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Rational Clinical Examination

Helen M Golder, Jennifer M Thomson, Stuart E Denman, Chris S McSweeney, Ian J Lean
Dairy heifers were subjected to a non-life-threatening challenge designed to induce ruminal acidosis by feeding grain and sugar. Large among animal variation in clinical signs of acidosis, rumen metabolite concentrations, and the rumen microbiome occurred. This exploratory study investigates sources of the variation by examining associations between the genome, metabolome, and microbiome, albeit with a limited population. The broader objective is to provide a rationale for a larger field study to identify markers for susceptibility to ruminal acidosis...
2018: Frontiers in Genetics
Hideaki Moteki, Yuichi Isaka, Yuji Inaba, Mitsuo Motobayashi, Shin-Ya Nishio, Satoshi Ohira, Takuya Yano, Satoshi Iwasaki, Tanri Shiozawa, Kenichi Koike, Shin-Ichi Usami
OBJECTIVE: Congenital cytomegalovirus (cCMV) infection is the most common congenital infection, with the majority of infected newborns having no detectable signs. The aim of this study was to examine the accuracy of our newly developed DBS-based assay as an appropriate mass screening method for cCMV infection. METHODS: Between May 2011 and October 2016, newborns delivered at six hospitals in Nagano Prefecture, Japan were enrolled prospectively. We employed dried blood spot (DBS)-based assays with real-time quantitative PCR (qPCR)...
March 7, 2018: Acta Oto-laryngologica
Floortje B Moes, Eddy S Houwaart, Diana M J Delnoij, Klasien Horstman
RATIONALE, AIMS, AND OBJECTIVES: This paper examines a remarkable dispute between Dutch insurers, hospitals, doctors, and patients about a set of quality indicators. In 2013, private insurers planned to drastically reform Dutch emergency care using quality indicators they had formulated drawing from clinical guidelines, RCTs, and systematic reviews. Insurers' plans caused much debate in the field of emergency care. As quality indicators have come to play a more central role in health care governance, the questions what constitutes good evidence for them, how they ought to be used, and who controls them have become politically and morally charged...
March 6, 2018: Journal of Evaluation in Clinical Practice
Silvia Paola Corona, Daniele Generali
Although early breast cancer (BC) is highly curable, advanced or metastatic disease poses numerous challenges in terms of medical management and treatment decisions and is associated with significantly worse prognosis. Among the new targeted agents, anticancer drugs exploiting the cell-cycle machinery have shown great potential in preclinical studies. CDK4/6 inhibitors target the cyclin D/CDK/retinoblastoma signaling pathway, inducing cell-cycle arrest, reduced cell viability and tumor shrinking. As the cyclin D/CDK complex is activated downstream of estrogen signaling, the combination of CDK4/6 inhibitors with standard endocrine therapies represents a rational approach to elicit synergic antitumor activity in hormone receptor-positive BC...
2018: Drug Design, Development and Therapy
Hao Fan, Kenneth H Fife, Dena Cox, Anthony D Cox, Gregory D Zimet
Much of the research examining predictors of HIV testing has used retrospective self-report to assess HIV testing. FINDINGS: therefore, may be subject to recall bias and to difficulties determining the direction of associations. In this prospective study, we administered surveys to women in community clinics to identify predictors of subsequent observed HIV testing, overcoming these limitations. Eighty-three percent were tested. In the adjusted multivariable model, being born in the U...
February 22, 2018: AIDS Care
Takayoshi Matsuda, Takuhiro Ito, Chie Takemoto, Kazushige Katsura, Mariko Ikeda, Motoaki Wakiyama, Mutsuko Kukimoto-Niino, Shigeyuki Yokoyama, Yoshikazu Kurosawa, Mikako Shirouzu
Growing numbers of therapeutic antibodies offer excellent treatment strategies for many diseases. Elucidation of the interaction between a potential therapeutic antibody and its target protein by structural analysis reveals the mechanism of action and offers useful information for developing rational antibody designs for improved affinity. Here, we developed a rapid, high-yield cell-free system using dialysis mode to synthesize antibody fragments for the structural analysis of antibody-antigen complexes. Optimal synthesis conditions of fragments (Fv and Fab) of the anti-EGFR antibody 059-152 were rapidly determined in a day by using a 30-μl-scale unit...
2018: PloS One
Maged A Tanios, Daniel Teres, Hyunsoon Park, Antonio Beltran, Arunpal Sehgal, James D Leo
BACKGROUND: Various intensivist staffing models have been suggested, but the long-term sustainability and outcomes vary and may not be sustained. We examined the impact of implementing a high-intensity intensivist coverage model with a nighttime in-house nocturnist (non-intensivist) and its effect on intensive care unit (ICU) outcomes. METHODS: We obtained historical control baseline data from 2007 to 2011 and compared the same data from 2011 to 2015. The Acute Physiological and Chronic Health Evaluation outcomes system was utilized to collect clinical, physiological, and outcome data on all adult patients in the medical ICU and to provide severity-adjusted outcome predictions...
