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https://www.readbyqxmd.com/read/28321533/perioperative-antibiotic-use-in-vagus-nerve-stimulator-implantation-a-clinical-series
#1
Jeffrey S Raskin, Daniel Hansen, Arvind Mohan, I-Wen Pan, Daniel J Curry, Sandi Lam
PURPOSE: Preoperative antibiosis contributes up to one third of total antibiotic use in major hospitals. Choice of antibiotic is not uniformly standardized, and polypharmacy regimens may be used without knowing the effect on rates of surgical site infection, nonsurgical infections, or antibiotic resistance. Careful examination of trends in surgical prophylaxis is warranted. In this study, we aimed to examine our institution's experience with vagus nerve stimulator (VNS) implantation, focusing on association between perioperative antibiotic practices and postoperative infectious outcomes...
March 20, 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/28316279/rivaroxaban-or-aspirin-for-extended-treatment-of-venous-thromboembolism
#2
Jeffrey I Weitz, Anthonie W A Lensing, Martin H Prins, Rupert Bauersachs, Jan Beyer-Westendorf, Henri Bounameaux, Timothy A Brighton, Alexander T Cohen, Bruce L Davidson, Hervé Decousus, Maria C S Freitas, Gerlind Holberg, Ajay K Kakkar, Lloyd Haskell, Bonno van Bellen, Akos F Pap, Scott D Berkowitz, Peter Verhamme, Philip S Wells, Paolo Prandoni
Background Although many patients with venous thromboembolism require extended treatment, it is uncertain whether it is better to use full- or lower-intensity anticoagulation therapy or aspirin. Methods In this randomized, double-blind, phase 3 study, we assigned 3396 patients with venous thromboembolism to receive either once-daily rivaroxaban (at doses of 20 mg or 10 mg) or 100 mg of aspirin. All the study patients had completed 6 to 12 months of anticoagulation therapy and were in equipoise regarding the need for continued anticoagulation...
March 18, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28302754/apixaban-pharmacokinetics-at-steady-state-in-hemodialysis-patients
#3
Thomas A Mavrakanas, Caroline F Samer, Sharon J Nessim, Gershon Frisch, Mark L Lipman
It is unclear whether warfarin is protective or harmful in patients with ESRD and atrial fibrillation. This state of equipoise raises the question of whether alternative anticoagulants may have a therapeutic role. We aimed to determine apixaban pharmacokinetics at steady state in patients on hemodialysis. Seven patients received apixaban 2.5 mg twice daily for 8 days. Blood samples were collected before and after apixaban administration on days 1 and 8 (nondialysis days). Significant accumulation of the drug was observed between days 1 and 8 with the 2...
March 16, 2017: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/28288065/how-has-virtual-hepatectomy-changed-the-practice-of-liver-surgery-experience-of-1194-virtual-hepatectomy-before-liver-resection-and-living-donor-liver-transplantation
#4
Yoshihiro Mise, Kiyoshi Hasegawa, Shouichi Satou, Junichi Shindoh, Kenji Miki, Nobuhisa Akamatsu, Junichi Arita, Junichi Kaneko, Yoshihiro Sakamoto, Norihiro Kokudo
OBJECTIVE: To assess how virtual hepatectomy (VH), conducted using surgical planning software, influences the outcomes of liver surgery. BACKGROUND: Imaging technology visualizes the territories of the liver vessels, which were previously impossible. However, the clinical impact of VH has not been evaluated. METHODS: From 2004 to 2013, we performed 1194 VHs preoperatively. Outcomes of living donor liver transplantation (LDLT) and hepatectomy for hepatocellular carcinoma (HCC)/colorectal liver metastases (CRLM) were compared between patients in whom VH was performed (VH) and those without VH evaluation (non-VH)...
March 10, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28284020/frenotomy-for-tongue-tie-in-newborn-infants
#5
REVIEW
Joyce E O'Shea, Jann P Foster, Colm Pf O'Donnell, Deirdre Breathnach, Susan E Jacobs, David A Todd, Peter G Davis
BACKGROUND: Tongue-tie, or ankyloglossia, is a condition whereby the lingual frenulum attaches near the tip of the tongue and may be short, tight and thick. Tongue-tie is present in 4% to 11% of newborns. Tongue-tie has been cited as a cause of poor breastfeeding and maternal nipple pain. Frenotomy, which is commonly performed, may correct the restriction to tongue movement and allow more effective breastfeeding with less maternal nipple pain. OBJECTIVES: To determine whether frenotomy is safe and effective in improving ability to feed orally among infants younger than three months of age with tongue-tie (and problems feeding)...
