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https://www.readbyqxmd.com/read/29784051/contributions-of-a-survey-and-retrospective-cohort-study-to-the-planning-of-a-randomised-controlled-trial-of-corticosteroids-in-the-treatment-of-paediatric-septic-shock
#1
Anna Liu, Kusum Menon
BACKGROUND: Randomised controlled trials (RCTs) are challenging to conduct in a paediatric critical-care environment. Background work, including surveys and observational studies, is often used to determine disease estimates, sample sizes and design protocols when planning such RCTs. Our objective was to determine the necessity of performing a survey or a retrospective chart review or both when planning an RCT on corticosteroids in the treatment of paediatric septic shock. METHODS: We compared information on corticosteroid use for moderate to severe paediatric septic shock obtained from a survey of physician beliefs and stated practices with that obtained from a retrospective cohort study...
May 21, 2018: Trials
https://www.readbyqxmd.com/read/29774757/extended-pelvic-lymph-node-dissection-in-bladder-cancer
#2
Roger Li, Firas G Petros, John W Davis
INTRODUCTION: Radical cystectomy and extended pelvic lymph node dissection (ePLND) are the gold standard treatment for muscle-invasive bladder cancer and BCG unresponsive nonmuscle-invasive bladder cancer. In this article, we review the rationale for ePLND in the treatment of bladder cancer and the evidence supporting the equipoise between robot-assisted (RA) and open ePLND. A step-by-step guide of robot-assisted ePLND (RA ePLND) is provided to illustrate the techniques currently employed at our institution...
May 2018: Journal of Endourology
https://www.readbyqxmd.com/read/29772572/lack-of-equipoise-on-ankle-block-after-hallux-valgus-surgery
#3
Mark C Kendall, Lucas Castro Alves
No Abstract.
May 17, 2018: Medical Principles and Practice: International Journal of the Kuwait University, Health Science Centre
https://www.readbyqxmd.com/read/29756373/do-feeding-practices-during-transfusion-influence-the-risk-of-developing-necrotising-enterocolitis-in-preterm-infants
#4
Cathie Hilditch, Amy Keir
Our evidence-based review set out to answer the clinical question 'In a preterm infant (patient) with anaemia of prematurity, do feeding practices (intervention) during blood transfusion reduce the risk of developing transfusion-associated necrotising enterocolitis (outcome)'? We found limited evidence that withholding feeding during red blood cell transfusion in preterm infants may reduce the risk of development of transfusion-associated necrotising enterocolitis. As clinical equipoise seemingly exists, it seems reasonable for individual units to make their own decisions regarding whether to withhold or continue enteral feeds during red blood cell transfusion until further evidence is available...
May 2018: Journal of Paediatrics and Child Health
https://www.readbyqxmd.com/read/29754673/prevalent-digoxin-use-and-subsequent-risk-of-death-or-hospitalization-in-ambulatory-heart-failure-patients-with-a-reduced-ejection-fraction-findings-from-the-heart-failure-a-controlled-trial-investigating-outcomes-of-exercise-training-hf-action-randomized-controlled
#5
Andrew P Ambrosy, Ankeet S Bhatt, Amanda L Stebbins, Lisa M Wruck, Marat Fudim, Stephen J Greene, William E Kraus, Christopher M O'Connor, Ileana L Piña, David J Whellan, Robert J Mentz
BACKGROUND: Despite more than 200 years of clinical experience and a pivotal trial, recently published research has called into question the safety and efficacy of digoxin therapy in heart failure (HF). METHODS: HF-ACTION (ClinicalTrials.gov Number: NCT00047437) enrolled 2331 outpatients with HF and an EF ≤35% between April 2003 and February 2007 and randomized them to aerobic exercise training versus usual care. Patients were grouped according to prevalent digoxin status at baseline...
