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Clinical uncertainty

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https://www.readbyqxmd.com/read/28830111/epidemic-forecasting-is-messier-than-weather-forecasting-the-role-of-human-behavior-and-internet-data-streams-in-epidemic-forecast
#1
Kelly R Moran, Geoffrey Fairchild, Nicholas Generous, Kyle Hickmann, Dave Osthus, Reid Priedhorsky, James Hyman, Sara Y Del Valle
Mathematical models, such as those that forecast the spread of epidemics or predict the weather, must overcome the challenges of integrating incomplete and inaccurate data in computer simulations, estimating the probability of multiple possible scenarios, incorporating changes in human behavior and/or the pathogen, and environmental factors. In the past 3 decades, the weather forecasting community has made significant advances in data collection, assimilating heterogeneous data steams into models and communicating the uncertainty of their predictions to the general public...
December 1, 2016: Journal of Infectious Diseases
https://www.readbyqxmd.com/read/28828761/coblation-versus-other-surgical-techniques-for-tonsillectomy
#2
REVIEW
Melissa Pynnonen, Jennifer V Brinkmeier, Marc C Thorne, Lee Yee Chong, Martin J Burton
BACKGROUND: Tonsillectomy is a very common operation and is performed using various surgical methods. Coblation is a popular method because it purportedly causes less pain than other surgical methods. However, the superiority of coblation is unproven. OBJECTIVES: To compare the effects of coblation tonsillectomy for chronic tonsillitis or tonsillar hypertrophy with other surgical techniques, both hot and cold, on intraoperative morbidity, postoperative morbidity and procedural cost...
August 22, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28827006/intraoperative-implantation-of-a-mesh-of-directional-palladium-sources-civasheet-dosimetry-verification-clinical-commissioning-dose-specification-and-preliminary-experience
#3
Gil'ad N Cohen, Karen Episcopia, Seng-Boh Lim, Thomas J LoSasso, Mark J Rivard, Amandeep S Taggar, Neil K Taunk, Abraham J Wu, Antonio L Damato
PURPOSE: To present the clinical commissioning of a novel (103)Pd directional brachytherapy device (CivaSheet) for intraoperative radiation therapy. METHODS AND MATERIALS: Clinical commissioning for the CivaSheet consisted of establishing: (1) source strength calibration capabilities, (2) experimental verification of TG-43 dosimetry parameters, (3) treatment planning system validation, and (4) departmental practice for dose specification and source ordering. Experimental verification was performed in water with radiochromic film calibrated with a 37 kVp X-ray beam...
August 18, 2017: Brachytherapy
https://www.readbyqxmd.com/read/28826376/nutrition-from-the-inside-out
#4
Dennis M Bier
Nearly 50 years ago, I set out to investigate the clinical problem of hypoglycemia in children with illnesses that limited their food intake. My goal was to gather accurate and precise measurable data. At the time, I wasn't interested in nutrition as a discipline defined in its more general or popular sense. To address the specific problem that interested me required development of entirely new methods based on stable, nonradioactive tracers that satisfied the conditions of accuracy and precision. At the time, I had no inclination of the various theoretical and practical problems that would have to be solved to achieve this goal...
August 21, 2017: Annual Review of Nutrition
https://www.readbyqxmd.com/read/28826308/the-influence-of-breathing-motion-and-a-variable-relative-biological-effectiveness-in-proton-therapy-of-left-sided-breast-cancer
#5
Jakob Ödén, Iuliana Toma-Dasu, Kjell Eriksson, Anna Maria Flejmer, Alexandru Dasu
BACKGROUND: Proton breast radiotherapy has been suggested to improve target coverage as well as reduce cardiopulmonary and integral dose compared with photon therapy. This study aims to assess this potential when accounting for breathing motion and a variable relative biological effectiveness (RBE). METHODS: Photon and robustly optimized proton plans were generated to deliver 50 Gy (RBE) in 25 fractions (RBE = 1.1) to the CTV (whole left breast) for 12 patients...
August 22, 2017: Acta Oncologica
https://www.readbyqxmd.com/read/28826292/radiobiological-issues-in-proton-therapy
#6
Radhe Mohan, Christopher R Peeler, Fada Guan, Lawrence Bronk, Wenhua Cao, David R Grosshans
The relative biological effectiveness (RBE) for particle therapy is a complex function of particle type, radiation dose, linear energy transfer (LET), cell type, endpoint, etc. In the clinical practice of proton therapy, the RBE is assumed to have a fixed value of 1.1. This assumption, along with the effects of physical uncertainties, may mean that the biologically effective dose distributions received by the patient may be significantly different from what is seen on treatment plans. This may contribute to unforeseen toxicities and/or failure to control the disease...