March 11, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28282628/blood-transfusion-indications-in-neurosurgical-patients-a-systematic-review
#6
REVIEW
Shefali Bagwe, Lawrance K Chung, Carlito Lagman, Brittany L Voth, Natalie E Barnette, Lekaa Elhajjmoussa, Isaac Yang
Neurosurgical procedures can be complicated by significant blood losses that have the potential to decrease tissue perfusion to critical brain tissue. Red blood cell transfusion is used in a variety of capacities both inside, and outside, of the operating room to prevent untoward neurologic damage. However, evidence-based guidelines concerning thresholds and indications for transfusion in neurosurgery remain limited. Consequently, transfusion practices in neurosurgical patients are highly variable and based on institutional experiences...
February 20, 2017: Clinical Neurology and Neurosurgery
https://www.readbyqxmd.com/read/28279467/controversies-and-consensus-in-preoperative-therapy-of-esophageal-and-gastroesophageal-junction-cancers
#7
REVIEW
Geoffrey Y Ku
This review summarizes established adjuvant approaches for locally advanced esophageal cancer (including preoperative, perioperative, or postoperative approaches, which include chemotherapy alone or chemoradiation). It also discusses areas of uncertainty and therapeutic equipoise.
April 2017: Surgical Oncology Clinics of North America
https://www.readbyqxmd.com/read/28278389/clinical-equipoise-and-shared-decision-making-in-pulmonary-nodule-management-a-survey-of-american-thoracic-society-clinicians
#8
Jonathan M Iaccarino, James Simmons, Michael K Gould, Christopher G Slatore, Steven Woloshin, Lisa M Schwartz, Renda Soylemez Wiener
RATIONALE: Guidelines for pulmonary nodule evaluation suggest a variety of strategies, reflecting the lack of high-quality evidence demonstrating the superiority of any one approach. It is unclear whether clinicians agree that multiple management options are appropriate at different levels of risk and whether this impacts their decision-making approaches with patients. OBJECTIVES: To assess clinicians' perceptions of the appropriateness of various diagnostic strategies, approach to decision-making, and perceived clinical equipoise in pulmonary nodule evaluation...
March 9, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28276121/re-opening-the-window-on-fenestration-as-a-treatment-for-acute-thoracolumbar-intervertebral-disc-herniation-in-dogs
#9
P Freeman, N D Jeffery
Acute thoracolumbar intervertebral disc herniation in dogs is a common cause of "back" pain, pelvic limb paresis or paralysis and incontinence. Treatment of this condition has long been a source of controversy, especially since the introduction of surgical interventions in the 1950s. Unfortunately, formal clinical trials to compare efficacy of conservative and surgical interventions have never been carried out and the current lack of clinical equipoise on this subject now precludes such a trial on ethical grounds...
April 2017: Journal of Small Animal Practice
https://www.readbyqxmd.com/read/28253558/surgeon-knows-best-versus-breast-cancer-surgical-clinical-trial-equipoise-a-plea-for-the-sake-of-future-trials
#10
Andrew J Spillane, G Bruce Mann
No abstract text is available yet for this article.
March 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/28220947/does-anyone-really-believe-the-results-of-the-danish-trial-implanting-an-icd-in-non-ischemic-cardiomyopathy-patients
#11
EDITORIAL
J Rod Gimbel, Judith Mackall
The recent publication of the DANISH Trial seems to leave clinicians and patients at a point of therapeutic equipoise regarding the implantation of an ICD in patients with non-ischemic cardiomyopathy. Limitations of the DANISH Trial are discussed and suggestions for a potential way forward are outlined in this controversial area of patient care. This article is protected by copyright. All rights reserved.
February 21, 2017: Pacing and Clinical Electrophysiology: PACE
https://www.readbyqxmd.com/read/28220082/synaptic-and-neuronal-autoantibody-associated-psychiatric-syndromes-controversies-and-hypotheses
#12
Adam Al-Diwani, Thomas A Pollak, Alexander E Langford, Belinda R Lennox
Autoimmune encephalitis (AE) mediated by antibodies against synaptic and neuronal surface targets frequently presents with a psychiatric syndrome. In these patients, removal of autoantibodies treats the disease and outcomes are closely linked to early intervention. The discovery of these autoantibodies in isolated psychiatric syndromes has raised the possibility that these patients may derive similar benefits from immunotherapy, a potentially transformational approach to the treatment of mental illness. Although open-label case series suggest impressive therapeutic outcomes, the pathological relevance of these autoantibodies outside of canonical presentations is debated...
2017: Frontiers in Psychiatry
https://www.readbyqxmd.com/read/28217492/glycemic-equipoise
#13
EDITORIAL
Sanjay Kalra, Mathew John, A G Unnikrishnan
No abstract text is available yet for this article.
January 2017: Indian Journal of Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28170466/equipoise-in-research-integrating-ethics-and-science-in-human-research
#14
Alex John London
No abstract text is available yet for this article.