May 2018: American Heart Journal
https://www.readbyqxmd.com/read/29753517/liberal-versus-restrictive-intravenous-fluid-therapy-for-early-septic-shock-rationale-for-a-randomized-trial
#6
Wesley H Self, Matthew W Semler, Rinaldo Bellomo, Samuel M Brown, Bennett P deBoisblanc, Matthew C Exline, Adit A Ginde, Colin K Grissom, David R Janz, Alan E Jones, Kathleen D Liu, Stephen P J Macdonald, Chadwick D Miller, Pauline K Park, Lora A Reineck, Todd W Rice, Jay S Steingrub, Daniel Talmor, Donald M Yealy, Ivor S Douglas, Nathan I Shapiro
Prompt intravenous fluid therapy is a fundamental treatment for patients with septic shock. However, the optimal approach for administering intravenous fluid in septic shock resuscitation is unknown. Two competing strategies are emerging: a liberal fluids approach, consisting of a larger volume of initial fluid (50 to 75 mL/kg [4 to 6 L in an 80-kg adult] during the first 6 hours) and later use of vasopressors, versus a restrictive fluids approach, consisting of a smaller volume of initial fluid (≤30 mL/kg [≤2 to 3 L]), with earlier reliance on vasopressor infusions to maintain blood pressure and perfusion...
May 9, 2018: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/29752325/sequential-versus-concurrent-chemoradiation-therapy-by-surgical-margin-status-in-resected-non-small-cell-lung-cancer
#7
Vivek Verma, Amy C Moreno, Waqar Haque, Penny Fang, Steven H Lin
Background: Postoperative chemoradiotherapy (CRT) for non-small cell lung cancer (NSCLC) can be delivered sequentially (sCRT) or concurrently (cCRT). Without high-volume data, current guidelines recommend either option for patients with negative margins (M-) and cCRT for those with positive margins (M+). In this study, survival was compared between sCRT versus cCRT for M- and M+ disease; survival in patients who underwent sCRT was also assessed with chemotherapy-first versus radiotherapy (RT)-first. Methods: The National Cancer Database was queried for patients with primary NSCLC undergoing surgery followed by CRT...
May 2018: Journal of the National Comprehensive Cancer Network: JNCCN
https://www.readbyqxmd.com/read/29735141/expert-consensus-and-equipoise-planning-a-randomized-controlled-trial-of-magnetically-controlled-growing-rods
#8
Nicholas Feinberg, Hiroko Matsumoto, Chun Wai Hung, Tricia St Hilaire, Jeff Pawelek, Jeffrey R Sawyer, Behrooz A Akbarnia, David L Skaggs, Benjamin D Roye, David P Roye, Michael G Vitale
STUDY DESIGN: Expert consensus building using combined Delphi method and Nominal group technique. OBJECTIVES: To identify the current state of equipoise surrounding the use of magnetically controlled growing rods (MCGRs) and to determine consensus for planning a randomized controlled trial (RCT) with MCGRs. BACKGROUND: The use of MCGRs for the treatment of early-onset scoliosis (EOS) is a new technology. Optimal use has not been thoroughly investigated and much uncertainty exists...
May 2018: Spine Deformity
https://www.readbyqxmd.com/read/29720045/protocol-for-a-prospective-collaborative-systematic-review-and-meta-analysis-of-individual-patient-data-from-randomized-controlled-trials-of-vasoactive-drugs-in-acute-stroke-the-blood-pressure-in-acute-stroke-collaboration-stage-3
#9
Else Charlotte Sandset, Nerses Sanossian, Lisa J Woodhouse, Craig Anderson, Eivind Berge, Kennedy R Lees, John F Potter, Thompson G Robinson, Nikola Sprigg, Joanna M Wardlaw, Philip M Bath
Rationale Despite several large clinical trials assessing blood pressure lowering in acute stroke, equipoise remains particularly for ischemic stroke. The "Blood pressure in Acute Stroke Collaboration" commenced in the mid-1990s focussing on systematic reviews and meta-analysis of blood pressure lowering in acute stroke. From the start, Blood pressure in Acute Stroke Collaboration planned to assess safety and efficacy of blood pressure lowering in acute stroke using individual patient data. Aims To determine the optimal management of blood pressure in patients with acute stroke, including both intracerebral hemorrhage and ischemic stroke...
