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Equipoise

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https://www.readbyqxmd.com/read/28220947/does-anyone-really-believe-the-results-of-the-danish-trial-implanting-an-icd-in-non-ischemic-cardiomyopathy-patients
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
https://www.readbyqxmd.com/read/28112403/a-systems-approach-to-physiologic-evolution-from-micelles-to-consciousness
#11
REVIEW
John S Torday, William B Miller
A systems approach to evolutionary biology offers the promise of an improved understanding of the fundamental principles of life through the effective integration of many biologic disciplines. It is presented that any critical integrative approach to evolutionary development involves a paradigmatic shift in perspective, more than just the engagement of a large number of disciplines. Critical to this differing viewpoint is the recognition that all biological processes originate from the unicellular state and remain permanently anchored to that phase throughout evolutionary development despite their macroscopic appearances...
January 23, 2017: Journal of Cellular Physiology
https://www.readbyqxmd.com/read/28106661/swallowing-after-transoral-surgery-for-oropharyngeal-cancer-comparison-with-primary-chemoradiotherapy-outcomes
#12
Nicholas Dawe, James O'Hara
PURPOSE OF REVIEW: Survival equipoise is recognized between the contemporary surgical and oncological approaches to oropharyngeal squamous cell carcinoma treatment. Primary transoral surgery (TOS) options have emerged that utilize either laser or robotic techniques. Our review presents an overview of the evidence available for swallowing outcomes following TOS approaches and compares these with outcomes following primary oncological management. RECENT FINDINGS: Meta-analysis of swallow outcomes following TOS or (chemo)radiotherapy is not possible given the heterogeneity of the available data...
January 18, 2017: Current Opinion in Otolaryngology & Head and Neck Surgery
https://www.readbyqxmd.com/read/28103445/factors-influencing-radiation-treatment-recommendations-in-early-stage-merkel-cell-carcinoma-a-survey-of-us-based-radiation-oncologists
#13
Yolanda D Tseng, Smith Apisarnthanarax, Jay J Liao, Shailender Bhatia, Paul T Nghiem, Upendra Parvathaneni
BACKGROUND: It is unclear which subgroups of Merkel cell carcinoma (MCC) patients benefit the most from radiation. We surveyed radiation oncologists (RO) that regularly see and treat MCC to understand how they approach the treatment of early-stage MCC. METHODS: A web-based survey was emailed to 63 ROs, who were identified through publications, guideline panel membership, and/or affiliation with institutions of high MCC volume. ROs provided treatment recommendations for two hypothetical case scenarios of early stage MCC...
March 2017: Expert Review of Anticancer Therapy
https://www.readbyqxmd.com/read/28100960/a-survey-of-thrombosis-experts-evaluating-practices-and-opinions-regarding-venous-thromboprophylaxis-in-patients-post-major-abdominal-surgery
#14
Bader Al Rawahi, Grégoire Le Gal, Rebecca Auer, Marc Carrier
BACKGROUND: Patients undergoing major abdominal surgery are at high risk for developing venous thromboembolism in the post-operative period. Current evidence-based guidelines recommend routine pharmacological venous thromboembolism prophylaxis in patient at moderate to high risk post major abdominal surgery. However, the type of agent, dose and duration of thromboprophylaxis remain unclear. We sought to survey current clinical practice and assess for potential clinical equipoise regarding pharmacological thromboprophylaxis post major abdominal surgery...
2017: Thrombosis Journal
https://www.readbyqxmd.com/read/28096194/autologous-cell-therapy-for-peripheral-arterial-disease-systematic-review-and-meta-analysis-of-randomized-non-randomized-and-non-controlled-studies
#15
Mauro Rigato, Matteo Monami, Gian Paolo Fadini
RATIONALE: Critical limb ischemia (CLI) is a life-threatening complication of peripheral arterial disease (PAD). In patients who are ineligible for revascularization procedures, there are few therapeutic alternatives, leading to amputations and death. OBJECTIVE: To provide a systematic review of the literature and a meta-analysis of studies evaluating safety and efficacy of autologous cell therapy for intractable PAD/CLI. METHODS AND RESULTS: We retrieved 19 randomized controlled trials (RCTs; 837 patients), 7 non-randomized trials (338 patients), and 41 non-controlled studies (1,177 patients)...