January 1, 2018: Journal of Intensive Care Medicine
J P Laroche, S Blaise, F Becker, C Laaeng Massoni, M Nou-Howaldt, O Pichot, H Desmurs-Clavel, J Jeancolas, C Jurus, G Sarlon-Bartoli, V Soulier-Sotto, H Thiel, M A Sevestre-Pietri, J Maloizel-Delaunay, S Mestre-Godin
The quality standards of the French Society of Vascular Medicine for the ultrasonographic assessment of vascular malformations are based on the two following requirements: (1) technical know-how: mastering the use of ultrasound devices and the method of examination; (2) medical know-how: ability to adapt the methods and scope of the examination to its clinical indication and purpose, and to rationally analyze and interpret its results. AIMS OF THE QUALITY STANDARDS: To describe an optimal method of examination in relation to the clinical question and hypothesis...
February 2018: Journal de Médecine Vasculaire
Meredith Van Natta, Nancy J Burke, Irene H Yen, Sara Rubin, Mark D Fleming, Ariana Thompson-Lastad, Janet K Shim
This article explores the complicated and often-contradictory notions of choice at play in complex care management (CCM) programmes in the US healthcare safety net. Drawing from longitudinal data collected over two years of ethnographic fieldwork at urban safety-net clinics, our study examines the CCM goal of transforming frequent emergency department (ED) utilisers into 'active' patients who will reduce their service utilisation and thereby contribute to a more rational, cost-effective healthcare system. By considering our data alongside philosopher Annemarie Mol's (2008) conceptualisation of the competing logics of choice and care, we argue that these premises often undermine CCM teams' efforts to support patients and provide the care they need - not only to prevent medical crises, but to overcome socio-economic barriers as well...
February 8, 2018: Sociology of Health & Illness
Ricardo L B Costa, Hyo Sook Han, William J Gradishar
PURPOSE: Triple-negative breast cancer (TNBC) accounts for approximately 20% of breast cancer cases. Although there have been advances in the treatment of hormone receptor-positive and human epidermal growth factor receptor 2-positive breast cancers, targeted therapies for TNBC remain unavailable. In this narrative review, we summarize recent discoveries related to the underlying biology of the phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/mechanistic target of rapamycin (mTOR) pathway in TNBC, examine clinical progress to date, and suggest rational future approaches for investigational therapies in TNBC...
February 7, 2018: Breast Cancer Research and Treatment
Chao Chen, Wen Sun, Xiaoli Wang, Yibing Wang, Ping Wang
Curcumin has attracted increasing attentions in recent years due to its promising anticancer activities. However, the hydrophobicity of curcumin has limited greatly its efficacy in clinical trials. In this study, folate (FA)-receptor targeting mesoporous silica nanoparticles that promise high loadings of curcumin via pH-sensitive Schiff base reactions were constructed and examined for targeted delivery of curcumin. Such nano-delivery system showed significantly improved stability and biocompatibility of curcumin under physiological conditions...
April 1, 2018: Materials Science & Engineering. C, Materials for Biological Applications
Robert M Califf
Biomarkers are critical to the rational development of medical therapeutics, but significant confusion persists regarding fundamental definitions and concepts involved in their use in research and clinical practice, particularly in the fields of chronic disease and nutrition. Clarification of the definitions of different biomarkers and a better understanding of their appropriate application could result in substantial benefits. This review examines biomarker definitions recently established by the U.S. Food and Drug Administration and the National Institutes of Health as part of their joint Biomarkers, EndpointS, and other Tools (BEST) resource...
February 2018: Experimental Biology and Medicine
Anil N Makam, Oanh Kieu Nguyen, Lei Xuan, Michael E Miller, James S Goodwin, Ethan A Halm
Importance: Despite providing an overlapping level of care, it is unknown why hospitalized older adults are transferred to long-term acute care hospitals (LTACs) vs less costly skilled nursing facilities (SNFs) for postacute care. Objective: To examine factors associated with variation in LTAC vs SNF transfer among hospitalized older adults. Design, Setting, and Participants: We conducted this retrospective observational cohort study of hospitalized older adults (≥65 years) transferred to an LTAC vs SNF during fiscal year 2012 using national 5% Medicare data...