January 1, 2018: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/29716584/clinicians-attitude-towards-a-placebo-controlled-randomised-clinical-trial-investigating-the-effect-of-neuraminidase-inhibitors-in-adults-hospitalised-with-influenza
#10
Naomi Bradbury, Jonathan Nguyen-Van-Tam, Wei Shen Lim
BACKGROUND: The value of neuraminidase inhibitors (NAIs) in reducing severe clinical outcomes from influenza is debated. A clinical trial to generate better evidence is desirable. However, it is unknown whether UK clinicians would support a placebo-controlled trial. A survey was conducted to determine the attitude of clinicians towards a clinical trial and their current practice in managing adults admitted to hospital with suspected influenza. METHODS: Senior clinicians (n = 50) across the UK actively involved in the care of patients hospitalised with severe respiratory infections and/or respiratory infection research were invited to participate in an on-line survey...
May 2, 2018: BMC Health Services Research
https://www.readbyqxmd.com/read/29703860/thinking-clearly-about-the-first-trial-addressing-ethical-challenges-in-cluster-randomised-trials-of-policy-interventions-involving-health-providers
#11
Austin R Horn, Charles Weijer, Spencer Phillips Hey, Jamie Brehaut, Dean A Fergusson, Cory E Goldstein, Jeremy Grimshaw, Monica Taljaard
The ethics of the Flexibility In duty hour Requirements for Surgical Trainees (FIRST) trial have been vehemently debated. Views on the ethics of the FIRST trial range from it being completely unethical to wholly unproblematic. The FIRST trial illustrates the complex ethical challenges posed by cluster randomised trials (CRTs) of policy interventions involving healthcare professionals. In what follows, we have three objectives. First, we critically review the FIRST trial controversy, finding that commentators have failed to sufficiently identify and address many of the relevant ethical issues...
April 27, 2018: Journal of Medical Ethics
https://www.readbyqxmd.com/read/29692235/perioperative-corticosteroids-in-children-undergoing-congenital-heart-surgery-five-decades-of-clinical-equipoise
#12
COMMENT
Kevin D Hill, Prince J Kannankeril
No abstract text is available yet for this article.
May 2018: World Journal for Pediatric & Congenital Heart Surgery
https://www.readbyqxmd.com/read/29691101/influenza-vaccination-in-the-elderly-is-a-trial-on-mortality-ethically-acceptable
#13
Ruud Andreas Fritz Verhees, Wybo Dondorp, Carel Thijs, Geert Jan Dinant, Johannes Andreas Knottnerus
The effectiveness of influenza vaccination in the elderly has long been a topic of debate, fueled by the absence of direct evidence from randomized trials on its effect on mortality and the methodological limitations of observational studies pointing this direction. It is argued that new placebo-controlled trials should be undertaken to resolve this uncertainty. However, such trials may be ethically questionable. To bring this discussion forward, we provide a comprehensive overview of the ethical challenges of an influenza vaccine efficacy trial designed to evaluate mortality in the elderly...
April 21, 2018: Vaccine
https://www.readbyqxmd.com/read/29680220/hybrid-coronary-revascularization-5-years-on-is-clinical-equipoise-good-enough
#14
EDITORIAL
Adrian W Messerli, Naoki Misumida
No abstract text is available yet for this article.
April 12, 2018: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/29677977/the-evaluation-of-decision-support-tools-requires-a-measure-of-decision-quality-that-has-content-and-construct-validity-in-person-centred-care
#15
Mette Kjer Kaltoft, Jesper Bo Nielsen, Jack Dowie
The evaluation of decision aids and support interventions requires a multi-attribute index which can be calculated for both aid and comparator/s. The Decision Conflict Scale (DCS) is such an index and has been widely used in this context, the recent Cochrane review Decision aids for people facing health treatment or screening decisions reporting its use in 63 of the 105 studies included. However, while the DCS may be a valid measure for the eponymous construct - decision conflict - it lacks both content and construct validity for the evaluation of decision aids...
