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https://www.readbyqxmd.com/read/29034674/-has-budget-impact-analysis-guidelines-a-new-decision-making-tool
#1
Salah Ghabri, Anne-Isabelle Poullié, Erwan Autin, Jean-Michel Josselin
INTRODUCTION: Budget impact analysis (BIA) provides short and medium-term estimates on changes in budgets and resources resulting from the adoption of new health interventions. OBJECTIVE: The objective of this article is to present the main messages of the newly developed French National Authority for Health (HAS) guidelines on budget impact analysis : issues, recommendations and perspectives. METHODS: The HAS guidelines development process was based on data derived from a literature review on BIA (search dates : January 2000 to June 2016), an HAS retrospective investigation, a public consultation, international expert advice, and approval from the HAS Board and the Economic and Public Health Evaluation Committee...
October 2, 2017: Santé Publique: Revue Multidisciplinaire Pour la Recherche et L'action
https://www.readbyqxmd.com/read/29033309/ethical-considerations-in-prenatal-testing-genomic-testing-and-medical-uncertainty
#2
REVIEW
Anastasia Richardson, Kelly E Ormond
Prenatal diagnostic testing has recently progressed from karyotype to routinely available chromosomal microarray, and the potential for fetal whole exome sequencing, both through invasive diagnostic testing and, in some cases, non-invasive prenatal testing. These tests bring beneficence through providing a higher diagnostic yield, often with lower risks of miscarriage than previously available testing, but also raise the question of harms related to an increase in uncertain and unknown results. Some parents-to-be report a desire to learn as much information as possible prenatally, and there may be beneficence in providing them with this information...
October 12, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29033060/a-review-of-international-coverage-and-pricing-strategies-for-personalized-medicine-and-orphan-drugs
#3
REVIEW
Irina Degtiar
BACKGROUND: Personalized medicine and orphan drugs share many characteristics-both target small patient populations, have uncertainties regarding efficacy and safety at payer submission, and frequently have high prices. Given personalized medicine's rising importance, this review summarizes international coverage and pricing strategies for personalized medicine and orphan drugs as well as their impact on therapy development incentives, payer budgets, and therapy access and utilization...
September 29, 2017: Health Policy
https://www.readbyqxmd.com/read/29032924/epidemiology-of-rare-cancers-and-inequalities-in-oncologic-outcomes
#4
G Gatta, A Trama, R Capocaccia
Rare cancers epidemiology is better known compared to the other rare diseases. Thanks to the long history of the European population-based cancer registries and to the EUROCARE huge database, the burden of rare cancers has been estimated the European (EU28) population. A considerable fraction of all cancers is represented by rare cancers (24%). They are a heterogeneous group of diseases, but they share similar problems: uncertainty of diagnosis, lack of therapies, poor research opportunities, difficulties in clinical trials, lack of expertise and of centres of reference...
September 19, 2017: European Journal of Surgical Oncology
https://www.readbyqxmd.com/read/29031410/harnessing-gut-microbes-for-mental-health-getting-from-here-to-there
#5
REVIEW
Annadora J Bruce-Keller, J Michael Salbaum, Hans-Rudolf Berthoud
There has been an explosion of interest in the study of microorganisms inhabiting the gastrointestinal tract (gut microbiota) and their impact on host health and physiology. Accumulating data suggest that altered communication between gut microbiota and host systems could participate in disorders such as obesity, diabetes mellitus, and autoimmune disorders as well as neuropsychiatric disorders, including autism, anxiety, and major depressive disorders. The conceptual development of the microbiome-gut-brain axis has facilitated understanding of the complex and bidirectional networks between gastrointestinal microbiota and their host, highlighting potential mechanisms through which this environment influences central nervous system physiology...