February 5, 2018: JAMA Internal Medicine
Rebecca Fahrenbruch, Polly Kintzel, Anne Marie Bott, Steven Gilmore, Ryan Markham
PURPOSE: To present a position statement from the Hematology/Oncology Pharmacy Association (HOPA) that pertains to dose rounding of biologic and cytotoxic anticancer agents. METHODS: The HOPA Standards Committee organized a work group of oncology pharmacist specialists to examine the safety and value of dose rounding of biologic and cytotoxic anticancer agents. Primary literature that describes methods for dose rounding, with clinical or economic data, were analyzed...
February 5, 2018: Journal of Oncology Practice
Olga Solomon, Mary C Lawlor
Research on autism spectrum disorder (ASD) and on Alzheimer's Disease (AD) and other types of dementia describes a behaviour called 'wandering', a term that denotes movement through space lacking intention or exact destination, as when a person is disoriented or not self-aware. In the U.S., 'wandering' in both ASD and AD has been examined mostly from a management and prevention perspective. It prioritizes safety while primarily overlooking personal experiences of those who 'wander' and their families, thus limiting the range of potentially effective strategies to address this issue...
January 24, 2018: Culture, Medicine and Psychiatry
Amanda Owen-Smith, Joanna Coast, Jenny L Donovan
BACKGROUND: Addressing the prevalence of severe obesity and its concomitant morbidities is widely acknowledged as one of the most pressing global health priorities. Nevertheless, a paucity of effective interventions and universal pressure on health-care budgets means that access to obesity treatments is often limited. Although health-care rationing can be conceived as a socially constructed process, little is known about how decisions emerge within the context of face-to-face doctor-patient interactions...
January 19, 2018: Health Expectations: An International Journal of Public Participation in Health Care and Health Policy
Carly J King, Josha Woodward, Jacob Schwartzman, Daniel J Coleman, Robert Lisac, Nicholas J Wang, Kathryn Van Hook, Lina Gao, Joshua Urrutia, Mark A Dane, Laura M Heiser, Joshi J Alumkal
Recent work demonstrates that castration-resistant prostate cancer (CRPC) tumors harbor countless genomic aberrations that control many hallmarks of cancer. While some specific mutations in CRPC may be actionable, many others are not. We hypothesized that genomic aberrations in cancer may operate in concert to promote drug resistance and tumor progression, and that organization of these genomic aberrations into therapeutically targetable pathways may improve our ability to treat CRPC. To identify the molecular underpinnings of enzalutamide-resistant CRPC, we performed transcriptional and copy number profiling studies using paired enzalutamide-sensitive and resistant LNCaP prostate cancer cell lines...
December 19, 2017: Oncotarget
Jamie R Friedman, Nick A Nolan, Sarah L Miles, Kathleen C Brown, Austin T Akers, Kate W Colclough, Jessica W Seidler, John M Rimoldi, Monica A Valentovic, Piyali Dasgupta
The nutritional compound capsaicin is the major spicy ingredient of chili peppers. Although traditionally associated analgesic activity, recent studies have shown that capsaicin has profound anti-neoplastic effects in several types of human cancers. However, the applications of capsaicin as a clinically viable drug are limited by its unpleasant side effects like gastric irritation, stomach cramps and burning sensation. This has led to extensive research focused on the identification and rational design of a second generation of non-pungent capsaicin-analogs which will retain the biological activity of capsaicin...
December 15, 2017: Journal of Pharmacology and Experimental Therapeutics
Desirée Kozlowski, Marie Hutchinson, John Hurley, Joanne Rowley, Joanna Sutherland
BACKGROUND: Traditionally, clinical decision making has been perceived as a purely rational and cognitive process. Recently, a number of authors have linked emotional intelligence (EI) to clinical decision making (CDM) and calls have been made for an increased focus on EI skills for clinicians. The objective of this integrative literature review was to identify and synthesise the empirical evidence for a role of emotion in CDM. METHODS: A systematic search of the bibliographic databases PubMed, PsychINFO, and CINAHL (EBSCO) was conducted to identify empirical studies of clinician populations...
December 15, 2017: BMC Medical Education
N-N Zhao, K-X Zeng, Y-L Wang, P-J Sheng, C-Z Tang, P Xiao, X-W Liu
OBJECTIVE: To investigate the prevalence rate of nutritional risk in high-risk stroke groups in community, analyze its influencing factors, and analyze and compare the relationship between nutritional risk or malnutrition assessed by different nutritional evaluation methods and cognitive function, so as to provide the basis and guidance for clinical nutritional assessment and support. PATIENTS AND METHODS: A cross-sectional survey was performed for 1196 cases in high-risk stroke groups in community from December 2015 to January 2017...
December 2017: European Review for Medical and Pharmacological Sciences
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