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https://www.readbyqxmd.com/read/29150875/treatment-of-acquired-thrombotic-thrombocytopenic-purpura-in-the-u-s-remains-heterogeneous-current-and-future-points-of-clinical-equipoise
#1
Marshall A Mazepa, Jay S Raval, Mark E Brecher, Yara A Park
BACKGROUND: The purpose of this survey was to describe current practices in the U.S. for treatment of acquired Thrombotic Thrombocytopenic Purpura (TTP), compare these with prior U.S. and current Canadian practices, and identify areas of clinical equipoise. STUDY DESIGN AND METHODS: A research team member administered the survey by telephone. Questions included an estimate of the annual patient volume treated, apheresis and medical therapy practices for acquired TTP...
November 18, 2017: Journal of Clinical Apheresis
https://www.readbyqxmd.com/read/29115100/efficacy-of-decompressive-craniectomy-in-the-management-of-intracranial-pressure-in-severe-traumatic-brain-injury
#2
John K Yue, Jonathan W Rick, Hansen Deng, Michael J Feldman, Ethan A Winkler
Traumatic brain injury (TBI) is a common cause of permanent disability for which clinical management remains suboptimal. Elevated intracranial pressure (ICP) is a common sequela following TBI leading to death and permanent disability if not properly managed. While clinicians often employ stepwise acute care algorithms to reduce ICP, a number of patients will fail medical management and may be considered for surgical decompression. Decompressive craniectomy (DC) involves removing a component of the bony skull to allow cerebral tissue expansion in order to reduce ICP...
November 7, 2017: Journal of Neurosurgical Sciences
https://www.readbyqxmd.com/read/29102583/endothelial-barrier-protein-expression-in-biodegradable-polymer-sirolimus-eluting-versus-durable-polymer-everolimus-eluting-metallic-stents
#3
Hiroyoshi Mori, Qi Cheng, Christoph Lutter, Samantha Smith, Liang Guo, Matthew Kutyna, Sho Torii, Emanuel Harari, Eduardo Acampado, Michael Joner, Frank D Kolodgie, Renu Virmani, Aloke V Finn
OBJECTIVES: This study sought to investigate endothelial coverage and barrier protein expression following stent implantation. BACKGROUND: Biodegradable polymer drug-eluting stents (BP-DES) have been purported to have biological advantages in vessel healing versus durable polymer DES (DP-DES), although clinical trial data suggest equipoise. METHODS: Biodegradable polymer-sirolimus-eluting stents (BP-SES), durable polymer-everolimus-eluting stents (DP-EES), and bare-metal stents (BMS) were compared...
October 25, 2017: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/29082019/antenatal-corticosteroids-for-women-at-risk-of-imminent-preterm-birth-in-low-resource-countries-the-case-for-equipoise-and-the-need-for-efficacy-trials
#4
REVIEW
Joshua P Vogel, Olufemi T Oladapo, Cynthia Pileggi-Castro, Ebunoluwa A Adejuyigbe, Fernando Althabe, Shabina Ariff, Adejumoke Idowu Ayede, Abdullah H Baqui, Anthony Costello, Davy M Chikamata, Caroline Crowther, Bukola Fawole, Luz Gibbons, Alan H Jobe, Monica Lulu Kapasa, John Kinuthia, Alka Kriplani, Oluwafemi Kuti, James Neilson, Janna Patterson, Gilda Piaggio, Rahat Qureshi, Zahida Qureshi, Mari Jeeva Sankar, Jeffrey S A Stringer, Marleen Temmerman, Khalid Yunis, Rajiv Bahl, A Metin Gülmezoglu
The scientific basis for antenatal corticosteroids (ACS) for women at risk of preterm birth has rapidly changed in recent years. Two landmark trials-the Antenatal Corticosteroid Trial and the Antenatal Late Preterm Steroids Trial-have challenged the long-held assumptions on the comparative health benefits and harms regarding the use of ACS for preterm birth across all levels of care and contexts, including resource-limited settings. Researchers, clinicians, programme managers, policymakers and donors working in low-income and middle-income countries now face challenging questions of whether, where and how ACS can be used to optimise outcomes for both women and preterm newborns...
