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Equipoise

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https://www.readbyqxmd.com/read/28920760/influence-analysis-for-the-area-under-the-receiver-operating-characteristic-curve
#1
Bo-Shiang Ke, An Jen Chiang, Yuan-Chin Ivan Chang
Classification measures play essential roles in the assessment and construction of classifiers. Hence, determining how to prevent these measures from being affected by individual observations has become an important problem. In this paper, we propose several indexes based on the influence function and the concept of local influence to identify influential observations that affect the estimate of the area under the receiver operating characteristic curve (AUC), an important and commonly used measure. Cumulative lift charts are also used to equipoise the disagreements among the proposed indexes...
September 18, 2017: Journal of Biopharmaceutical Statistics
https://www.readbyqxmd.com/read/28882925/snap-2-epiccs-the-second-sprint-national-anaesthesia-project-epidemiology-of-critical-care-after-surgery-protocol-for-an-international-observational-cohort-study
#2
S Ramani Moonesinghe, Danny J N Wong, Laura Farmer, Richard Shawyer, Paul S Myles, Steve K Harris
INTRODUCTION: The admission of high-risk patients to critical care after surgery is a recommended standard of care. Nevertheless, poor compliance against this recommendation has been repeatedly demonstrated in large epidemiological studies. It is unclear whether this is due to reasons of capacity, equipoise, poor quality clinical care or because hospitals are working creatively to create capacity for augmented care on normal surgical wards. The EPIdemiology of Critical Care after Surgery study aims to address these uncertainties...
September 7, 2017: BMJ Open
https://www.readbyqxmd.com/read/28882584/prophylactic-cranial-irradiation-pci-vs-active-mri-surveillance-for-small-cell-lung-cancer-the-case-for-equipoise
#3
REVIEW
Chad G Rusthoven, Brian D Kavanagh
Prophylactic cranial irradiation (PCI) for small-cell lung cancer (SCLC) offers a consistent reduction in the incidence of brain metastases (BM), at the cost of measurable toxicity to neurocognitive function and quality of life in the setting of characteristic pathologic changes to the brain. The sequelae of PCI have historically been justified by the perception of an overall survival (OS) advantage specific to SCLC. This rationale has now been challenged by a randomized trial in extensive-stage SCLC demonstrating equivalent progression-free survival and a trend toward improved OS with PCI omission in the context of modern MRI staging, surveillance, and salvage therapy...
September 4, 2017: Journal of Thoracic Oncology
https://www.readbyqxmd.com/read/28879021/diamond-digital-alcohol-management-on-demand-a-mixed-methods-feasibility-rct-and-embedded-process-evaluation-of-a-digital-health-intervention-to-reduce-hazardous-and-harmful-alcohol-use
#4
Fiona L Hamilton, Jo Hornby, Jessica Sheringham, Stuart Linke, Charlotte Ashton, Kevin Moore, Fiona Stevenson, Elizabeth Murray
BACKGROUND: Alcohol is a major risk factor for preventable illness, with huge cost to healthcare economies. There is a role for alcohol-specific digital health interventions (DHI), but there have been few randomised controlled trials (RCT) comparing DHI with face-to-face treatment. Such trials are complex and face obstacles in recruitment and retention. METHODS: Mixed-methods feasibility RCT of an alcohol DHI, testing recruitment, online data-collection and randomisation processes, with an embedded process evaluation...
2017: Pilot and Feasibility Studies
https://www.readbyqxmd.com/read/28852836/indications-for-surgical-stabilization-of-rib-fractures-in-patients-without-flail-chest-surveyed-opinions-of-members-of-the-chest-wall-injury-society
#5
Fredric M Pieracci, Suresh Agarwal, Andrew Doben, Adam Shiroff, Larwence Lottenberg, Sarah Ann Whitbeck, Thomas W White
PURPOSE: There are currently no evidence-based indications for surgical stabilization of rib fractures (SSRF) in patients without flail chest. The purpose of this survey was to identify patients for whom there is relative equipoise (operative vs. non-operative) in order to assist in designing a randomized clinical trial. METHODS: Members of the Chest Wall Injury Society were sent an online survey, in which 18 patient scenarios were presented. The baseline patient had ≥ three displaced, contiguous fractures and had no other contraindications for surgery...
