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Clinical decision-making

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https://www.readbyqxmd.com/read/28944732/patient-centered-drug-approval-the-role-of-patient-advocacy-in-the-drug-approval-process
#1
T Joseph Mattingly, Linda Simoni-Wastila
Recent approval of eteplirsen for Duchenne muscular dystrophy (DMD), a rare disease with few treatment alternatives, has reignited the debate over the U.S. drug approval process. The evolution of legal and regulatory restrictions to the marketing and sale of pharmaceuticals has spanned more than a century, and throughout this history, patient advocacy has played a significant role. Scientific evidence from clinical trials serves as the foundation for drug approval, but the patient voice has become increasingly influential...
October 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28944638/-unknown-title
#2
(no author information available yet)
Clinical judgment is a critical concept for the development of nursing and nursing education. Its theoretical origins are multiple and its definition is not yet consensus. The analysis of the scientific and professional literature shows heterogeneous and dispersed points of views, notably on the role of intuition, on its cognitive and metacognitive dimensions, and on its proximity to other concepts. Between professional stakes and epistemological constructions, clinical judgment is still an emerging concept...
August 17, 2017: Recherche en Soins Infirmiers
https://www.readbyqxmd.com/read/28944408/etiology-of-childhood-pneumonia-what-we-know-and-what-we-need-to-know-based-on-5th-dr-ic-verma-excellence-oration-award
#3
Joseph L Mathew
Childhood community acquired pneumonia continues to be an important clinical problem at the individual, institutional and community levels. Determination of microbial etiology is critical to develop evidence-based management (therapeutic and prophylactic) decisions. For decades, the approach to this relied on culture of lung aspirate specimens obtained from children with radiographically confirmed pneumonia, before administering antibiotics. Such studies revealed the major bacteria associated with pneumonia, prompting the World Health Organization to develop a highly sensitive clinical definition of pneumonia and advocate empiric antibiotic therapy; in order to save lives (focusing on community settings lacking resources for diagnostic tests)...
September 25, 2017: Indian Journal of Pediatrics
https://www.readbyqxmd.com/read/28944231/1993-2014-two-decades-of-predictive-testing-for-huntington-s-disease-at-the-medical-genetics-unit-of-the-university-of-genoa
#4
Paola Mandich, Merit Lamp, Fabio Gotta, Rossella Gulli, Ariela Iacometti, Roberta Marchese, Emilia Bellone, Giovanni Abbruzzese, Giovanna Ferrandes
BACKGROUND: Predictive testing for Huntington's disease has been available at the Medical Genetics Unit of the University of Genoa from 1987. In 1989, an integrated counseling protocol (geneticist, psychologist, and neurologist) was developed following International Guidelines. METHODS: This is a retrospective analysis of the clinical charts and motivation questionnaires of persons seeking predictive testing through direct DNA analysis from 1993 until 2014, with the aim to evaluate their individual characteristics, motivations, and the outcomes of the counseling protocol...
September 2017: Molecular Genetics & Genomic Medicine
https://www.readbyqxmd.com/read/28944163/weathering-the-storm-improving-therapeutic-interventions-for-cytokine-storm-syndromes-by-targeting-disease-pathogenesis
#5
Lehn K Weaver, Edward M Behrens
Cytokine storm syndromes require rapid diagnosis and treatment to limit the morbidity and mortality caused by the hyperinflammatory state that characterizes these devastating conditions. Herein, we discuss the current knowledge that guides our therapeutic decision-making and personalization of treatment for patients with cytokine storm syndromes. Firstly, ICU-level supportive care is often required to stabilize patients with fulminant disease while additional diagnostic evaluations proceed to determine the underlying cause of cytokine storm...
March 2017: Current Treatment Options in Rheumatology
https://www.readbyqxmd.com/read/28944160/strategies-for-assessing-gfr-and-albuminuria-in-the-living-kidney-donor-evaluation
#6
Lesley A Inker, Naya Huang, Andrew S Levey
PURPOSE OF REVIEW: The international guideline development group Kidney Disease Improving Global Outcomes (KDIGO) recently published a comprehensive set of recommendations for living donor evaluation which contains a new framework for decision making in the evaluation of kidney donor candidates. RECENT FINDINGS: The guidelines recommend that decisions to accept or decline a candidate donor should be based on incorporation of multiple sources of information pertaining to the donor candidate's likelihood of serious adverse outcomes after donation...