February 7, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28168945/psychiatric-pharmacogenomics-how-to-integrate-into-clinical-practice
#15
Stephen M Stahl
Pharmacogenomic testing can be integrated into modern mental health practices to help select psychotropic drugs for individuals who have failed first-line evidence-based treatments. This can be done by the process of "equipoise"-namely, balancing the weight of all available evidence. That evidence now includes not only diagnosis-specific treatment guidelines and "personalized" patient information, such as an individual's specific symptom profile, past response to medications, side effects, family history, and patient preference, but also "precision medicine," which incorporates the ever-expanding base of pharmacogenomic evidence for how an individual's own biomarkers alter the odds for that individual's treatment response or treatment intolerance...
February 2017: CNS Spectrums
https://www.readbyqxmd.com/read/28156499/palliative-treatment-directives-for-bone-metastases-a-quality-directed-approach-to-guiding-institutional-practice
#16
Lucille Lee, Petrina Zuvic, Isabella Bingchan Zhang, Louis Potters, Beatrice Bloom
188 Background: The efficacy of single fraction (fx) radiation treatment (RT) has proven to have equipoise for palliation of bone metastases when compared to courses of 10 fx or more. Despite these data, there has been a slow adoption of this practice in the US and worldwide. Examination of our multicenter practice from 2004 - 2016 showed that single fx RT utilization has remained at 17% and hypofractionationed (HFX) courses (1 or 5 fx) have remained at 71% since 2009. We hypothesized that evidence-based, treatment-guiding directives could improve HFX utilization in this population...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28142289/time-lapse-imaging-is-it-time-to-incorporate-this-technology-into-routine-clinical-practice
#17
Priya Bhide, Abha Maheshwari, Rachel Cutting, Susan Seenan, Anita Patel, Khalid Khan, Roy Homburg
Time-lapse imaging (TLI) systems for embryo incubation, assessment and selection are a novel technology available to in vitro fertilization (IVF) clinics. However, there is uncertainty about their clinical and cost-effectiveness and insufficient good quality evidence to warrant their routine use. Despite this, enthusiastic commercial marketing and slipping clinical equipoise have led to the widespread hasty introduction of this technology into practice, often at a considerable expense to the patient. We have reviewed the published literature and aim to summarize the strengths, weaknesses, opportunities and threats of these systems...
February 1, 2017: Human Fertility: Journal of the British Fertility Society
https://www.readbyqxmd.com/read/28135804/the-interaction-between-equipoise-and-logistics-in-clinical-trials-a-case-study
#18
Meredith G Warshaw, Vincent J Carey, Elizabeth J McFarland, Liza Dawson, Elaine Abrams, Ann Melvin, Lee Fairlie, Hans Spiegel, Jonathan Jay, Allison L Agwu
INTRODUCTION: Equipoise is usually discussed as an ethical issue in clinical trials. However, it also has practical implications. BACKGROUND: Clinical equipoise is usually construed to mean uncertainty or disagreement among the expert clinician community. However, an individual physician's sense of equipoise may vary by location, based on the local standard of care or availability of specific treatment options, and these differences can affect providers' willingness to enroll participants into clinical trials...
January 1, 2017: Clinical Trials: Journal of the Society for Clinical Trials
https://www.readbyqxmd.com/read/28125553/o-005-combination-therapy-with-methotrexate-does-not-change-infliximab-pharmacokinetics-in-children-with-inflammatory-bowel-disease
#19
Valentina Shakhnovich, Leon Van Haandel, Mara Becker, Ryan Funk
BACKGROUND: There remains a question of equipoise regarding the use of anti-TNF-α agent (e.g., infliximab) monotherapy versus combination therapy with immunomodulators (e.g., methotrexate), for the treatment of pediatric Inflammatory Bowel Disease (IBD). The aim of this prospective cross-sectional study was to assess the impact of methotrexate (MTX) on infliximab (IFX) pharmacokinetics (i.e., serum trough levels) and infliximab antibody (anti-IFX) formation in children with IBD. METHODS: Forty-one children with IBD (9-21 yr of age), receiving maintenance IFX infusions as part of their standard-of-medical-care, had serum IFX and anti-IFX concentrations assessed via an established NF-kB luciferase gene-reporter assay (ARUP Laboratories)...
February 2017: Inflammatory Bowel Diseases
https://www.readbyqxmd.com/read/28119447/equipoise-and-the-rct
#20
REVIEW
M Braakhekke, F Mol, S Mastenbroek, B Willem J Mol, F van der Veen
Clinical decisions in reproductive medicine are often made in uncertainty. To reduce uncertainty and to improve clinical decision-making, RCTs are increasingly called upon. A key concept underpinning the ethics of RCTs is equipoise. Here, we aimed to dissect the basic reasoning behind the concept of equipoise and we proposed a line of thinking delineating under which conditions it is ethical to design and execute an RCT. This might prevent a priori negative trials, reduce research waste and aid in the design of meaningful ones...
February 2017: Human Reproduction
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