2018: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/29675941/anticoagulation-in-the-management-of-neonatal-cerebral-sinovenous-thrombosis-a-systematic-review-and-meta-analysis
#16
REVIEW
Thomas Rossor, Tomoki Arichi, Sanjay Bhate, Anthony R Hart, Rahul Raman Singh
AIM: To determine whether anticoagulation therapy (ACT) in the treatment of neonatal cerebral sinovenous thrombosis (CSVT) improves outcomes, in the presence or absence of pre-existing intracerebral haemorrhage (ICH). METHOD: We searched CENTRAL, MEDLINE, Embase, CINAHL, the Web of Science, and clinical trial databases. We considered data from retrospective and prospective cohort studies, case series, and randomized controlled studies evaluating outcomes of CSVT treated with anticoagulation or no anticoagulation...
April 19, 2018: Developmental Medicine and Child Neurology
https://www.readbyqxmd.com/read/29650060/gastrostomy-versus-nasogastric-tube-feeding-for-chemoradiation-patients-with-head-and-neck-cancer-the-tube-pilot-rct
#17
Vinidh Paleri, Joanne Patterson, Nikki Rousseau, Eoin Moloney, Dawn Craig, Dimitrios Tzelis, Nina Wilkinson, Jeremy Franks, Ann Marie Hynes, Ben Heaven, David Hamilton, Teresa Guerrero-Urbano, Rachael Donnelly, Stewart Barclay, Tim Rapley, Deborah Stocken
BACKGROUND: Approximately 9000 new cases of head and neck squamous cell cancers (HNSCCs) are treated by the NHS each year. Chemoradiation therapy (CRT) is a commonly used treatment for advanced HNSCC. Approximately 90% of patients undergoing CRT require nutritional support via gastrostomy or nasogastric tube feeding. Long-term dysphagia following CRT is a primary concern for patients. The effect of enteral feeding routes on swallowing function is not well understood, and the two feeding methods have, to date (at the time of writing), not been compared...
April 2018: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/29626285/image-guided-minimally-invasive-treatment-for-small-renal-cell-carcinoma
#18
REVIEW
Miltiadis E Krokidis, Panagiotis Kitrou, Stavros Spiliopoulos, Dimitrios Karnabatidis, Konstantinos Katsanos
Surgical partial nephrectomy is still considered as the "gold standard" for the definitive management of small malignant renal masses, whereas treatment with image-guided percutaneous ablation is still mainly reserved for those patients who cannot undergo nephron-sparing surgical resection due to advanced age, underlying comorbidities or compromised renal function. Nonetheless, the recent evidence that underlines the long-term oncological equipoise of percutaneous ablation methods with surgical resection in combination with the reduced complication rate and cost supports the use of an image-guided minimally invasive approach as a first-line treatment...
April 6, 2018: Insights Into Imaging
https://www.readbyqxmd.com/read/29624530/diagnostic-accuracy-of-point-of-care-gastric-ultrasound
#19
Richelle Kruisselbrink, Angineh Gharapetian, Luis E Chaparro, Noam Ami, Dustin Richler, Vincent W S Chan, Anahi Perlas
BACKGROUND: Pulmonary aspiration of gastric contents is associated with significant perioperative morbidity and mortality. Previous studies have investigated the validity, reliability, and possible clinical impact of gastric ultrasound for the assessment of gastric content at the bedside. In the present study, we examined the accuracy (evaluated as sensitivity, specificity, and likelihood ratios) of point-of-care gastric ultrasound to detect a "full stomach" in a simulated scenario of clinical equipoise...
April 5, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29600929/-paediatric-epilepsy-surgery-the-earlier-the-better
#20
K P J Braun, P van Eijsden
The first randomised trial of paediatric epilepsy surgery demonstrated what was already known for decades among physicians of children with refractory epilepsy: surgical treatment is a highly successful treatment option with superior efficacy compared to ongoing drug treatment in well-selected surgical candidates. The lack of equipoise and the design of the trial - in which half of the children had to wait for one year before being offered surgery - raises questions about its ethical justification. A shorter duration of epilepsy predicts better cognitive and seizure outcomes after surgery...
2018: Nederlands Tijdschrift Voor Geneeskunde
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