August 29, 2017: International Orthopaedics
https://www.readbyqxmd.com/read/28851407/restricted-fluid-resuscitation-in-sepsis-associated-hypotension-refresh-study-protocol-for-a-pilot-randomised-controlled-trial
#6
Stephen P J Macdonald, David McD Taylor, Gerben Keijzers, Glenn Arendts, Daniel M Fatovich, Frances B Kinnear, Simon G A Brown, Rinaldo Bellomo, Sally Burrows, John F Fraser, Edward Litton, Juan Carlos Ascencio-Lane, Matthew Anstey, David McCutcheon, Lisa Smart, Ioana Vlad, James Winearls, Bradley Wibrow
BACKGROUND: Guidelines recommend an initial intravenous (IV) fluid bolus of 30 ml/kg isotonic crystalloid for patients with sepsis and hypotension. However, there is a lack of evidence from clinical trials to support this. Accumulating observational data suggest harm associated with the injudicious use of fluids in sepsis. There is currently equipoise regarding liberal or restricted fluid-volume resuscitation as first-line treatment for sepsis-related hypotension. A randomised trial comparing these two approaches is, therefore, justified...
August 29, 2017: Trials
https://www.readbyqxmd.com/read/28838092/percutaneous-coronary-intervention-vs-coronary-artery-bypass-grafting-for-left-main-revascularization-an-updated-meta-analysis
#7
Navkaranbir S Bajaj, Nirav Patel, Rajat Kalra, Peter Marogil, Ashwanikumar Bhardwaj, Garima Arora, Pankaj Arora
Aims: The optimal revascularization strategy for left main coronary artery disease (LMD) remains controversial, especially with two recent randomized controlled trials showing conflicting results. We sought to address this controversy with our analysis. Methods and results: Comprehensive literature search was performed. We compared percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for LMD revascularization using standard meta-analytic techniques...
July 1, 2017: European Heart Journal. Quality of Care & Clinical Outcomes
https://www.readbyqxmd.com/read/28826953/mesh-cruroplasty-in-laparoscopic-repair-of-paraesophageal-hernias%C3%A2-is%C3%A2-not-associated-with-better-long-term-outcomes-compared%C3%A2-to%C3%A2-primary-repair
#8
Vernissia Tam, James D Luketich, Ryan M Levy, Neil A Christie, Omar Awais, Manisha Shende, Katie S Nason
BACKGROUND: Equipoise still exists regarding routine mesh cruroplasty during laparoscopic paraesophageal hernia (PEH). We aimed to determine whether selective mesh cruroplasty is associated with differences in recurrence and patient-reported outcomes. METHODS: We compared symptom outcomes (n = 688) and radiographic recurrences (n = 101; at least 10% [or 2 cm] of stomach above hiatus) for 795 non-emergent PEH repair with fundoplication (n = 106 with mesh)...
June 24, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28807254/minimally-invasive-gastrectomy-for-gastric-cancer-a-national-perspective-on-oncologic-outcomes-and-overall-survival
#9
Kenneth Leung, Zhifei Sun, Daniel P Nussbaum, Mohamed A Adam, Mathias Worni, Dan G Blazer
BACKGROUND: Minimally invasive (MI) gastrectomy has become increasingly common as a resection technique for gastric cancer; however, data are limited regarding peri-operative morbidity, oncologic outcomes and long-term survival, particularly in the Western patient population. STUDY DESIGN: The 2010-2012 National Cancer Data Base was queried for adult patients who underwent gastrectomy for localized, intestinal-type gastric adenocarcinoma. Patients were classified by surgical approach (MI vs...