January 17, 2017: Circulation Research
https://www.readbyqxmd.com/read/28034908/targeted-oxygen-in-the-resuscitation-of-preterm-infants-a-randomized-clinical-trial
#16
Ju Lee Oei, Ola D Saugstad, Kei Lui, Ian M Wright, John P Smyth, Paul Craven, Yueping Alex Wang, Rowena McMullan, Elisabeth Coates, Meredith Ward, Parag Mishra, Koert De Waal, Javeed Travadi, Kwee Ching See, Irene G S Cheah, Chin Theam Lim, Yao Mun Choo, Azanna Ahmad Kamar, Fook Choe Cheah, Ahmed Masoud, William Tarnow-Mordi
BACKGROUND AND OBJECTIVES: Lower concentrations of oxygen (O2) (≤30%) are recommended for preterm resuscitation to avoid oxidative injury and cerebral ischemia. Effects on long-term outcomes are uncertain. We aimed to determine the effects of using room air (RA) or 100% O2 on the combined risk of death and disability at 2 years in infants <32 weeks' gestation. METHODS: A randomized, unmasked study designed to determine major disability and death at 2 years in infants <32 weeks' gestation after delivery room resuscitation was initiated with either RA or 100% O2 and which were adjusted to target pulse oximetry of 65% to 95% at 5 minutes and 85% to 95% until NICU admission...
January 2017: Pediatrics
https://www.readbyqxmd.com/read/28003553/economics-of-home-monitoring-for-apnea-in-late-preterm-infants
#17
Brian L Montenegro, Michael Amberson, Lauren Veit, Christina Freiberger, Dmitry Dukhovny, Lawrence M Rhein
BACKGROUND: Apnea of prematurity affects a small proportion but large absolute number of late preterm infants, with out-patient management variably utilized despite relative clinical equipoise and potential for improved cost-effectiveness. METHODS: Over a 5-y period, from 2009 to 2013, infants born at ≥34 weeks gestational age at a level IIIB academic center in Boston, Massachusetts, with discharge-delaying apnea, bradycardia, and desaturation (ABD) events were identified...
January 2017: Respiratory Care
https://www.readbyqxmd.com/read/27982726/a-bayesian-analysis-of-a-randomized-clinical-trial-comparing-antimetabolite-therapies-for-non-infectious-uveitis
#18
Erica N Browne, Sivakumar R Rathinam, Anuradha Kanakath, Radhika Thundikandy, Manohar Babu, Thomas M Lietman, Nisha R Acharya
PURPOSE: To conduct a Bayesian analysis of a randomized clinical trial (RCT) for non-infectious uveitis using expert opinion as a subjective prior belief. METHODS: A RCT was conducted to determine which antimetabolite, methotrexate or mycophenolate mofetil, is more effective as an initial corticosteroid-sparing agent for the treatment of intermediate, posterior, and pan-uveitis. Before the release of trial results, expert opinion on the relative effectiveness of these two medications was collected via online survey...
February 2017: Ophthalmic Epidemiology
https://www.readbyqxmd.com/read/27965848/a-feasibility-study-incorporating-a-pilot-randomised-controlled-trial-of-oral-feeding-plus-pre-treatment-gastrostomy-tube-versus-oral-feeding-plus-as-needed-nasogastric-tube-feeding-in-patients-undergoing-chemoradiation-for-head-and-neck-cancer-tube-trial-study
#19
Vinidh Paleri, Joshua Wood, Joanne Patterson, Deborah D Stocken, Mike Cole, Luke Vale, Jeremy Franks, Teresa Guerrero-Urbano, Rachael Donnelly, Stewart Barclay, Tim Rapley, Nikki Rousseau
BACKGROUND: There are 7000 new cases of head and neck squamous cell cancers (HNSCC) treated by the NHS each year. Stage III and IV HNSCC can be treated non-surgically by radio therapy (RT) or chemoradiation therapy (CRT). CRT can affect eating and drinking through a range of side effects with 90 % of patients undergoing this treatment requiring nutritional support via gastrostomy (G) or nasogastric (NG) tube feeding. Long-term dysphagia following CRT is a primary concern for patients...
2016: Pilot and Feasibility Studies
https://www.readbyqxmd.com/read/27940456/perioperative-cognitive-protection
#20
C Brown, S Deiner
There is significant evidence that many older surgical patients experience at least a transient decrease in cognitive function. Although there is still equipoise regarding the degree, duration, and mechanism of cognitive dysfunction, there is a concurrent need to provide best-practice clinical evidence. The two major cognitive disorders seen after surgery are postoperative delirium and postoperative cognitive dysfunction. Delirium is a public health problem; millions of dollars are spent annually on delirium-related medical resource use and prolonged hospital stays...
December 2016: British Journal of Anaesthesia
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