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https://www.readbyqxmd.com/read/28633456/feeding-during-dialysis-risks-and-uncertainties
#1
Rajiv Agarwal, Panagiotis Georgianos
Allowing dialysis patients to eat during the treatment is controversial. It is, therefore, no surprise that practices and policies with respect to intradialytic food consumption vary considerably from unit to unit and from country to country. Those who defend the position of feeding during dialysis reason that intradialytic meals offer a supervised and effective therapy for protein-energy wasting. Those who take the opposite view argue that intradialytic food intake should be avoided for the following three reasons...
June 19, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28633302/mumps-clinical-diagnostic-uncertainty
#2
Fabio Magurano, Melissa Baggieri, Antonella Marchi, Paola Bucci, Giovanni Rezza, Loredana Nicoletti
During recent years, various mumps outbreaks have occurred among populations vaccinated for mumps worldwide. In Italy, improving routine coverage with two doses of measles, mumps and rubella (MMR) vaccine is one of the key strategies to eliminate measles and rubella. To monitor the effect of the vaccination programme on the population, the surveillance of these vaccine-preventable diseases has been implemented. This provided the opportunity to evaluate the accuracy of the clinical diagnosis of those diseases, including mumps...
June 12, 2017: European Journal of Public Health
https://www.readbyqxmd.com/read/28632247/antecedents-and-outcomes-of-uncertainty-in-older-adults-with-cancer-a-scoping-review-of-the-literature
#3
Vida Ghodraty Jabloo, Shabbir M H Alibhai, Margaret Fitch, Ann E Tourangeau, Ana Patricia Ayala, Martine T E Puts
PROBLEM IDENTIFICATION: Uncertainty is a major source of distress for cancer survivors. Because cancer is primarily a disease of older adults, a comprehensive understanding of the antecedents and outcomes of uncertainty in older adults with cancer is essential. 
. LITERATURE SEARCH: MEDLINE®, PsycINFO®, Scopus, and CINAHL® were searched from inception to December 2015. Medical Subject Headings (MeSH) terms and free text words were used for the search concepts, including neoplasms, uncertainty, and aging...
July 1, 2017: Oncology Nursing Forum
https://www.readbyqxmd.com/read/28628931/-the-probabilistic-efficiency-frontier-a-value-assessment-of-treatment-options-in-hepatitis-c
#4
Axel C Mühlbacher, Andrew Sadler
Background The German Institute for Quality and Efficiency in Health Care (IQWiG) recommends the concept of the efficiency frontier to assess health care interventions. The efficiency frontier supports regulatory decisions on reimbursement prices for the appropriate allocation of health care resources. Until today this cost-benefit assessment framework has only been applied on the basis of individual patient-relevant endpoints. This contradicts the reality of a multi-dimensional patient benefit. Objective The objective of this study was to illustrate the operationalization of multi-dimensional benefit considering the uncertainty in clinical effects and preference data in order to calculate the efficiency of different treatment options for hepatitis C (HCV)...
June 19, 2017: Das Gesundheitswesen
https://www.readbyqxmd.com/read/28628736/-it-s-definitely-not-alzheimer-s-perceived-benefits-and-drawbacks-of-a-mild-cognitive-impairment-diagnosis
#5
Tim Gomersall, Sarah Kate Smith, Charlotte Blewett, Arlene Astell
OBJECTIVES: To understand the perceived benefits and drawbacks of a mild cognitive impairment (MCI) diagnosis from the perspective of those living with the label. METHODS: Participants were included if they had recently (within 6 months) received a MCI diagnosis. We also recruited close family members to gain their perspectives. Each was interviewed separately with a semi-structured topic guide covering three areas: (1) experience of cognitive impairments and changes in the individual; (2) impact of cognitive impairment(s) on daily activities and social relationships; and (3) experience of the diagnosis process and living with the label...