August 30, 2017: Biological Psychiatry
https://www.readbyqxmd.com/read/29031035/-controversy-in-the-postoperative-treatment-of-low-grade-gliomas
#6
T Kazda, R Lakomý, A Poprach, P Pospíšil, R Jančálek, P Šlampa
BACKGROUND: The optimal treatment for low-grade gliomas remains controversial. Neurosurgery, radiotherapy, and chemotherapy are the main treatment options. Despite advances in oncology, there are still a lot of uncertainties, and the optimal sequences, combinations, and timings of these procedures have not yet been optimized. It is still unclear whether temozolomide can replace effective, but toxic PCV chemotherapy (procarbazine, lomustine, vincristine) and whether temozolomide can be used upfront alone instead of radiotherapy alone...
2017: Klinická Onkologie: Casopis Ceské a Slovenské Onkologické Spolecnosti
https://www.readbyqxmd.com/read/29031018/strategies-to-define-performance-specifications-in-laboratory-medicine-3-years-on-from-the-milan-strategic-conference
#7
Mauro Panteghini, Ferruccio Ceriotti, Graham Jones, Wytze Oosterhuis, Mario Plebani, Sverre Sandberg
Measurements in clinical laboratories produce results needed in the diagnosis and monitoring of patients. These results are always characterized by some uncertainty. What quality is needed and what measurement errors can be tolerated without jeopardizing patient safety should therefore be defined and specified for each analyte having clinical use. When these specifications are defined, the total examination process will be "fit for purpose" and the laboratory professionals should then set up rules to control the measuring systems to ensure they perform within specifications...
October 14, 2017: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/29029832/tumour-auto-contouring-on-2d-cine-mri-for-locally-advanced-lung-cancer-a-comparative-study
#8
Martin F Fast, Björn Eiben, Martin J Menten, Andreas Wetscherek, David J Hawkes, Jamie R McClelland, Uwe Oelfke
BACKGROUND AND PURPOSE: Radiotherapy guidance based on magnetic resonance imaging (MRI) is currently becoming a clinical reality. Fast 2d cine MRI sequences are expected to increase the precision of radiation delivery by facilitating tumour delineation during treatment. This study compares four auto-contouring algorithms for the task of delineating the primary tumour in six locally advanced (LA) lung cancer patients. MATERIAL AND METHODS: Twenty-two cine MRI sequences were acquired using either a balanced steady-state free precession or a spoiled gradient echo imaging technique...
October 10, 2017: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
https://www.readbyqxmd.com/read/29029621/uncertainty-on-the-effectiveness-and-safety-of-rivaroxaban-in-premenopausal-women-with-atrial-fibrillation-empirical-evidence-needed
#9
Herbert J A Rolden, Angela H E M Maas, Gert Jan van der Wilt, Janneke P C Grutters
BACKGROUND: Novel anticoagulations (NOACs) are increasingly prescribed for the prevention of stroke in premenopausal women with atrial fibrillation. Small studies suggest NOACs are associated with a higher risk of abnormal uterine bleeds than vitamin K antagonists (VKAs). Because there is no direct empirical evidence on the benefit/risk profile of rivaroxaban compared to VKAs in this subgroup, we synthesize available indirect evidence, estimate decision uncertainty on the treatments, and assess whether further research in premenopausal women is warranted...
October 13, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/29029109/early-diagnosis-of-acute-coronary-syndrome
#10
Hugo Katus, André Ziegler, Okan Ekinci, Evangelos Giannitsis, Wendy Gattis Stough, Stephan Achenbach, Stefan Blankenberg, Martina Brueckmann, Paul Collinson, Dorin Comaniciu, Filippo Crea, Wilfried Dinh, Grégory Ducrocq, Frank A Flachskampf, Keith A A Fox, Matthias G Friedrich, Kathy A Hebert, Anders Himmelmann, Mark Hlatky, Dominik Lautsch, Bertil Lindahl, Daniel Lindholm, Nicholas L Mills, Giorgio Minotti, Martin Möckel, Torbjørn Omland, Véronique Semjonow
The diagnostic evaluation of acute chest pain has been augmented in recent years by advances in the sensitivity and precision of cardiac troponin assays, new biomarkers, improvements in imaging modalities, and release of new clinical decision algorithms. This progress has enabled physicians to diagnose or rule-out acute myocardial infarction earlier after the initial patient presentation, usually in emergency department settings, which may facilitate prompt initiation of evidence-based treatments, investigation of alternative diagnoses for chest pain, or discharge, and permit better utilization of healthcare resources...