March 2017: Current Transplantation Reports
https://www.readbyqxmd.com/read/28943990/motivators-and-barriers-of-tamoxifen-use-as-risk-reducing-medication-amongst-women-at-increased-breast-cancer-risk-a-systematic-literature-review
#7
REVIEW
B Meiser, W K T Wong, M Peate, C Julian-Reynier, J Kirk, G Mitchell
BACKGROUND: Selective estrogen receptor modulators, such as tamoxifen, reduce breast cancer risk by up to 50% in women at increased risk for breast cancer. Despite tamoxifen's well-established efficacy, many studies show that most women are not taking up tamoxifen. This systematic literature review aimed to identify the motivators and barriers to tamoxifen use 's amongst high-risk women. METHODS: Using MEDLINE, PsycINFO, and Embase plus reviewing reference lists of relevant articles published between 1995 and 2016, 31 studies (published in 35 articles) were identified, which addressed high-risk women's decisions about risk-reducing medication to prevent breast cancer and were peer-reviewed primary clinical studies...
2017: Hereditary Cancer in Clinical Practice
https://www.readbyqxmd.com/read/28943986/medical-and-pharmacy-students-attitudes-towards-physician-pharmacist-collaboration-in-kuwait
#8
Maram G Katoue, Abdelmoneim I Awad, Aishah Al-Jarallah, Ebaa Al-Ozairi, Terry L Schwinghammer
OBJECTIVE: To assess and compare the attitudes of medical and pharmacy students towards physician-pharmacist collaboration and explore their opinions about the barriers to collaborative practice in Kuwait. METHODS: A cross-sectional survey of pharmacy and medical students (n=467) was conducted in Faculties of Medicine and Pharmacy, Kuwait University. Data were collected via self-administered questionnaire from first-year pharmacy and medical students and students in the last two professional years of the pharmacy and medical programs...
July 2017: Pharmacy Practice
https://www.readbyqxmd.com/read/28943693/evaluation-of-a-clinical-decision-making-aid-for-nutrition-advice-in-age-related-macular-degeneration
#9
Rebekah Stevens, Hannah Bartlett, Richard Cooke
Age-related macular disease (AMD) is a multifactorial degenerative condition affecting the central area of the retina. Patients with AMD report that eye care practitioners are not giving consistent advice regarding nutrition and reported confusion as to what advice, if any, to follow. The aim of this study was to design and conduct a preliminary evaluation of a flowchart to support eye care practitioners in providing accurate, evidence-based nutritional advice to their patients. A flowchart was designed to take practitioners through a decision-making process that would determine whether a patient matched the Age-Related Eye Disease Study (AREDS) 2 eligibility criteria for supplementation...
September 2017: British Journal of Visual Impairment
https://www.readbyqxmd.com/read/28943495/percutaneous-transcatheter-biopsy-for-intracardiac-mass-diagnosis
#10
Gautam Reddy, Elad Maor, Melanie C Bois, Krishnaswamy Chandrasekharan, Charanjit S Rihal, Rick A Nishimura, David R Holmes, Guy S Reeder, Joseph J Maleszewski, Kyle W Klarich
AIMS: The differential diagnosis of intracardiac masses (ICM) is wide. While imaging modalities cansuggest a diagnosis, clinical decision making usually requires histopathologic diagnosis. The aimwas to describe procedural technique, safety outcomes, diagnostic accuracy and clinical utilityof percutaneous transcatheter biopsy (TCB) for histopathologic diagnosis of ICM. The records ofall patients undergoing TCB of ICM at the Mayo Clinic catheterization laboratories in RochesterMinnesota between 2002 and 2017 were retrieved and reviewed...
September 26, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28943233/unravelling-fibromyalgia-steps-towards-individualized-management
#11
Winfried Häuser, Serge Perrot, Daniel J Clauw, Mary-Ann Fitzcharles
The heterogeneity of the clinical presentation and the pathophysiologic mechanisms associated with fibromyalgia (FM), and the modest results on average for any therapy, call for a more individualized management strategy. Individualized treatment can be based on subgrouping of patients according to associated conditions (mental health problems; chronic overlapping pain conditions; other somatic diseases) or on the disease severity. Categorizing FM as mild, moderate or severe can be based on clinical assessment (e...