June 19, 2017: British Journal of Health Psychology
https://www.readbyqxmd.com/read/28628537/needs-of-stroke-survivors-as-perceived-by-their-caregivers-a-scoping-review
#6
Shilpa Krishnan, Monique R Pappadis, Susan C Weller, Marsja Stearnes, Amit Kumar, Kenneth J Ottenbacher, Timothy A Reistetter
OBJECTIVE: Caregivers usually are not involved while planning the stroke survivor's medical and rehabilitation goals and interventions. This review aimed to identify the needs of stroke survivors as perceived by their caregivers. DESIGN: A literature search from 2003 to 2014 was conducted using Medline, CINAHL, PsychINFO, and Google Scholar. Sixty-six studies were included. Most studies excluded did not encompass caregivers' perspectives. Four reviewers screened the titles, abstracts, and full texts of the articles for inclusion...
July 2017: American Journal of Physical Medicine & Rehabilitation
https://www.readbyqxmd.com/read/28627841/clinical-decision-making-from-theory-to-practice%C3%A2-and-backward
#7
Lionel De Alencastro, Carole Clair, Isabella Locatelli, Mark H Ebell, Nicolas Senn
Being able to analyze all the successive steps of decision making from the first contact with the patient to the final diagnosis is complex because it refers sometimes to intuitive elements proper to each clinician. However, understanding how they integrate probabilities of diseases into their clinical practice and manage diagnostic uncertainties is crucial. This allows a more rational practice of medicine and identifying factors related to the patient, physician or context that may modify the clinical decision making...
May 2017: Revue Médicale Suisse
https://www.readbyqxmd.com/read/28626920/experimental-verification-of-egsnrc-monte-carlo-calculated-depth-doses-within-a-realistic-parallel-magnetic-field-in-a-polystyrene-phantom
#8
Andrei Ghila, Stephen Steciw, B Gino Fallone, Satyapal Rathee
PURPOSE: Integrating a linac with a magnetic resonance imager (MRI) will revolutionize the accuracy of external beam radiation treatments. Irradiating in the presence of a strong magnetic field, however, will modify the dose distribution. These dose modifications have been investigated previously, mainly using Monte Carlo simulations. The purpose of this work is to experimentally verify the use of the EGSnrc Monte Carlo (MC) package for calculating percent depth doses (PDDs) in a homogeneous phantom, in the presence of a realistic parallel magnetic field...
June 19, 2017: Medical Physics
https://www.readbyqxmd.com/read/28625472/3d-catheter-reconstruction-in-hdr-prostate-brachytherapy-for-pre-treatment-verification-using-a-flat-panel-detector
#9
Ryan L Smith, Annette Haworth, Vanessa Panettieri, Jeremy L Millar, Rick D Franich
PURPOSE: High dose rate prostate brachytherapy is a widely-practiced treatment, delivering large conformal doses in relatively few treatment fractions. Inter- and intra-fraction catheter displacements have been reported. Unrecognized displacement can have a significant impact on dosimetry. Knowledge of the implant geometry at the time of treatment is important for ensuring safe and effective treatment. In this work we demonstrate a method to reconstruct the catheter positions pre-treatment, using a 'shift' imaging technique, and perform registration with the treatment plan for verification relative to the prostate...
June 15, 2017: Physica Medica: PM
https://www.readbyqxmd.com/read/28624466/resectable-clinical-n2-non-small-cell-lung-cancer-what-is-the-optimal-treatment-strategy-an-update-by-the-british-thoracic-society-lung-cancer-specialist-advisory-group
#10
Matthew Evison, Amelia Clive, Lianne Castle, Helen Powell, Rachel Thomas, Robert Buttery, Vidan Masani, Susan Harden, Doug West, Ian Woolhouse
Patients and clinicians are faced with uncertainty on the optimal treatment strategy for potentially resectable non-small cell lung cancer where there is clinical evidence of involvement of the ipsilateral mediastinum. Randomised controlled trials and meta-analyses have failed to demonstrate superiority of one bimodality strategy over another (chemotherapy plus surgery versus chemotherapy plus radiotherapy). One trial of trimodality treatment with chemotherapy, radiotherapy and surgery demonstrated an improvement in progression-free, but not overall, survival versus chemotherapy and radiotherapy...