August 22, 2017: Acta Oncologica
https://www.readbyqxmd.com/read/28822667/doppler-parameters-derived-from-transthoracic-echocardiography-accurately-detect-bioprosthetic-mitral-valve-dysfunction
#7
Ryan J Spencer, Ken G Gin, Michael Y C Tsang, Teresa S M Tsang, Parvathy Nair, Pui K Lee, John Jue
BACKGROUND: Detecting bioprosthetic mitral valve dysfunction on transthoracic echocardiography can be challenging because of acoustic shadowing of regurgitant jets and a wide normal range of transvalvular gradients. Several studies in mechanical mitral valves have demonstrated the utility of the transthoracically derived parameters E (peak early mitral inflow velocity), pressure half-time, and the ratio of mitral inflow velocity-time integral (VTIMV) to left ventricular outflow tract velocity-time integral (VTILVOT) in detecting significant prosthetic dysfunction...
August 16, 2017: Journal of the American Society of Echocardiography
https://www.readbyqxmd.com/read/28821268/hypo-fractionated-sbrt-for-localized-prostate-cancer-a-german-bi-center-single-treatment-group-feasibility-trial
#8
Ping Jiang, Katja Krockenberger, Reinhard Vonthein, Jane Tereszczuk, Arne Schreiber, Sebastian Liebau, Stefan Huttenlocher, Detlef Imhoff, Panagiotis Balermpas, Christian Keller, Kathrin Dellas, Rene Baumann, Claus Rödel, Guido Hildebrandt, Klaus-Peter Jünemann, Alex S Merseburger, Alan Katz, Andreas Ziegler, Oliver Blanck, Jürgen Dunst
BACKGROUND: For prostate cancer treatment, treatment options with minimal side effects are desired. External beam radiation therapy (EBRT) is non-invasive, standard of care and delivered in either conventional fractionation over 8 weeks or with moderate hypo-fractionation over about 5 weeks. Recent advances in radiotherapy technology have made extreme hypo-fractionated stereotactic body radiation therapy (SBRT) of prostate cancer feasible, which has not yet been introduced as a standard treatment method in Germany...
August 18, 2017: Radiation Oncology
https://www.readbyqxmd.com/read/28820870/controversies-in-the-identification-and-management-of-acute-pulmonary-hypertension-in-preterm-neonates
#9
REVIEW
Regan E Giesinger, Kiran More, Jodie Odame, Amish Jain, Robert P Jankov, Patrick J McNamara
It is increasingly recognized that the abnormal physiologic consequences of pulmonary hypertension (PH) may contribute to poor cardiopulmonary health in premature babies. Conflicting literature has led to clinical uncertainty, pathological misinterpretation and variability in treatment approaches among practitioners. There are several disorders with overlapping and interrelated presentations and other disorders with a similar clinical phenotype but diverse pathophysiological contributors. In this review, we provide a diagnostic approach for acute HRF in the preterm neonate, outline the pathophysiological conditions that may present as acute PH and discuss the implications of high pulmonary vascular resistance (PVR) on the cardiovascular system...
August 18, 2017: Pediatric Research
https://www.readbyqxmd.com/read/28820515/the-role-of-oncology-nurses-in-discussing-clinical-trials
#10
Susan A Flocke, Elizabeth Antognoli, Barbara J Daly, Brigid Jackson, Sarah E Fulton, Tasnuva M Liu, Jessica Surdam, Sharon Manne, Neal J Meropol
PURPOSE/OBJECTIVES: To describe oncology nurses' experiences discussing clinical trials with their patients, and to assess barriers to these discussions.
. RESEARCH APPROACH: A qualitative study designed to elicit narratives from oncology nurses. 
. SETTING: Community- and academic-based oncology clinics throughout the United States.
. PARTICIPANTS: 33 oncology nurses involved in direct patient care in community-based and large hospital-based settings...
September 1, 2017: Oncology Nursing Forum
https://www.readbyqxmd.com/read/28819182/impact-of-extracellular-matrix-on-engraftment-and-maturation-of-pluripotent-stem-cell-derived-cardiomyocytes-in-a-rat-myocardial-infarct-model
#11
Tatsuki Ogasawara, Satomi Okano, Hajime Ichimura, Shin Kadota, Yuki Tanaka, Itsunari Minami, Motonari Uesugi, Yuko Wada, Naoto Saito, Kenji Okada, Koichiro Kuwahara, Yuji Shiba
Pluripotent stem cell-derived cardiomyocytes show great promise in regenerating the heart after myocardial infarction; however, several uncertainties exist that must be addressed before clinical trials. One practical issue is graft survival following transplantation. Although a pro-survival cocktail with Matrigel has been shown to enhance graft survival, the use of Matrigel may not be clinically feasible. The purpose of this study was to test whether a hyaluronan-based hydrogel, HyStem, could be a substitute for Matrigel...