September 21, 2017: Journal of Pain: Official Journal of the American Pain Society
https://www.readbyqxmd.com/read/28943192/preoperative-factors-that-predict-the-need-to-morcellate-in-total-laparoscopic-hysterectomy
#12
Morgan Wolfe, Scott Biest, Nhial Tutlam, Candice Woolfolk, Brooke Winner
STUDY OBJECTIVE: To determine which preoperative factors best predict the need for uterine morcellation at the time of total laparoscopic hysterectomy and to identify cut-offs that can help guide clinical decision-making. DESIGN: Data were collected from a prospective quality assurance database and reviewed retrospectively. Preoperative factors assessed included uterine volume, cross-sectional area, length, size of largest leiomyoma, and bimanual exam. Receiver-operator curves (ROC) were used to establish cut-offs that maximized sensitivity and specificity for each factor...
September 21, 2017: Journal of Minimally Invasive Gynecology
https://www.readbyqxmd.com/read/28943073/the-reliability-and-validity-of-a-venezuelan-version-of-the-bath-ankylosing-spondylitis-functional-index-basfi-and-bath-ankylosing-spondylitis-disease-activity-index-basdai
#13
Mayra Rauseo Vera, Luis Arturo Gutiérrez-González, Irama Maldonado, Soham Al Snih
INTRODUCTION: Spondyloarthropathies (SpA) are disabling diseases with a prevalence of 1.9% in the general population. The indices designed for monitoring the disease should be valid, reliable and cross-culturally adapted for decision-making concerning the appropriate treatment. Changing an adjective or pronoun in a self-administered questionnaire could be the big difference in condensing an idea in a few words and transmitting that concept to all those who share the same language. OBJECTIVES: To develop a Venezuelan version of the original English version of the BASDAI/BASFI and to evaluate its reliability and validity in Venezuelan patients with SpA...
September 21, 2017: Reumatología Clinica
https://www.readbyqxmd.com/read/28942909/a-systematic-review-of-exercise-systematic-reviews-in-the-cancer-literature-2005-2017
#14
REVIEW
Nicole L Stout, Jennifer Baima, Anne K Swisher, Kerri M Winters-Stone, Judith Welsh
BACKGROUND: Evidence supports the benefits of exercise for patients with cancer; however, specific guidance for clinical decision making regarding exercise timing, frequency, duration, and intensity is lacking. Efforts are needed to optimize clinical recommendations for exercise in the cancer population. OBJECTIVES: To aggregate information regarding the benefit of exercise through a systematic review of existing systematic reviews in the cancer exercise literature...
September 2017: PM & R: the Journal of Injury, Function, and Rehabilitation
https://www.readbyqxmd.com/read/28942077/transcervical-extended-mediastinal-lymphadenectomy-experience-from-a-north-american-cancer-center
#15
Sai Yendamuri, Athar Battoo, Grace Dy, Hongbin Chen, Jorge Gomez, Anurag K Singh, Mark Hennon, Chukwumere E Nwogu, Elisabeth U Dexter, Miriam Huang, Anthony Picone, Todd L Demmy
BACKGROUND: Accurate staging of the mediastinum is a critical element of therapeutic decision making in non-small cell lung cancer. We sought to determine the utility of transcervical extended mediastinal lymphadenectomy (TEMLA) in staging non-small cell lung cancer for large central tumors and after induction therapy. METHODS: A retrospective record review was performed of all patients who underwent TEMLA at our institution from 2010 to 2015. Clinical stage as assessed by positron emission tomography integrated with computed tomography (PET-CT), stage as assessed by TEMLA, final pathologic stage, lymph node yield, and clinical characteristics of tumors were assessed along with TEMLA-related perioperative morbidity...