October 3, 2017: European Heart Journal
https://www.readbyqxmd.com/read/29028766/immunotherapy-for-metastatic-urothelial-carcinoma-status-quo-and-the-future
#11
Andrea Necchi, Michael Rink, Patrizia Giannatempo, Daniele Raggi, Evanguelos Xylinas
PURPOSE OF REVIEW: The treatment paradigm of urothelial carcinoma has been revolutionized by the advent of multiple anti-programmed-cell death-1/ligand-1 (PD-1/PD-L1) antibodies. Significant improvements have been obtained in the locally advanced or metastatic stage, which was lacking of therapeutic standards. This review reports key findings from completed and ongoing clinical trials that highlight the potential of PD-1/PD-L1 blockade in this disease. RECENT FINDINGS: Anti-PD-1/PD-L1 monoclonal antibodies have shown efficacy and safety in patients with urothelial carcinoma, regardless of their prognostic features...
October 11, 2017: Current Opinion in Urology
https://www.readbyqxmd.com/read/29028765/preventing-clinical-progression-and-need-for-treatment-in-patients-on-active-surveillance-for-prostate-cancer
#12
Hanan Goldberg, Zachary Klaassen, Thenappan Chandrasekar, Neil Fleshner
PURPOSE OF REVIEW: Active surveillance is an established treatment option for men with localized, low-risk prostate cancer (CaP). It entails the postponement of immediate therapy with the option of delayed intervention upon disease progression. The rate of clinical progression and need for treatment on active surveillance is approximately 50% over 15 years. The present review summarizes recent data on current methods, attempting to prevent clinical progression. RECENT FINDINGS: Patient selection for active surveillance is the first mandatory step required to lower progression...
October 11, 2017: Current Opinion in Urology
https://www.readbyqxmd.com/read/29028465/cultivating-humility-and-diagnostic-openness-in-clinical-judgment
#13
John R Stone
In this case, a physician rejects a patient's concerns that tainted water is harming the patient and her community. Stereotypes and biases regarding socioeconomic class and race/ethnicity, constraining diagnostic frameworks, and fixed first impressions could skew the physician's judgment. This paper narratively illustrates how cultivating humility could help the physician truly hear the patient's suggestions. The discussion builds on the multifaceted concept of cultural humility as a lifelong journey that addresses not only stereotypes and biases but also power inequalities and community inequities...
October 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29027539/fatigue-as-a-symptom-or-comorbidity-of-neurological-diseases
#14
REVIEW
Iris-Katharina Penner, Friedemann Paul
Fatigue, best described as an overwhelming feeling of tiredness and exhaustion, occurs in the context of various neurological diseases. The high prevalence of fatigue as either a symptom or a comorbidity of neurological disease must be taken seriously, as fatigue interferes with patients' activities of daily living, has a remarkable negative impact on quality of life, and is a major reason for early retirement. The tremendous consequences of fatigue are consistent across neurological diseases, as is the uncertainty concerning its underlying pathophysiological mechanisms...
October 13, 2017: Nature Reviews. Neurology
https://www.readbyqxmd.com/read/29026635/lytic-lesions-looking-lethal-but-leaving-room-for-a-simple-cure-a-case-of-veillonella-spinal-osteomyelitis
#15
Sarah Baker, Rebecca Allyn
Introduction. Diagnosing clinically significant infection caused by Veillonella species can be a challenge. Veillonella species are usually found in polymicrobial processes and are often regarded as a contaminant. Additionally, they are slow to grow in culture and this can lead to a delay in diagnosis or a missed diagnosis. Veillonella species rarely cause serious infections, but have been found to cause bacteraemia and osteomyelitis. Case presentation. A 67-year-old man with a history of treated prostate cancer presented with 2 weeks of progressive lower back pain and weakness...