August 17, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28819067/health-economics-of-targeted-intraoperative-radiotherapy-targit-iort-for-early-breast-cancer-a-cost-effectiveness-analysis-in-the-united-kingdom
#12
Anil Vaidya, Param Vaidya, Brigitte Both, Chris Brew-Graves, Max Bulsara, Jayant S Vaidya
OBJECTIVE: The clinical effectiveness of targeted intraoperative radiotherapy (TARGIT-IORT) has been confirmed in the randomised TARGIT-A (targeted intraoperative radiotherapy-alone) trial to be similar to a several weeks' course of whole-breast external-beam radiation therapy (EBRT) in patients with early breast cancer. This study aims to determine the cost-effectiveness of TARGIT-IORT to inform policy decisions about its wider implementation. SETTING: TARGIT-A randomised clinical trial (ISRCTN34086741) which compared TARGIT with traditional EBRT and found similar breast cancer control, particularly when TARGIT was given simultaneously with lumpectomy...
August 17, 2017: BMJ Open
https://www.readbyqxmd.com/read/28818507/optimizing-quality-of-endoscopy-in-inflammatory-bowel-disease-focus-on-surveillance-and-management-of-colorectal-dysplasia-using-interactive-image-and-video-based-teaching
#13
Tonya R Kaltenbach, Roy M Soetikno, Rebecca DeVivo, Loren A Laine, Alan Barkun, Kenneth R McQuaid
BACKGROUND & AIMS: Varying recommendations regarding the detection and management of dysplasia can lead to uncertainty and may have impeded the uptake of strategies that could improve surveillance in patients with inflammatory bowel disease (IBD). As such, an educational event was held to assist in disseminating the recently published Surveillance for Colorectal Endoscopic Neoplasia Detection and Management in Inflammatory Bowel Disease Patients: International Consensus Recommendations (SCENIC)...
August 14, 2017: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/28818324/the-treatment-of-segmental-tibial-fractures-does-patient-preference-differ-from-surgeon-choice
#14
Z Little, T O Smith, S E McMahon, C Cooper, A Trompeter, M Pearse, S Britten, B Rogers, H Sharma, B Narayan, M Costa, D J Beard, C B Hing
INTRODUCTION: Segmental tibial fractures are complex injuries with a prolonged recovery time. Current definitive treatment options include intramedullary fixation or a circular external fixator. However, there is uncertainty as to which surgical option is preferable and there are no sufficiently rigorous multi-centre trials that have answered this question. The objective of this study was to determine whether patient and surgeon opinion was permissive for a randomised controlled trial (RCT) comparing intramedullary nailing to the application of a circular external fixator...
August 9, 2017: Injury
https://www.readbyqxmd.com/read/28816167/variabilities-of-magnetic-resonance-imaging-computed-tomography-and-positron-emission-tomography-computed-tomography-based-tumor-and-lymph-node-delineations-for-lung-cancer-radiation-therapy-planning
#15
COMPARATIVE STUDY
Kishor Karki, Siddharth Saraiya, Geoffrey D Hugo, Nitai Mukhopadhyay, Nuzhat Jan, Jessica Schuster, Matthew Schutzer, Lester Fahrner, Robert Groves, Kathryn M Olsen, John C Ford, Elisabeth Weiss
PURPOSE: To investigate interobserver delineation variability for gross tumor volumes of primary lung tumors and associated pathologic lymph nodes using magnetic resonance imaging (MRI), and to compare the results with computed tomography (CT) alone- and positron emission tomography (PET)-CT-based delineations. METHODS AND MATERIALS: Seven physicians delineated the tumor volumes of 10 patients for the following scenarios: (1) CT only, (2) PET-CT fusion images registered to CT ("clinical standard"), and (3) postcontrast T1-weighted MRI registered with diffusion-weighted MRI...