September 21, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28942029/chemotherapy-for-advanced-her2-negative-breast-cancer-can-one-algorithm-fit-all
#16
REVIEW
F Miglietta, M V Dieci, G Griguolo, V Guarneri, P F Conte
HER2negative (HER2-) metastatic breast cancer (MBC) represents a challenging scenario for clinicians due to its great biological and clinical heterogeneity. Although management of HER2-MBC currently relies on several options, CT still remains a worthwhile strategy to be exploited. However, to date, there is not an univoque algorithm capable of guiding the choice of the proper CT agent/regimen, sequence and duration. Evidence from randomized clinical trials (RCT) and meta-analyses can actually help guiding the decision making process, however the definition of a standard of care for all HER2-MBC patients may be impractical, also in the light of the identification of new promising molecular and immunotherapeutic agents...
September 15, 2017: Cancer Treatment Reviews
https://www.readbyqxmd.com/read/28941999/structured-reporting-platform-improves-cad-rads-assessment
#17
Bálint Szilveszter, Márton Kolossváry, Júlia Karády, Ádám L Jermendy, Mihály Károlyi, Alexisz Panajotu, Zsolt Bagyura, Milán Vecsey-Nagy, Ricardo C Cury, Jonathon A Leipsic, Béla Merkely, Pál Maurovich-Horvat
BACKGROUND: Structured reporting in cardiac imaging is strongly encouraged to improve quality through consistency. The Coronary Artery Disease - Reporting and Data System (CAD-RADS) was recently introduced to facilitate interdisciplinary communication of coronary CT angiography (CTA) results. We aimed to assess the agreement between manual and automated CAD-RADS classification using a structured reporting platform. METHODS: Five readers prospectively interpreted 500 coronary CT angiographies using a structured reporting platform that automatically calculates the CAD-RADS score based on stenosis and plaque parameters manually entered by the reader...
September 18, 2017: Journal of Cardiovascular Computed Tomography
https://www.readbyqxmd.com/read/28941959/translation-cross-adaptation-and-measurement-properties-of-the-brazilian-version-of-the-acl-rsi-scale-and-acl-qol-questionnaire-in-patients-with-anterior-cruciate-ligament-reconstruction
#18
Laryssa Oliveira Silva, Luana Maria Ramos Mendes, Pedro Olavo de Paula Lima, Gabriel Peixoto Leão Almeida
BACKGROUND: Scales to assess the quality of life and return-to-sport after reconstruction of the anterior cruciate ligament (ACL) may help the clinical decision-making process. OBJECTIVE: To cross-culturally adapt and determine the validity of the Brazilian versions of the Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI) and the Quality of Life Questionnaire (ACL-QoL). METHODS: The process of translation and cross-cultural adaptation followed the recommendations of international guidelines...
September 12, 2017: Brazilian Journal of Physical Therapy
https://www.readbyqxmd.com/read/28941606/new-developments-in-hypertrophic-cardiomyopathy
#19
REVIEW
Robert M Cooper, Claire E Raphael, Max Liebregts, Nandan S Anavekar, Josef Veselka
Hypertrophic cardiomyopathy is the leading cause of sudden death in young individuals and an important cause of heart failure at any age. In this review we discuss advances in investigation and management of this heterogenous disease. Improved cardiac imaging has allowed us to detail many of the structural abnormalities whereas the use of new techniques, predominantly in cardiac magnetic resonance imaging, has given us a greater insight in to tissue architecture, mechanism of contractile abnormalities, and function...
October 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/28941186/three-novel-mutations-in-cyba-among-22-iranians-with-chronic-granulomatous-disease
#20
M Badalzadeh, S Tajik, M R Fazlollahi, M Houshmand, F Fattahi, Z Alizadeh, M Movahedi, Z Adab, G T Khotaei, A A Hamidieh, H Heidarnazhad, Z Pourpak
Chronic granulomatous disease (CGD) is a rare primary immunodeficiency caused by defect in one of the components of nicotinamide adenine dinucleotide phosphate (NADPH)-oxidase enzyme. The enzyme is at least composed of membrane-bound subunits gp91-phox and p22-phox (also named cytochrome b558 ), and cytosolic ones p40-phox, p47-phox and p67-phox. A defect in the enzyme activity leads to impaired intracellular killing of phagocytic cells. The CYBA gene encoding p22-phox is located on chromosome 16q24. In this study, new genetic changes of CYBA gene in 22 Iranian patients with autosomal recessive-CGD (AR-CGD) were identified...
September 20, 2017: International Journal of Immunogenetics
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