2017: BMJ Global Health
https://www.readbyqxmd.com/read/29074336/the-role-of-fenestration-in-management-of-type-i-thoracolumbar-disk-degeneration
#5
REVIEW
Nick D Jeffery, Paul M Freeman
Fenestration offers the advantages of prophylaxis without the need for specialized instrumentation and imaging. Currently there is a lack of equipoise regarding the efficacy of fenestration relative to decompression for treatment of acute canine intervertebral disk herniation; most veterinary spinal surgeons do not consider the 2 procedures equivalently efficacious. Therapeutic fenestration should perhaps be given greater consideration, especially if advanced imaging shows only mild to moderate spinal cord compression or there are restrictions on the duration of surgery, when it might be better to spend the time on fenestration rather than decompression...
October 23, 2017: Veterinary Clinics of North America. Small Animal Practice
https://www.readbyqxmd.com/read/29065916/a-randomised-controlled-trial-assessing-the-severity-and-duration-of-depressive-symptoms-associated-with-a-clinically-significant-response-to-sertraline-versus-placebo-in-people-presenting-to-primary-care-with-depression-panda-trial-study-protocol-for-a-randomised
#6
George Salaminios, Larisa Duffy, Anthony Ades, Ricardo Araya, Katherine S Button, Rachel Churchill, Tim Croudace, Catherine Derrick, Padraig Dixon, Christopher Dowrick, Simon Gilbody, William Hollingworth, Vivien Jones, Tony Kendrick, David Kessler, Daphne Kounali, Paul Lanham, Alice Malpass, Tim J Peters, Derek Riozzie, Jude Robinson, Debbie Sharp, Laura Thomas, Nicky J Welton, Nicola Wiles, Glyn Lewis
BACKGROUND: Depressive symptoms are usually managed within primary care and antidepressant medication constitutes the first-line treatment. It remains unclear at present which people are more likely to benefit from antidepressant medication. This paper describes the protocol for a randomised controlled trial (PANDA) to investigate the severity and duration of depressive symptoms that are associated with a clinically significant response to sertraline compared to placebo, in people presenting to primary care with depression...
October 24, 2017: Trials
https://www.readbyqxmd.com/read/29059621/short-term-ozone-exposure-and-asthma-severity-weight-of-evidence-analysis
#7
REVIEW
Julie E Goodman, Ke Zu, Christine T Loftus, Heather N Lynch, Robyn L Prueitt, Isaac Mohar, Sara Pacheco Shubin, Sonja N Sax
To determine whether evidence indicates that short-term exposure to ambient concentrations of ozone in the United States can affect asthma severity, we systematically reviewed published controlled human exposure, epidemiology, and animal toxicity studies. The strongest evidence for a potential causal relationship came from epidemiology studies reporting increased emergency department visits and hospital admissions for asthma following elevated ambient ozone concentrations. However, while controlled exposure studies reported lung function decrements and increased asthma symptoms following high ozone exposures 160-400 parts per billion [ppb]), epidemiology studies evaluating similar outcomes reported less consistent results...
October 20, 2017: Environmental Research
https://www.readbyqxmd.com/read/29030896/how-good-are-the-current-guidelines-on-endometriosis
#8
Ying Cheong
Endometriosis is an enigmatic disorder that is fraught with management controversies and very often, there exists deep divides in management strategies amongst the generalist, the specialist who favours surgery, the specialist who favour medical treatment, and those who are equipoised. The lack of clarity on the aetiology of the disease most likely fuels the existing debates and enhance subjective management options. This article is protected by copyright. All rights reserved.
October 14, 2017: BJOG: An International Journal of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/29023957/the-ethics-of-public-policy-rcts-the-principle-of-policy-equipoise
#9
Douglas MacKay
In this article, I ask whether a principle analogous to the principle of clinical equipoise should govern the design and conduct of RCTs evaluating the effectiveness of policy interventions. I answer this question affirmatively, and introduce and defend the principle of policy equipoise. According to this principle, all arms of a policy RCT must be, at minimum, in a state of equipoise with the best proven policy that is also morally and practically attainable and sustainable. For all arms of a policy RCT, policy experts must either (1) reasonably disagree about whether the trial arms are more effective than this policy, or (2) know that they are...
October 11, 2017: Bioethics
https://www.readbyqxmd.com/read/29023642/hospital-admission-and-surgical-approach-to-tubal-ectopic-pregnancy-in-australia-2000-to-2014-a-population-based-study
#10
Charlotte Paull, Stephen J Robson
BACKGROUND: There are several accepted approaches to management of ectopic pregnancy, both surgical and non-surgical. When a surgical approach is used, there appears to be an equipoise between tubal preservation and removal. We sought to determine the patterns of surgical management of ectopic pregnancy in Australia since the year 2000. MATERIALS AND METHODS: Data regarding hospital admissions for ectopic pregnancy were extracted from the Australian Institute of Health and Welfare national procedural dataset for the years 2000-2013...