September 2017: Surgical Oncology
https://www.readbyqxmd.com/read/28801416/outcome-of-revascularisation-in-stable-coronary-artery-disease-without-ischaemia-a-danish-registry-based-follow-up-study
#10
Jane Angel Simonsen, Hans Mickley, Allan Johansen, Søren Hess, Anders Thomassen, Oke Gerke, Lisette O Jensen, Jesper Hallas, Werner Vach, Poul F Hoilund-Carlsen
OBJECTIVES: In stable coronary artery disease (CAD), coronary revascularisation may reduce mortality of patients with a certain amount of left ventricular myocardial ischaemia. However, revascularisation does not always follow the guidance suggested by ischaemia testing. We compared outcomes in patients without ischaemia who had either revascularisation or medical treatment. DESIGN AND POPULATION: Based on registries, 1327 consecutive patients with normal myocardial perfusion scintigraphy (MPS) and 278 with fixed perfusion defects were followed for a median of 6...
August 11, 2017: BMJ Open
https://www.readbyqxmd.com/read/28800389/silicon-micropore-based-parallel-plate-membrane-oxygenator
#11
Ajay Dharia, Emily Abada, Benjamin Feinberg, Torin Yeager, Willieford Moses, Jaehyun Park, Charles Blaha, Nathan Wright, Benjamin Padilla, Shuvo Roy
Extracorporeal membrane oxygenation (ECMO) is a life support system that circulates the blood through an oxygenating system to temporarily (days to months) support heart or lung function during cardiopulmonary failure until organ recovery or replacement. Currently, the need for high levels of systemic anticoagulation and the risk for bleeding are main drawbacks of ECMO that can be addressed with a redesigned ECMO system. Our lab has developed an approach using microelectromechanical systems (MEMS) fabrication techniques to create novel gas exchange membranes consisting of a rigid silicon micropore membrane (SμM) support structure bonded to a thin film of gas-permeable polydimethylsiloxane (PDMS)...
August 11, 2017: Artificial Organs
https://www.readbyqxmd.com/read/28798779/one-swallow-does-not-a-summer-make-but-many-swallows-do-accumulating-clinical-evidence-for-nearly-eliminated-peri-procedural-and-30-day-complications-with-mesh-covered-stents-transforms-the-carotid-revascularisation-field
#12
REVIEW
Piotr Musiałek, L Nelson Hopkins, Adnan H Siddiqui
Atherosclerotic carotid artery stenosis (CS) continues to be a common cause of acute ischaemic stroke. Optimised medical therapy (OMT), the first-line treatment modality in CS, may reduce or delay - but it does not abolish - CS-related strokes. As per current AHA/ASA and ESC/ESVS/ESO guidelines, carotid artery stenting (CAS) is a less-invasive alternative to carotid endarterectomy (CEA) for CS revascularisation in primary and secondary stroke prevention. Ten-year follow-up from the CREST trial in patients with symptomatic and asymptomatic CS confirmed equipoise of CAS and CEA in the primary endpoint...
2017: Postępy W Kardiologii Interwencyjnej, Advances in Interventional Cardiology
https://www.readbyqxmd.com/read/28798225/ethical-issues-in-alzheimer-s-disease-research-involving-human-subjects
#13
Dena S Davis
As we aggressively pursue research to cure and prevent Alzheimer's disease, we encounter important ethical challenges. None of these challenges, if handled thoughtfully, would pose insurmountable barriers to research. But if they are ignored, they could slow the research process, alienate potential study subjects and do damage to research recruits and others. These challenges are (1) the necessity of very large cohorts of research subjects, recruited for lengthy studies, probably ending only in the subjects' death; (2) the creation of cohorts of 'study ready' volunteers, many of whom will be competent to consent at the beginning of the process, but move into cognitive impairment later; (3) reliance on adaptive trial design, creating challenges for informed consent, equipoise and justice; (4) the use of biomarkers and predictive tests that describe risk rather than certainty, and that can threaten participants' welfare if the information is obtained by insurance companies or long-term care providers; (5) the use of study partners that creates unique risks of harm to the relationship of subject and study partner...
August 10, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28782112/lower-vs-higher-fluid-volumes-in-sepsis-protocol-for-a-systematic-review-with-meta-analysis
#14
T S Meyhoff, M H Møller, P B Hjortrup, M Cronhjort, A Perner, J Wetterslev
BACKGROUND: Intravenous fluid administration with crystalloids is recommended in the initial management of sepsis. However, the quality of evidence supporting the recommendation on fluid volumes is low, and clinical equipoise exists. Potential benefits of restricting fluid volumes has been suggested, but the overall benefit or harm in patients with sepsis is unknown. Accordingly, we aim to assess patient-important benefits and harms of lower vs. higher fluid volumes in resuscitation of adult patients with sepsis...