August 2017: JMM Case Reports
https://www.readbyqxmd.com/read/29025899/a-novel-single-beat-approach-to-assess-right-ventricular-systolic-function
#16
Alessandro Bellofiore, Rebecca R Vanderpool, Melanie J Brewis, Andrew J Peacock, Naomi C Chesler
Clinical assessment of right ventricular (RV) contractility in diseases such as pulmonary arterial hypertension (PAH) has been hindered by the lack of a robust methodology. Here, a novel clinically-viable single-beat method was developed to assess end-systolic elastance (Ees), a measure of RV contractility. We hypothesized that this novel approach reduces uncertainty and interobserver variability in the estimation of the maximum isovolumic pressure (Piso), the key step in single-beat methods. The new method was designed to include a larger portion of the RV pressure data and minimize subjective adjustments by the operator...
October 12, 2017: Journal of Applied Physiology
https://www.readbyqxmd.com/read/29025786/disparity-between-nephrologists-opinions-and-contemporary-practices-for-community-follow-up-after-aki-hospitalization
#17
Divya J Karsanji, Neesh Pannu, Braden J Manns, Brenda R Hemmelgarn, Zhi Tan, Kailash Jindal, Nairne Scott-Douglas, Matthew T James
BACKGROUND AND OBJECTIVES: Recent guidelines suggest that patients should be evaluated after AKI for resolution versus progression of CKD. There is uncertainty as to the role of nephrologists in this process. The objective of this study was to compare the follow-up recommendations from nephrologists with contemporary processes of care for varying scenarios of patients hospitalized with AKI. DESIGN, SETTING PARTICIPANTS, & MEASUREMENTS: We surveyed Canadian nephrologists using a series of clinical vignettes of patients hospitalized with severe AKI and asked them to rank their likelihood of recommending follow-up for each patient after hospital discharge...
October 12, 2017: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/29025443/perceptions-of-nurses-roles-in-end-of-life-care-and-organ-donation-imposition-or-obligation
#18
Kim Crymble, June Fabian, Harriet Etheredge, Petra Gaylard
South Africa has a rich organ-transplant history, and studies suggest that the SA public supports organ donation. In spite of this, persistently low donor numbers are a significant challenge. This may be due to a lack of contextually appropriate awareness and education, or to barriers to referring patients and families in clinical settings. It may also be due to ad hoc regulations that are not uniformly endorsed or implemented. In this article we present the findings of a study in Johannesburg that explored the attitudes and roles of nurses in end-of-life care and organ donation...
June 30, 2017: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
https://www.readbyqxmd.com/read/29024949/nutritional-optimization-during-neoadjuvant-therapy-prior-to-surgical-resection-of-esophageal-cancer-a-narrative-review
#19
Jeremy R Huddy, Fiona M S Huddy, Sheraz R Markar, Olga Tucker
This narrative review aims to evaluate the evidence for the different nutritional approaches employed during neoadjuvant therapy in patients with loco-regional esophageal cancer. Patients with esophageal cancer are often malnourished and difficult to optimise nutritionally. Whilst evidence suggests neoadjuvant therapy can offer a survival advantage, associated toxicity can exacerbate poor nutritional status. There is currently no accepted standard of care regarding optimal nutritional approach.A systematic literature search was undertaken...
August 30, 2017: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
https://www.readbyqxmd.com/read/29024649/obsessing-about-uncertainty
#20
Jacqueline Scholl, Matthew F S Rushworth
A striking observation in obsessive-compulsive disorder is that patients know that their obsessions and compulsions are excessive, but their symptoms nevertheless persist. Drawing on computational models from basic neuroscience, Vaghi and colleagues (2017) suggest a quantitative account of this clinical finding.
October 11, 2017: Neuron
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