June 14, 2017: Journal of Thoracic Oncology
https://www.readbyqxmd.com/read/28624329/the-bebig-valencia-type-skin-applicators-dosimetric-study-and-implementation-of-a-dosimetric-hybrid-technique
#11
Georgios Anagnostopoulos, Michael Andrássy, Dimos Baltas
PURPOSE: To determine the relative dose rate distribution in water for the Bebig 20 mm and 30 mm skin applicators and report results in a form suitable for potential clinical use. Results for both skin applicators are also provided in the form of a hybrid Task Group 43 (TG-43) dosimetry technique. Furthermore, the radiation leakage around both skin applicators from the radiation protection point of view and the impact of the geometrical source position uncertainties are studied and reported...
June 14, 2017: Brachytherapy
https://www.readbyqxmd.com/read/28624294/patient-decision-aids-for-patients-considering-total-joint-replacement-a-cost-effectiveness-analysis-alongside-a-randomised-controlled-trial
#12
Logan Trenaman, Dawn Stacey, Stirling Bryan, Monica Taljaard, Gillian Hawker, Geoff Dervin, Peter Tugwell, Nick Bansback
BACKGROUND: Shared decision-making (SDM) is a key priority to improve patient-centred care, and can play an important role in helping patients decide whether to undergo total joint arthroplasty (TJA). Patient decision aids can support SDM; however, they may incur an upfront cost. We aimed to estimate the health and economic effects of patient decision aids for TJA. METHODS: A cost-effectiveness analysis of a randomised controlled trial with 2-year follow-up. 343 patients were recruited from two orthopedic screening clinics in Ottawa, Canada...
June 14, 2017: Osteoarthritis and Cartilage
https://www.readbyqxmd.com/read/28623146/an-update-of-the-global-burden-of-pertussis-in-children-younger-than-5-years-a-modelling-study
#13
Karene Hoi Ting Yeung, Philippe Duclos, E Anthony S Nelson, Raymond Christiaan W Hutubessy
BACKGROUND: Since the publication in 2003 of a model to estimate the disease burden of pertussis, new evidence of the protective effect of incomplete pertussis vaccination against severe pertussis has been reported. We revised the model to provide new estimates of regional and global pertussis cases and deaths for children younger than 5 years. METHODS: We developed a revised model with data from 2014 to estimate pertussis cases and deaths. Pertussis cases were defined according to the WHO clinical case definition, as a coughing illness lasting at least 2 weeks with paroxysms of coughing, inspiratory whooping, or post-tussive vomiting...
June 13, 2017: Lancet Infectious Diseases
https://www.readbyqxmd.com/read/28622285/what-is-the-effectiveness-of-systemic-corticosteroids-in-children-with-croup
#14
Elizabeth Muñoz-Osores, Deidyland Arenas
Systemic corticosteroids constitute standard treatment in children with acute obstructive laryngitis (croup). However, there is some uncertainty in relation with the magnitude of the benefits and risks associated with their use. To answer this question, we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We identified six systematic reviews including 25 randomized trials relevant for the question of interest...
June 6, 2017: Medwave
https://www.readbyqxmd.com/read/28621030/plugging-the-patient-evidence-gap-what-patients-with-swallowing-disorders-post-stroke-say-about-thickened-liquids
#15
Arlene McCurtin, Chiara Healy, Linda Kelly, Fiona Murphy, Jean Ryan, Joanne Walsh
BACKGROUND: Oropharyngeal dysphagia post-stroke is well known, with its presence increasing the risk of poor outcomes in particular aspiration and aspiration pneumonia. Management to minimize the risk of aspiration and improve swallow safety post-stroke includes the treatment of thickened liquids (TL), an established bolus modification intervention. Despite widespread use, there is a lack of robust empirical evidence and minimal patient evidence as to the experience and acceptability of using thickeners by people who experience dysphagia after a stroke...