September 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/28753234/manipulative-interventions-for-reducing-pulled-elbow-in-young-children
#15
REVIEW
Marjolein Krul, Johannes C van der Wouden, Emma J Kruithof, Lisette Wa van Suijlekom-Smit, Bart W Koes
BACKGROUND: Pulled elbow (nursemaid's elbow) is a common injury in young children. It often results from a sudden pull on the arm, usually by an adult or taller person, which pulls the radius through the annular ligament, resulting in subluxation (partial dislocation) of the radial head. It can also be caused by a fall or twist. The child experiences sudden acute pain and loss of function in the affected arm. Pulled elbow is usually treated by manual reduction of the subluxed radial head...
July 28, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28724326/sting-signalling-an-emerging-common-pathway-in-autoimmunity-and-cancer
#16
David McCaffary
The equipoise between the disease states of cancer and autoinflammation has perhaps been underappreciated in clinical practice and biomedical research. However, since the discover of STING (stimulator of interferon genes) as an integral regulator of innate immunity, a wealth of information has implicated this signaling pathway in both of these diseases. Under cellular homeostasis, STING serves to detect - and promote immune defense against - DNA viruses and intracellular bacteria, as described in its initial discovery...
July 20, 2017: Immunopharmacology and Immunotoxicology
https://www.readbyqxmd.com/read/28719534/is-the-perioperative-ischemic-evaluation-2-trial-equipoised
#17
Samia Madi-Jebara, Ghassan Sleilaty
No abstract text is available yet for this article.
August 2017: Anesthesiology
https://www.readbyqxmd.com/read/28683990/how-safe-is-it-to-train-residents-to-perform-coronary-surgery-with-multiple-arterial-grafting-nineteen-years-of-training-at-a-single-institution
#18
COMPARATIVE STUDY
Umberto Benedetto, Massimo Caputo, Mario Gaudino, Hunaid Vohra, Pierpaolo Chivasso, Alan Bryan, Gianni D Angelini
The learning curve of coronary artery bypass grafting (CABG) with multiple arterial grafting (MAG) is perceived to be associated with increased surgical morbidity and potentially poorer long-term outcomes. We compared short-term outcomes and long-term survival in patients who underwent CABG with MAG performed by attending surgeons or resident trainees at a single institution over a period of 19 years. Using our institutional database, we identified 3039 patients undergoing MAG from 1996-2015. Of those, 958 (32%) were operated on by residents and 2081 (68%) by attending surgeons...
April 2017: Seminars in Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28679200/closed-loop-ventilation-mode-in-intensive-care-unit-a-randomized-controlled-clinical-trial-comparing-the-numbers-of-manual-ventilator-setting-changes
#19
Jean-Michel Arnal, Aude Garnero, Dominik Novotni, Gaëlle Corno, Stéphane Y Donati, Didier Demory, Gabrielle Quintana, Laurent Ducros, Thomas Laubscher, Jacques Durand-Gasselin
BACKGROUND: There is an equipoise regarding closed-loop ventilation modes and the ability to reduce workload for providers. On one hand some settings are managed by the ventilator but on another hand the automatic mode introduces new settings for the user. METHODS: This randomized controlled trial compared the number of manual ventilator setting changes between a full closed loop ventilation and oxygenation mode (INTELLiVENT-ASV®) and conventional ventilation modes (volume assist control and pressure support) in intensive care unit (ICU) patients...
July 5, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28669261/dupuytren-s-disease-my-personal-view
#20
D Warwick
Dupuytren's disease is a heterogenous condition for which a palette of treatment options is required. Randomized control trial evidence is sparse; design challenges, such as validated outcome measures, blinding, equipoise, funding and assessment of recurrence, may limit further data accrual. Recurrence has different significance with different treatments and so rates are not directly comparable. The risk of any treatment is a function of both the chance of a complication and the clinical sequelae of that complication...
June 1, 2017: Journal of Hand Surgery, European Volume
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