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https://www.readbyqxmd.com/read/28423227/a-national-survey-of-screening-and-management-of-hypogammaglobulinemia-in-canadian-transplantation-centers
#1
Samuel Bourassa-Blanchette, Greg Knoll, Jason Tay, Christopher Bredeson, Donald W Cameron, Juthaporn Cowan
BACKGROUND: Infection remains one of the most common transplant-related causes of death in patients undergoing transplantation. Secondary hypogammaglobulinemia (HGG) as a component of immune suppression and deficiency is associated with both solid organ (SOT) and hematopoietic cell transplantation (HCT). Available data and clinical experience for the supplementation of immunoglobulin (Ig) in these patients is conflicting, and clinical equipoise accounts for non-uniform practice in the use of Ig treatment...
April 18, 2017: Transplant Infectious Disease: An Official Journal of the Transplantation Society
https://www.readbyqxmd.com/read/28417662/clinician-views-of-patient-decisional-conflict-when-deciding-between-dialysis-and-conservative-management-qualitative-findings-from-the-palliative-care-in-chronic-kidney-disease-packs-study
#2
Helen Noble, Kevin Brazil, Aine Burns, Sarah Hallahan, Charles Normand, Paul Roderick, Colin Thompson, Peter Maxwell, Magdi Yaqoob
BACKGROUND: Only a paucity of studies have addressed clinician perspectives on patient decisional conflict, in making complex decisions between dialysis and conservative management (renal supportive and palliative care). AIM: To explore clinician views on decisional conflict in patients with end-stage kidney disease. DESIGN: Interpretive, qualitative study. SETTING AND PARTICIPANTS: As part of the wider National Institute for Health Research, PAlliative Care in chronic Kidney diSease study, semi-structured interviews were conducted with clinicians (nephrologists n = 12; 7 female and clinical nurse specialists n = 15; 15 female) across 10 renal centres in the United Kingdom...
April 1, 2017: Palliative Medicine
https://www.readbyqxmd.com/read/28410636/stent-and-leaflet-stresses-in-29-mm-second-generation-balloon-expandable-transcatheter-aortic-valve
#3
Yue Xuan, Kapil Krishnan, Jian Ye, Danny Dvir, Julius M Guccione, Liang Ge, Elaine E Tseng
BACKGROUND: Equipoise of transcatheter aortic valve replacement with surgical aortic valve replacement in intermediate-risk patients has been demonstrated. As transcatheter aortic valve replacement usage expands, questions regarding long-term durability become paramount. Valve design impacts durability with regions of increased leaflet stress being vulnerable to early failure. However, transcatheter aortic valve (TAV) leaflet stresses are unknown. The objective of this study was to determine stent and leaflet stresses of second-generation balloon-expandable TAV...
April 12, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28396558/vaccine-testing-for-emerging-infections-the-case-for-individual-randomisation
#4
Nir Eyal, Marc Lipsitch
During the 2014-2015 Ebola outbreak in Guinea, Liberia and Sierra Leone, many opposed the use of individually randomised controlled trials to test candidate Ebola vaccines. For a raging fatal disease, they explained, it is unethical to relegate some study participants to control arms. In Zika and future emerging infections, similar opposition may hinder urgent vaccine research, so it is best to address these questions now. This article lays out the ethical case for individually randomised control in testing vaccines against many emerging infections, including lethal infections in low-income countries, even when at no point in the trial do the controls receive the countermeasures being tested...
April 10, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28377232/comparison-of-safety-and-efficacy-of-unfractionated-heparin-versus-bivalirudin-in-patients-undergoing-percutaneous-coronary-intervention
#5
Ahmed Rehmani, Chris Judkins, Alan Whelan, Michael Nguyen, Carl Schultz
BACKGROUND: Anti-platelet and anti-coagulant adjunctive therapies are associated with a clinically significant increased risk of major bleeding. We retrospectively assessed in hospital major adverse clinical events (MACE) and major bleeding in patients undergoing percutaneous coronary intervention (PCI) who received either unfractionated heparin (UFH) or bivalirudin. METHOD: Consecutive patients undergoing PCI for acute coronary syndrome (ACS) at Fremantle Hospital from August 2008 to December 2013 were identified...
February 28, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28376001/equipoise-on-the-use-of-steroids-in-systemic-inflammatory-response-syndrome
#6
David Jardine
No abstract text is available yet for this article.
April 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28362926/launching-effectiveness-research-to-guide-practice-in-neurosurgery-a-national-institute-neurological-disorders-and-stroke-workshop-report
#7
Patricia Walicke, Aviva Abosch, Anthony Asher, Fred G Barker, Zoher Ghogawala, Robert Harbaugh, Lara Jehi, John Kestle, Walter Koroshetz, Roderick Little, Donald Rubin, Alex Valadka, Stephen Wisniewski, E Antonio Chiocca
This workshop addressed challenges of clinical research in neurosurgery. Randomized controlled clinical trials (RCTs) have high internal validity, but often insufficiently generalize to real-world practice. Observational studies are inclusive but often lack sufficient rigor. The workshop considered possible solutions, such as (1) statistical methods for demonstrating causality using observational data; (2) characteristics required of a registry supporting effectiveness research; (3) trial designs combining advantages of observational studies and RCTs; and (4) equipoise, an identified challenge for RCTs...
April 1, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28347354/equipoise-across-the-patient-population-optimising-recruitment-to-a-randomised-controlled-trial
#8
Paul Whybrow, Robert Pickard, Susan Hrisos, Tim Rapley
BACKGROUND: This paper proposes a novel perspective on the value of qualitative research for improving trial design and optimising recruitment. We report findings from a qualitative study set within the OPEN trial, a surgical randomised controlled trial (RCT) comparing two interventions for recurrent bulbar urethral stricture, a common cause of urinary problems in men. METHODS: Interviews were conducted with men meeting trial eligibility criteria (n = 19) to explore reasons for accepting or declining participation and with operating urologists (n = 15) to explore trial acceptability...
March 27, 2017: Trials
https://www.readbyqxmd.com/read/28343732/ethical-issues-in-non-intervention-trials-for-thyroid-cancer
#9
P Angelos, D M Hartl, J P Shah, I J Nixon, R P Owen, A Rinaldo, J P Rodrigo, A R Shaha, C E Silver, C Suárez, A Ferlito
In recent years, the increasing numbers of small, apparently indolent thyroid cancers diagnosed in the world have encouraged investigators to consider non-intervention as an alternative to surgical management. In the following pages, the prospect of a non-intervention trial for thyroid cancer is considered with attention to the ethical issues that such a trial might raise. Such a non-intervention trial is analyzed relative to 7 ethical considerations: the social or scientific value of the research, the scientific validity of the trial, the necessity of fair selection of participants, a favorable risk-benefit ratio for trial participants, independent review of the trial, informed consent, and allowing the study participants to withdraw from the trial...
March 16, 2017: European Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28321533/perioperative-antibiotic-use-in-vagus-nerve-stimulator-implantation-a-clinical-series
#10
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
#11
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 30, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28302754/apixaban-pharmacokinetics-at-steady-state-in-hemodialysis-patients
#12
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
#13
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
#14
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
#15
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...
April 2017: Clinical Neurology and Neurosurgery
https://www.readbyqxmd.com/read/28279467/controversies-and-consensus-in-preoperative-therapy-of-esophageal-and-gastroesophageal-junction-cancers
#16
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
#17
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
#18
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
#19
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
#20
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
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