September 1, 2017: International Journal of Radiation Oncology, Biology, Physics
https://www.readbyqxmd.com/read/28816159/consensus-guidelines-for-implementing-pencil-beam-scanning-proton-therapy-for-thoracic-malignancies-on-behalf-of-the-ptcog-thoracic-and-lymphoma-subcommittee
#16
REVIEW
Joe Y Chang, Xiaodong Zhang, Antje Knopf, Heng Li, Shinichiro Mori, Lei Dong, Hsiao-Ming Lu, Wei Liu, Shahed N Badiyan, Stephen Both, Arturs Meijers, Liyong Lin, Stella Flampouri, Zuofeng Li, Kikuo Umegaki, Charles B Simone, Xiaorong R Zhu
Pencil-beam scanning (PBS) proton therapy (PT), particularly intensity modulated PT, represents the latest advanced PT technology for treating cancers, including thoracic malignancies. On the basis of virtual clinical studies, PBS-PT appears to have great potential in its ability to tightly tailor the dose to the target while sparing critical structures, thereby reducing treatment-related toxicities, particularly for tumors in areas with complicated anatomy. However, implementing PBS-PT for moving targets has several additional technical challenges compared with intensity modulated photon radiation therapy or passive scattering PT...
September 1, 2017: International Journal of Radiation Oncology, Biology, Physics
https://www.readbyqxmd.com/read/28816148/prompt-gamma-imaging-for-in%C3%A2-vivo-range-verification-of-pencil-beam-scanning-proton-therapy
#17
Yunhe Xie, El Hassane Bentefour, Guillaume Janssens, Julien Smeets, François Vander Stappen, Lucian Hotoiu, Lingshu Yin, Derek Dolney, Stephen Avery, Fionnbarr O'Grady, Damien Prieels, James McDonough, Timothy D Solberg, Robert A Lustig, Alexander Lin, Boon-Keng K Teo
PURPOSE: To report the first clinical results and value assessment of prompt gamma imaging for in vivo proton range verification in pencil beam scanning mode. METHODS AND MATERIALS: A stand-alone, trolley-mounted, prototype prompt gamma camera utilizing a knife-edge slit collimator design was used to record the prompt gamma signal emitted along the proton tracks during delivery of proton therapy for a brain cancer patient. The recorded prompt gamma depth detection profiles of individual pencil beam spots were compared with the expected profiles simulated from the treatment plan...
September 1, 2017: International Journal of Radiation Oncology, Biology, Physics
https://www.readbyqxmd.com/read/28815514/intraepithelial-lymphocyte-immunophenotype-a-useful-tool-in-the-diagnosis-of-celiac-disease
#18
Rebeca Saborido, Nazareth Martinón, Alexandra Regueiro, Vanesa Crujeiras, Pablo Eiras, Rosaura Leis
According to new ESPGHAN guidelines, gluten challenge is considered necessary when there is doubt about the initial diagnosis of celiac disease (CD). The main aim of this study was to quantify intraepithelial lymphocyte (IEL) immunophenotype on celiac patients on gluten-containing diet (GCD) compared to those on gluten-free diet (GFD). Another aim was to evaluate the clinical utility of IELs in the CD diagnosis, especially in selected patients on GFD where diagnostic uncertainty remains. IEL immunophenotype (TCRγδ and NK-like IELs) were studied by flow cytometry in 111 children with CD (81 children with CD on GCD and 30 celiac patients on GFD) and a control group (10 children)...
August 16, 2017: Journal of Physiology and Biochemistry
https://www.readbyqxmd.com/read/28815436/headache-attributed-to-airplane-travel-diagnosis-pathophysiology-and-treatment-a-systematic-review
#19
Sebastian Bao Dinh Bui, Parisa Gazerani
BACKGROUND: Headache attributed to airplane travel, also named "airplane headache" (AH) is a headache that occurs during take-off and landing. Today, there are still uncertainties about the pathophysiology and treatment of AH. This systematic review was performed to facilitate identification of the existing literature on AH in order to discuss the current evidence and areas that remain to be investigated in AH. METHODS: The systematic literature search was performed in 3 relevant medical databases; PubMed, Scopus, and Embase...
August 16, 2017: Journal of Headache and Pain
https://www.readbyqxmd.com/read/28815014/the-relationship-between-intolerance-of-uncertainty-in-chiropractic-students-and-their-treatment-intervention-choices
#20
Stanley I Innes, Charlotte Leboeuf-Yde, Bruce F Walker
BACKGROUND: Psychological factors, such as intolerance of uncertainty (IU), have been shown to impact on the quality of medical care. However, this psychological measure has not been studied in the chiropractic profession. Our objective was to investigate if higher levels of IU in chiropractic students were related to poor choices of management in specific clinical scenarios. Also, we sought to investigate if levels of IU were related to students' intentions to adopt a prescriptive chiropractic technique system and evaluate their levels of self-belief...
2017: Chiropractic & Manual Therapies
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