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https://www.readbyqxmd.com/read/28730648/calcineurin-inhibitor-withdrawal-or-tapering-for-kidney-transplant-recipients
#1
REVIEW
Krishna M Karpe, Girish S Talaulikar, Giles D Walters
BACKGROUND: Calcineurin inhibitors (CNI) can reduce acute transplant rejection and immediate graft loss but are associated with significant adverse effects such as hypertension and nephrotoxicity which may contribute to chronic rejection. CNI toxicity has led to numerous studies investigating CNI withdrawal and tapering strategies. Despite this, uncertainty remains about minimisation or withdrawal of CNI. OBJECTIVES: This review aimed to look at the benefits and harms of CNI tapering or withdrawal in terms of graft function and loss, incidence of acute rejection episodes, treatment-related side effects (hypertension, hyperlipidaemia) and death...
July 21, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28730303/exhaled-breath-online-measurement-for-cervical-cancer-patients-and-healthy-subjects-by-proton-transfer-reaction-mass-spectrometry
#2
Wenzhao Zhou, Chaoqun Huang, Xue Zou, Yan Lu, Chengyin Shen, Xiping Ding, Hongzhi Wang, Haihe Jiang, Yannan Chu
Cervical cancer is a common cancer among women and has a high morbidity and mortality. The traditional clinical methods for cervical cancer screening are invasive and limited in terms of cost and time. There is an unmet clinical need for new methods to aid clinicians in the rapid screening and auxiliary diagnosis of cervical precancer. Recently, breath analysis has become an attractive approach for investigation of cancer biomarkers and shows great potential in cancer screening owing to its high sensitivity, quickness, and non-invasive nature...
July 20, 2017: Analytical and Bioanalytical Chemistry
https://www.readbyqxmd.com/read/28729382/recommended-clinical-trial-end-points-for-dialysis-catheters
#3
Michael Allon, Deborah J Brouwer-Maier, Kenneth Abreo, Kevin M Baskin, Kay Bregel, Deepa H Chand, Andrea M Easom, Leonard Mermel, Michele H Mokrzycki, Priti R Patel, Prabir Roy-Chaudhury, Surendra Shenoy, Rudolph P Valentini, Haimanot Wasse
Central venous catheters are used frequently in patients on hemodialysis as a bridge to a permanent vascular access. They are prone to frequent complications, including catheter-related bloodstream infection, catheter dysfunction, and central vein obstruction. There is a compelling need to develop new drugs or devices to prevent central venous catheter complications. We convened a multidisciplinary panel of experts to propose standardized definitions of catheter end points to guide the design of future clinical trials seeking approval from the Food and Drug Administration...
July 20, 2017: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/28729329/fluids-in-sepsis-and-septic-shock-fissh-protocol-for-a-pilot-randomised-controlled-trial
#4
Bram Rochwerg, Tina Millen, Peggy Austin, Michelle Zeller, Frédérick D'Aragon, Roman Jaeschke, Marie-Hélène Masse, Sangeeta Mehta, Francois Lamontagne, Maureen Meade, Gordon Guyatt, Deborah J Cook
INTRODUCTION: Observational evidence suggests physiological benefits and lower mortality with lower chloride solutions; however, 0.9% saline remains the most widely used fluid worldwide. Given uncertainty regarding the association of lower chloride on mortality, it is unlikely that practice will change without direct randomised clinical trial (RCT) evidence. This pilot RCT will investigate the feasibility of a large-scale trial directly comparing low chloride with high chloride fluids in patients with septic shock...
July 20, 2017: BMJ Open
https://www.readbyqxmd.com/read/28728605/surrogate-endpoints-in-oncology-when-are-they-acceptable-for-regulatory-and-clinical-decisions-and-are-they-currently-overused
#5
Robert Kemp, Vinay Prasad
BACKGROUND: Surrogate outcomes are not intrinsically beneficial to patients, but are designed to be easier and faster to measure than clinically meaningful outcomes. The use of surrogates as an endpoint in clinical trials and basis for regulatory approval is common, and frequently exceeds the guidance given by regulatory bodies. DISCUSSION: In this article, we demonstrate that the use of surrogates in oncology is widespread and increasing. At the same time, the strength of association between the surrogates used and clinically meaningful outcomes is often unknown or weak...