June 16, 2017: International Journal of Language & Communication Disorders
https://www.readbyqxmd.com/read/28619594/characterisation-of-medical-microfluidic-systems-regarding-fast-changing-flow-rates-using-optical-front-tracking-methods
#16
Joerg Schroeter, Lino Del Bianco, Christian Damiani, Stephan Klein, Bodo Nestler
The presented optical flow metering methods are appropriate to characterise the dynamic properties of microfluidic systems. The dynamic behaviour of clinical or medical devices, micro pumps and flow sensors based on thermal methods were investigated. The Camera-System covers a flow range from 50nl/min to 500µl/min. The uncertainty is less than 4%, sample rates up to 5kS/s. The Displacement-Sensor-System covers a flow range between 100µl/min and 50ml/min. The uncertainty is less than 3% at sample rates up to 49kS/s...
June 12, 2017: Medical Engineering & Physics
https://www.readbyqxmd.com/read/28619270/what-is-symptom-meaning-a-framework-analysis-of-communication-in-palliative-care-consultations
#17
Celina F Estacio, Phyllis N Butow, Melanie R Lovell, Skye T Dong, Josephine M Clayton
OBJECTIVE: There is a limited understanding of symptom meaning and its significance to clinical practice within symptom experience literature. This study aims to qualitatively explore the ways in which symptom meanings are discussed by patients and responded to by palliative care physicians during consultations. METHODS: Framework analysis was conducted with 40 palliative care consultation transcripts. RESULTS: 55% of consultations discussed symptom meaning...
May 5, 2017: Patient Education and Counseling
https://www.readbyqxmd.com/read/28619124/multiplex-tests-to-identify-gastrointestinal-bacteria-viruses-and-parasites-in-people-with-suspected-infectious-gastroenteritis-a-systematic-review-and-economic-analysis
#18
Karoline Freeman, Hema Mistry, Alexander Tsertsvadze, Pam Royle, Noel McCarthy, Sian Taylor-Phillips, Rohini Manuel, James Mason
BACKGROUND: Gastroenteritis is a common, transient disorder usually caused by infection and characterised by the acute onset of diarrhoea. Multiplex gastrointestinal pathogen panel (GPP) tests simultaneously identify common bacterial, viral and parasitic pathogens using molecular testing. By providing test results more rapidly than conventional testing methods, GPP tests might positively influence the treatment and management of patients presenting in hospital or in the community. OBJECTIVE: To systematically review the evidence for GPP tests [xTAG(®) (Luminex, Toronto, ON, Canada), FilmArray (BioFire Diagnostics, Salt Lake City, UT, USA) and Faecal Pathogens B (AusDiagnostics, Beaconsfield, NSW, Australia)] and to develop a de novo economic model to compare the cost-effectiveness of GPP tests with conventional testing in England and Wales...
April 2017: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/28618973/from-clinical-uncertainties-to-precision-medicine-the-emerging-role-of-the-gut-barrier-and-microbiome-in-small-bowel-functional-diseases
#19
Wojciech Marlicz, Diana Yung, Karolina Skonieczna-Żydecka, Igor Loniewski, Saskia van Hemert, Beata Loniewska, Anastasios Koulaouzidis
Over the last decade, remarkable progress has been made in the understanding of disease pathophysiology. Many new theories expound on the importance of emerging factors such as microbiome influences, genomics/omics, stem cells, innate intestinal immunity or mucosal barrier complexities. This has introduced a further dimension of uncertainty into clinical decision-making, but equally, may shed some light on less well-understood and difficult to manage conditions. Areas covered: Comprehensive review of the literature on gut barrier and microbiome relevant to small bowel pathology...
June 16, 2017: Expert Review of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/28618101/understanding-nurses-concerns-when-caring-for-patients-from-diverse-cultural-and-ethnic-backgrounds
#20
Kathleen Markey, Mary Tilki, Georgina Taylor
AIMS AND OBJECTIVES: This study aimed to explore the experiences of both student and qualified nurses of caring for patients from diverse cultural, ethnic and linguistic backgrounds, in one region of Ireland. Hearing the stories, experiences and attitudes of nurses has the potential to influence future clinical practice and has implications for nurses, nurse educators and nurse managers and leaders. BACKGROUND: There is a wealth of international literature highlighting the importance of providing culturally sensitive care...
June 15, 2017: Journal of Clinical Nursing
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