October 11, 2017: Australian & New Zealand Journal of Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/29020367/clinical-outcomes-of-state-of-the-art-percutaneous-coronary-revascularization-in-patients-with-de-novo-three-vessel-disease-1-year-results-of-the-syntax-ii-study
#11
Javier Escaned, Carlos Collet, Nicola Ryan, Giovanni Luigi De Maria, Simon Walsh, Manel Sabate, Justin Davies, Maciej Lesiak, Raul Moreno, Ignacio Cruz-Gonzalez, Stephan P Hoole, Nick Ej West, J J Piek, Azfar Zaman, Farzin Fath-Ordoubadi, Rodney H Stables, Clare Appleby, Nicolas van Mieghem, Robert Jm van Geuns, Neal Uren, Javier Zueco, Pawel Buszman, Andres Iñiguez, Javier Goicolea, David Hildick-Smith, Andrzej Ochala, Dariusz Dudek, Colm Hanratty, Rafael Cavalcante, Arie Pieter Kappetein, David P Taggart, Gerrit-Anne van Es, Marie-Angèle Morel, Ton de Vries, Yoshinobu Onuma, Vasim Farooq, Patrick W Serruys, Adrian P Banning
Aims: To investigate if recent technical and procedural developments in percutaneous coronary intervention (PCI) significantly influence outcomes in appropriately selected patients with three-vessel (3VD) coronary artery disease. Methods and results: The SYNTAX II study is a multicenter, all-comers, open-label, single arm study that investigated the impact of a contemporary PCI strategy on clinical outcomes in patients with 3VD in 22 centres from four European countries...
November 7, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28984168/perceptions-of-equipoise-risk-benefit-ratios-and-otherwise-healthy-volunteers-in-the-context-of-early-phase-hiv-cure-research-in-the-united-states-a-qualitative-inquiry
#12
Karine Dubé, Lynda Dee, David Evans, Laurie Sylla, Jeff Taylor, Brandon Brown, Veronica Miller, Amy Corneli, Asheley Skinner, Sandra B Greene, Joseph D Tucker, Stuart Rennie
Early-phase HIV cure research is conducted against a background of highly effective antiretroviral therapy, and involves risky interventions in individuals who enjoy an almost normal life expectancy. To explore perceptions of three ethical topics in the context of HIV cure research-(a) equipoise, (b) risk-benefit ratios, and (c) "otherwise healthy volunteers"-we conducted 36 in-depth interviews (IDIs) with three groups of purposively selected key informants: clinician-researchers ( n = 11), policy-makers and bioethicists ( n = 13), and people living with HIV (PLWHIV; n = 12)...
October 1, 2017: Journal of Empirical Research on Human Research Ethics: JERHRE
https://www.readbyqxmd.com/read/28982030/identifying-the-factors-influencing-practice-variation-in-thrombosis-medicine-a-qualitative-content-analysis-of-published-practice-pattern-surveys
#13
Leslie Skeith, Carol Gonsalves
Practice variation, the differences in clinical management between physicians, is one reason why patient outcomes may differ. Identifying factors that contribute to practice variation in areas of clinical uncertainty or equipoise may have implications for understanding and improving patient care. To discern what factors may influence practice variation, we completed a qualitative content analysis of all practice-pattern surveys in thrombosis medicine in the last 10years. Out of 2117 articles screened using a systematic search strategy, 33 practice-pattern surveys met eligibility criteria...
September 27, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28979535/exploring-obstacles-to-critical-care-trials-in-the-uk-a-qualitative-investigation
#14
Natalie Pattison, Nishkantha Arulkumaran, Sally Humphreys, Tim Walsh
BACKGROUND: Clinical trials in critical care are often resource-intense, with many unique challenges. Barriers to effective recruitment and implementation of study intervention have not been explored in a UK context. AIM: To identify facilitating factors and barriers to enrolling patients into critical care clinical trials within the UK from clinician's perspectives. METHODS: A qualitative interview study was undertaken on behalf of the National Institute of Health Research critical care specialty group, in which research active clinicians across different Clinical Research Networks were interviewed...