July 21, 2017: BMC Medicine
https://www.readbyqxmd.com/read/28727658/white-cell-and-marrow-imaging-subtracting-uncertainty
#6
Chelsey Turner, Alison A Bolster, Carolyn L Paterson, Hugh J Wallace
A subtraction method for assessments of dual-isotope indium-111 (In)-labelled white cell and Tc-nanocoll was proposed, and following a pilot study was introduced in routine service to improve the confidence of reporters. This technical note describes a simple technique to produce subtraction images from routinely acquired images to investigate and exclude post joint replacement infection. Labelled leucocytes (with In) show areas of increased white cell accumulation, whereas Tc-nanocoll images show bone marrow distribution...
July 19, 2017: Nuclear Medicine Communications
https://www.readbyqxmd.com/read/28726185/raising-awareness-on-the-therapeutic-role-of-cholecalciferol-in-ckd-a-multidisciplinary-based-opinion
#7
REVIEW
Sandro Giannini, Sandro Mazzaferro, Salvatore Minisola, Luca De Nicola, Maurizio Rossini, Mario Cozzolino
Vitamin D is recognized to play an essential role in health and disease. In kidney disease, vitamin D analogs have gained recognition for their involvement and potential therapeutic importance. Nephrologists are aware of the use of oral native vitamin D supplementation, however, uncertainty still exists with regard to the use of this treatment option in chronic kidney disease as well as clinical settings related to chronic kidney disease, where vitamin D supplementation may be an appropriate therapeutic choice...
July 19, 2017: Endocrine
https://www.readbyqxmd.com/read/28726048/is-ct-perfusion-helpful-in-the-treatment-allocation-of-patients-with-acute-ischemic-stroke-an-expert-opinion-analysis
#8
Laura Strada, Jonathan Y Streifler, Bruno Del Sette, Matteo Puntoni, Antonio Castaldi, Daria Bianchini, Massimo Del Sette
BACKGROUND: Intravenous tPA is the standard treatment for acute ischemic stroke within 4.5 hours of symptom onset. Neuroradiological selection is currently based upon non-contrast- brain CT scan (NCCT). AIMS: To verify, in an "expert-opinion setting", the possible usefulness of CT perfusion (CTP) in decision-making toward i.v. thrombolysis. PATIENTS AND METHOD: One hundred and three consecutive patients with acute ischemic stroke who underwent NCCT and CTP were re-evaluated by an expert in cerebrovascular disease, to verify if adding CTP information would have changed expert's opinion...
July 19, 2017: Neurological Sciences
https://www.readbyqxmd.com/read/28725586/role-of-prostate-magnetic-resonance-imaging-in-active-surveillance
#9
REVIEW
Xiaosong Meng, Andrew B Rosenkrantz, Samir S Taneja
Active surveillance (AS) has emerged as a beneficial strategy for management of low risk prostate cancer (PCa) and prevention of overtreatment of indolent disease. However, selection of patients for AS using traditional 12-core transrectal prostate biopsy is prone to sampling error and presents a challenge for accurate risk stratification. In fact, around a third of men are upgraded on repeat biopsy which disqualifies them as appropriate AS candidates. This uncertainty affects adoption of AS among patients and physicians, leading to current AS protocols involving repetitive prostate biopsies and unclear triggers for progression to definitive treatment...
June 2017: Translational Andrology and Urology
https://www.readbyqxmd.com/read/28725259/cardiovascular-disease-risk-and-prevention-amongst-syrian-refugees-mixed-methods-study-of-m%C3%A3-decins-sans-fronti%C3%A3-res-programme-in-jordan
#10
Dylan R J Collins, Kiran Jobanputra, Thomas Frost, Shoaib Muhammed, Alison Ward, Abed Alrazzaq Shafei, Taissir Fardous, Sadeq Gabashneh, Carl Heneghan
BACKGROUND: The growing burden of non-communicable diseases (NCDs) presented new challenges for medical humanitarian aid and little was known about primary health care approaches for these diseases in humanitarian response. We aimed to evaluate Médecins Sans Frontières (MSF's) use of total CVD risk based prevention strategies amongst Syrian refugees in northern Jordan to identify opportunities to improve total CVD risk based guidance for humanitarian settings. METHODS: We evaluated CVD risk assessment and management in two outpatient NCD clinics in the Irbid governorate of Jordan using a mixed methods design with qualitative and quantitative strands of equal priority, integrated during data collection and interpretation...
