve treatment options by adding a team member with the necessary skillset to deliver evidence-based psychological interventions for anxiety. We conducted a narrative review of psychological interventions for anxiety applied within adult primary care settings (k = 44) to update the literature and evaluate the fit of existing interventions with the PCBH model...
January 2, 2018: Journal of Anxiety Disorders
Steve J Edwards, Victoria Wakefield, Peter Cain, Charlotta Karner, Kayleigh Kew, Mariana Bacelar, Natalie Masento, Fatima Salih
BACKGROUND: Several therapies have recently been approved for use in the NHS for pretreated advanced or metastatic renal cell carcinoma (amRCC), but there is a lack of comparative evidence to guide decisions between them. OBJECTIVE: To evaluate the clinical effectiveness and cost-effectiveness of axitinib (Inlyta®, Pfizer Inc., NY, USA), cabozantinib (Cabometyx®, Ipsen, Slough, UK), everolimus (Afinitor®, Novartis, Basel, Switzerland), nivolumab (Opdivo®, Bristol-Myers Squibb, NY, USA), sunitinib (Sutent®, Pfizer, Inc...
January 2018: Health Technology Assessment: HTA
Amirrtha Srikanthan, Eitan Amir, Philippe Bedard, Meredith Giuliani, David Hodgson, Stephanie Laframboise, Anca Prica, Karen Yee, Ellen Greenblatt, Jeremy Lewin, Abha Gupta
Increasing accessibility of fertility preservation (FP) options has permitted women to retain fertility following anticancer therapies. Several published guidelines have made recommendations for FP however their implementation into practice is currently unknown. In this review, we aim to provide oncology clinicians practical information about FP options for post-pubescent female cancer patients and recommendations for care delivery in order to answer preliminary questions and help triage whether FP referral is appropriate...
January 2018: Molecular and Clinical Oncology
Cristina Mei, Vicki Anderson, Mary-Clare Waugh, Louise Cahill, Angela T Morgan
OBJECTIVE: Evidence-based management guidelines for communication and swallowing disorders following pediatric traumatic brain injury (TBI) are scarcely available, potentially resulting in suboptimal outcomes. To improve clinical care of this population, a multidisciplinary guideline development committee was formed to develop evidence-based recommendation (EBR) and consensus-based recommendation (CBR) for the management of speech, language, and swallowing disorders during the first year of recovery...
January 30, 2018: Journal of Head Trauma Rehabilitation
Jordi Merino, Jose C Florez
Metabolic disorders present a public health challenge of staggering proportions. In diabetes, there is an urgent need to better understand disease heterogeneity, clinical trajectories, and related comorbidities. A pressing and timely question is whether we are ready for precision medicine in diabetes. Some biological insights that have emerged during the last decade have already been used to direct clinical decision making, especially in monogenic forms of diabetes. However, much work is necessary to integrate high-dimensional explorations into complex disease architectures, less penetrant biological alterations, and broader phenotypes, such as type 2 diabetes...
January 2018: Annals of the New York Academy of Sciences
Kirsten Bobrow, Andrew Farmer, Nomazizi Cishe, Ntobeko Nwagi, Mosedi Namane, Thomas P Brennan, David Springer, Lionel Tarassenko, Naomi Levitt
BACKGROUND: Several frameworks now exist to guide intervention development but there remains only limited evidence of their application to health interventions based around use of mobile phones or devices, particularly in a low-resource setting. We aimed to describe our experience of using the Medical Research Council (MRC) Framework on complex interventions to develop and evaluate an adherence support intervention for high blood pressure delivered by SMS text message. We further aimed to describe the developed intervention in line with reporting guidelines for a structured and systematic description...
January 23, 2018: BMC Health Services Research
Fatima B Wurie, Vanessa Cooper, Robert Horne, Andrew C Hayward
INTRODUCTION: Treatment for tuberculosis (TB) is highly effective if taken according to prescribed schedules. However, many people have difficulty adhering to treatment which can lead to poorer clinical outcomes, the development of drug resistance, increased duration of infectivity and consequent onward transmission of infection. A range of approaches are available to support adherence but in order to target these effectively a better understanding of the predictors of poor adherence is needed...
January 21, 2018: BMJ Open
Robert M Carey, Paul K Whelton
Description: In November 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) released a clinical practice guideline for the prevention, detection, evaluation, and treatment of high blood pressure (BP) in adults. This article summarizes the major recommendations. Methods: In 2014, the ACC and the AHA appointed a multidisciplinary committee to update previous reports of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure...
January 23, 2018: Annals of Internal Medicine
Xianghong Chen, Bo Chen, Xingui Gu, Zhe Shi, Zelin Chen
The importance of pressing hand in clinical practice of acupuncture was explored in this paper. Through literature review and clinical experience, the role of pressing hand before, during and after acupuncture was summarized and analyzed. Before acupuncture, the pressing hand helped to diagnose diseases, examine pulse and locate acupoints; during acupuncture, it participated in needle insertion and reinforcing-reducing manipulation; after acupuncture, it played a role in needle withdrawal and regulate human body...
November 12, 2017: Zhongguo Zhen Jiu, Chinese Acupuncture & Moxibustion
K M Marks, N P West, E Morris, P Quirke
BACKGROUND: Numerous factors affect the prognosis of colorectal cancer (CRC), many of which have long been identified, such as patient demographics and the multidisciplinary team. In more recent years, molecular and immunological biomarkers have been shown to have a significant influence on patient outcomes. Whilst some of these biomarkers still require ongoing validation, if proven to be worthwhile they may change our understanding and future management of CRC. The aim of this review was to identify the key prognosticators of CRC, including new molecular and immunological biomarkers, and outline how these might fit into the whole wider context for patients...
January 2018: British Journal of Surgery
Chui Ming Gemmy Cheung, Timothy Y Y Lai, Paisan Ruamviboonsuk, Shih-Jen Chen, Youxin Chen, K Bailey Freund, Fomi Gomi, Adrian H Koh, Won-Ki Lee, Tien Yin Wong
Polypoidal choroidal vasculopathy (PCV) is an age-related macular degeneration (AMD) subtype and is seen particularly in Asians. Previous studies have suggested disparity in response to intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents between PCV and typical AMD, and thus, the preferred treatment for PCV has remained unclear. Recent research has provided novel insights into the pathogenesis of PCV, and imaging studies based on OCT suggest that PCV belongs to a spectrum of conditions characterized by pachychoroid, in which disturbance in the choroidal circulation seems to be central to its pathogenesis...
January 10, 2018: Ophthalmology
Carmen Tur, Marcello Moccia, Frederik Barkhof, Jeremy Chataway, Jaume Sastre-Garriga, Alan J Thompson, Olga Ciccarelli
Increasing numbers of drugs are being developed for the treatment of multiple sclerosis (MS). Measurement of relevant outcomes is key for assessing the efficacy of new drugs in clinical trials and for monitoring responses to disease-modifying drugs in individual patients. Most outcomes used in trial and clinical settings reflect either clinical or neuroimaging aspects of MS (such as relapse and accrual of disability or the presence of visible inflammation and brain tissue loss, respectively). However, most measures employed in clinical trials to assess treatment effects are not used in routine practice...
January 12, 2018: Nature Reviews. Neurology
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