February 2017: J Intensive Care Soc
https://www.readbyqxmd.com/read/28960673/screening-for-heart-transplantation-and-left-ventricular-assist-system-results-from-the-screening-for-advanced-heart-failure-treatment-see-hf-study
#15
Lars H Lund, Jean-Noel Trochu, Bart Meyns, Kadir Caliskan, Steven Shaw, Jan D Schmitto, David Schibilsky, Laura Damme, Jerry Heatley, Finn Gustafsson
BACKGROUND: Heart transplantation (HTx) and implantable left ventricular assist systems (LVAS) improve outcomes in advanced heart failure but may be underutilized. We hypothesized that screening can identify appropriate candidates. METHODS AND RESULTS: The ScrEEning for advanced Heart Failure treatment (SEE-HF) study was a multicentre prospective study screening patients with existing cardiac resynchronization therapy (CRT) and/or implantable cardioverter-defibrillator (ICD) for ejection fraction ≤40% and New York Heart Association (NYHA) class III-IV, and subsequently for guideline-based HTx and LVAS indication...
September 27, 2017: European Journal of Heart Failure
https://www.readbyqxmd.com/read/28947723/-einstein-choice-comparison-of-rivaroxaban-treatment-and-prophylactic-doses-with-aspirin-in-the-extended-treatment-of-patients-with-venous-thromboembolism
#16
Cihangir Kaymaz
Although many patients with venous thromboembolism (VTE) may need extended treatment, efficacy and safety issues of full- or lower-intensity anticoagulation over acetyl salicylic acid (ASA) treatment have remained to be determined. EINSTEIN CHOICE is a randomized, double-blind and phase 3 study, and compared either once-daily rivaroxaban (at doses of 20 mg or 10 mg) and 100 mg of ASA in patients with VTE who were in equipoise regarding the need for extended anticoagulation. Study drugs were administered for up to 12 months...
September 2017: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
https://www.readbyqxmd.com/read/28945893/novel-method-of-measuring-canal-dehiscence-and-evaluation-of-its-potential-as-a-predictor-of-symptom-outcomes-after-middle-fossa-craniotomy
#17
Carlito Lagman, Joel S Beckett, Lawrance K Chung, Cheng Hao Jacky Chen, Brittany L Voth, Bilwaj Gaonkar, Quinton Gopen, Isaac Yang
BACKGROUND: Superior semicircular canal dehiscence (SSCD) is an osseous defect of the arcuate eminence of the petrous temporal bone. Strategies for measuring dehiscence size are variable, and the usefulness of such parameters remains in clinical equipoise. OBJECTIVE: To present a novel method of measuring dehiscence volume and to evaluate its potential as a predictor of symptom outcomes after surgical repair of SSCD. METHODS: High-resolution computed tomographic temporal bone images were imported into a freely available segmentation software...
August 9, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28936698/recommendations-for-mechanical-ventilation-of-critically-ill-children-from-the-paediatric-mechanical-ventilation-consensus-conference-pemvecc
#18
Martin C J Kneyber, Daniele de Luca, Edoardo Calderini, Pierre-Henri Jarreau, Etienne Javouhey, Jesus Lopez-Herce, Jürg Hammer, Duncan Macrae, Dick G Markhorst, Alberto Medina, Marti Pons-Odena, Fabrizio Racca, Gerhard Wolf, Paolo Biban, Joe Brierley, Peter C Rimensberger
PURPOSE: Much of the common practice in paediatric mechanical ventilation is based on personal experiences and what paediatric critical care practitioners have adopted from adult and neonatal experience. This presents a barrier to planning and interpretation of clinical trials on the use of specific and targeted interventions. We aim to establish a European consensus guideline on mechanical ventilation of critically children. METHODS: The European Society for Paediatric and Neonatal Intensive Care initiated a consensus conference of international European experts in paediatric mechanical ventilation to provide recommendations using the Research and Development/University of California, Los Angeles, appropriateness method...
September 22, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28927764/how-to-value-patient-values-cesarean-sections-for-the-periviable-fetus-and-home-births
#19
REVIEW
Howard Minkoff, Fouad Atallah
Respect for patient autonomy involves providing sufficient information to patients to allow them to make informed decisions, and then honoring their requests unless they are unethical or futile. At times, the factors that patients consider may not be purely biologic ones but rather will include "spiritual" factors (a sense of control in a home birth). When patients balance biologic risks against spiritual gain, physicians may not be comfortable giving deference to patients' choice. In order to explicate this issue we explore two clinical scenarios: home birth, and cesarean section for a periviable fetus; and we consider futility and limits on affirmative autonomy...
September 15, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28920760/influence-analysis-for-the-area-under-the-receiver-operating-characteristic-curve
#20
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
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