2017: Conflict and Health
https://www.readbyqxmd.com/read/28724320/statins-and-venous-thromboembolism-do-they-represent-a-viable-therapeutic-agent
#11
Setor K Kunutsor, Michael R Whitehouse, Ashley W Blom, Jari A Laukkanen
Venous thromboembolism (VTE) is an important cause of preventable morbidity and mortality. Though anticoagulants are effective in preventing VTE, they are associated with major bleeding risk. The 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (known as statins), are well established for the primary and secondary prevention of cardiovascular disease via their lipid-lowering properties. Emerging evidence suggests that statins may play a role in the prevention of VTE, but the evidence has been uncertain...
July 21, 2017: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/28723476/charting-recent-progress-and-challenges-in-metastatic-castration-resistant-prostate-cancer-is-there-an-optimal-treatment-sequence
#12
REVIEW
Stéphane Oudard, Pablo Maroto, Gaston Demonty, Winald R Gerritsen
CONTEXT: Recent developments in the treatment of metastatic castration-resistant prostate cancer (mCRPC) have led to uncertainty about the optimal sequence of agents. OBJECTIVE: To review and assess treatment options and sequence in patients with mCRPC. EVIDENCE ACQUISITION: To identify data on the optimal use of approved treatments, we searched PubMed for studies on the use of recently approved agents for men with mCRPC published before March 2015...
October 2016: European Urology Focus
https://www.readbyqxmd.com/read/28723244/evaluation-of-the-national-health-service-nhs-direct-pilot-telehealth-program-cost-effectiveness-analysis
#13
Malcolm Clarke, Joanna Fursse, Nancy Connolly, Urvashi Sharma, Russell Jones
OBJECTIVE: To evaluate the cost-effectiveness of a pilot telehealth program applied to a wide population of patients with chronic obstructive pulmonary disease (COPD). DESIGN: Vital signs data were transmitted from the home of the patient on a daily basis using a patient monitoring system for review by community nurse to assist decisions on management. SETTING: Community services for patients diagnosed with COPD. PARTICIPANTS: Two Primary Care Trusts (PCTs) enrolled 321 patients diagnosed with COPD into the telehealth program...
July 18, 2017: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
https://www.readbyqxmd.com/read/28722180/a-generic-tg-186-shielded-applicator-for-commissioning-model-based-dose-calculation-algorithms-for-high-dose-rate-192-ir-brachytherapy
#14
Yunzhi Ma, Javier Vijande, Facundo Ballester, Åsa Carlsson Tedgren, Domingo Granero, Annette Haworth, Firas Mourtada, Gabriel Paiva Fonseca, Kyveli Zourari, Panagiotis Papagiannis, Mark J Rivard, Frank André Siebert, Ron S Sloboda, Ryan Smith, Marc J P Chamberland, Rowan M Thomson, Frank Verhaegen, Luc Beaulieu
PURPOSE: A joint working group was created by the American Association of Physicists in Medicine (AAPM), the European Society for Radiotherapy and Oncology (ESTRO), and the Australasian Brachytherapy Group (ABG) with the charge, among others, to develop a set of well-defined test case plans and perform model-based dose calculation algorithms (MBDCA) dose calculations and comparisons. Its main goal is to facilitate a smooth transition from the AAPM Task Group No. 43 (TG-43) dose calculation formalism, widely being used in clinical practice for brachytherapy, to the one proposed by Task Group No...
July 19, 2017: Medical Physics
https://www.readbyqxmd.com/read/28721677/the-pervasive-nature-of-uncertainty-a-qualitative-study-of-patients-with-advanced-cancer-and-their-informal-caregivers
#15
Valerie Shilling, Rachel Starkings, Valerie Jenkins, Lesley Fallowfield
PURPOSE: The aim of this study was to explore the impact of extended cancer survival on broader aspects of life and wellbeing such as occupational, financial and family life for patients with advanced cancer and their nominated informal caregivers. METHODS: In-depth qualitative interviews were transcribed verbatim. A thematic framework was developed from an initial process of open coding and tested iteratively as new data were collected. RESULTS: Twenty-four patient-caregiver dyads with advanced ovarian (9), melanoma (9) or lung cancer (6)...
July 18, 2017: Journal of Cancer Survivorship: Research and Practice
https://www.readbyqxmd.com/read/28720515/ahrq-series-on-complex-intervention-systematic-reviews-paper-4-selecting-analytic-approaches
#16
Meera Viswanathan, Melissa L McPheeters, M Hassan Murad, Mary E Butler, Emily E Beth Devine, Michele P Dyson, Jeanne-Marie Guise, Leila C Kahwati, Jeremy N V Miles, Sally C Morton
BACKGROUND: Systematic reviews of complex interventions can vary widely in purpose, data availability and heterogeneity, and stakeholder expectations. RATIONALE: This article addresses the uncertainty that systematic reviewers face in selecting methods for reviews of complex interventions. Specifically, it lays out parameters for systematic reviewers to consider when selecting analytic approaches that best answer the questions at hand, and suggests analytic techniques that may be appropriate in different circumstances...
June 29, 2017: Journal of Clinical Epidemiology
https://www.readbyqxmd.com/read/28720447/projected-impact-of-hpv-vaccination-and-primary-hpv-screening-on-cervical-adenocarcinoma-example-from-australia
#17
Megan A Smith, Karen Canfell
Cytology-based cervical screening appears to have had a limited effect on the incidence of adenocarcinoma, however HPV vaccination and HPV-based screening will likely play a role in reducing future burden. Using Australia as an example, we estimated the future burden (2015-2040) of adenocarcinoma in the absence of other interventions; and the impact of HPV vaccination (introduced 2007) and HPV-based screening (commencing 2017). Future burden was estimated considering underlying trends in adenocarcinoma, using national data (1982-2010)...
June 2017: Papillomavirus Research
https://www.readbyqxmd.com/read/28720346/pharmacokinetic-data-reduce-uncertainty-in-the-acceptable-daily-intake-for-benzoic-acid-and-its-salts
#18
K Zu, D M Pizzurro, T A Lewandowski, J E Goodman
The current acceptable daily intake (ADI) for benzoic acid and its salts as food additives is 0-5 mg/kg bw-day. This accounts for a total uncertainty factor (UF) of 100, which includes a default factor of 10 for interspecies differences. Based on pharmacokinetic data in rodents and humans, we derived a chemical-specific adjustment factor (CSAF) of 2 for the pharmacokinetic component of the interspecies UF. Additional analyses indicate that this CSAF is conservative and interspecies differences between rats and humans are likely closer to unity...
July 15, 2017: Regulatory Toxicology and Pharmacology: RTP
https://www.readbyqxmd.com/read/28718981/health-economic-analysis-of-allergen-immunotherapy-ait-for-the-management-of-allergic-rhinitis-asthma-food-allergy-and-venom-allergy-a-systematic-overview
#19
REVIEW
Miqdad Asaria, Sangeeta Dhami, Ronald van Ree, Roy Gerth van Wijk, Antonella Muraro, Graham Roberts, Aziz Sheikh
BACKGROUND: The European Academy of Allergy and Clinical Immunology (EAACI) is developing guidelines for allergen immunotherapy (AIT) for the management of allergic rhinitis, allergic asthma, IgE-mediated food allergy and venom allergy. To inform the development of clinical recommendations, we undertook systematic reviews to critically assess evidence on the effectiveness, safety and cost-effectiveness of AIT for these conditions. This paper focusses on synthesizing data and gaps in the evidence on the cost-effectiveness of AIT for these conditions...
July 18, 2017: Allergy
https://www.readbyqxmd.com/read/28717861/patient-perspectives-on-gene-transfer-therapy-for-sickle-cell-disease
#20
Heather Strong, Monica J Mitchell, Alana Goldstein-Leever, Lisa Shook, Punam Malik, Lori E Crosby
INTRODUCTION: Sickle cell disease (SCD) is a chronic genetic disease with high morbidity and early mortality; it affects nearly 100,000 individuals in the USA. Bone marrow transplantation, the only curative treatment, is available to less than 20% of patients because of a number of access barriers. Gene transfer therapy (GTT) has been shown to be curative in animal models and is approved for use in humans for early-phase studies at a few centers. GTT would offer a more accessible treatment option available to all patients...
July 17, 2017: Advances in Therapy
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