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https://www.readbyqxmd.com/read/29244075/the-athlete-s-heart-is-a-proarrhythmic-heart-and-what-that-means-for-clinical-decision-making
#1
Hein Heidbuchel
Recurring questions when dealing with arrhythmias in athletes are about the cause of the arrhythmia and, more importantly, about the eligibility of the athlete to continue sports activities. In essence, the relation between sports and arrhythmias can be understood along three lines: sports as arrhythmia trigger on top of an underlying problem, sports as arrhythmic substrate promotor, or sports as substrate inducer. Often, there is no sharp divider line between these entities. The athlete's heart, a heart that adapts so magically to cope with the demands of exercise, harbours many structural and functional changes that by themselves predispose to arrhythmia development, at the atrial, nodal and ventricular levels...
December 13, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/29242798/anterior-elbow-pain-caused-by-compression-of-the-lateral-antebrachial-cutaneous-nerve
#2
Sean M Booth, Abdulbaset Abosala, Chris Peach
Introduction: The complex anatomy and biomechanics of the elbow joint can lead to diagnostic uncertainty when a clinician is determining the cause of a patient's anterior elbow pain. We present a case of anterior elbow pain with an uncommon and often overlooked etiology. Elbow pain due to compression of the lateral antebrachial nerve (LACN) has an unknown incidence or prevalence. Case Report: A 27-year-old left-hand dominant male presented to our orthopedic elbow clinic complaining of bilateral elbow clicking and discomfort which had been present for several years...
September 2017: Journal of Orthopaedic Case Reports
https://www.readbyqxmd.com/read/29241890/value-of-information-analysis-of-multiparameter-tests-for-chemotherapy-in-early-breast-cancer-the-optima-prelim-trial
#3
Peter S Hall, Alison Smith, Claire Hulme, Armando Vargas-Palacios, Andreas Makris, Luke Hughes-Davies, Janet A Dunn, John M S Bartlett, David A Cameron, Andrea Marshall, Amy Campbell, Iain R Macpherson, Dan Rea, Adele Francis, Helena Earl, Adrienne Morgan, Robert C Stein, Christopher McCabe
BACKGROUND: Precision medicine is heralded as offering more effective treatments to smaller targeted patient populations. In breast cancer, adjuvant chemotherapy is standard for patients considered as high-risk after surgery. Molecular tests may identify patients who can safely avoid chemotherapy. OBJECTIVES: To use economic analysis before a large-scale clinical trial of molecular testing to confirm the value of the trial and help prioritize between candidate tests as randomized comparators...
December 2017: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
https://www.readbyqxmd.com/read/29240766/estimated-clinical-impact-of-the-xpert-mtb-rif-ultra-cartridge-for-diagnosis-of-pulmonary-tuberculosis-a-modeling-study
#4
Emily A Kendall, Samuel G Schumacher, Claudia M Denkinger, David W Dowdy
BACKGROUND: The Xpert MTB/RIF (Xpert) assay offers rapid and accurate diagnosis of tuberculosis (TB) but still suffers from imperfect sensitivity. The newer Xpert MTB/RIF Ultra cartridge has shown improved sensitivity in recent field trials, but at the expense of reduced specificity. The clinical implications of switching from the existing Xpert cartridge to the Xpert Ultra cartridge in different populations remain uncertain. METHODS AND FINDINGS: We developed a Markov microsimulation model of hypothetical cohorts of 100,000 individuals undergoing diagnostic sputum evaluation with Xpert for suspected pulmonary TB, in each of 3 emblematic settings: an HIV clinic in South Africa, a public TB center in India, and an adult primary care setting in China...
December 2017: PLoS Medicine
https://www.readbyqxmd.com/read/29239999/care-management-to-reduce-disparities-and-control-hypertension-in-primary-care-a-cost-effectiveness-analysis
#5
Jonathan C Hong, William V Padula, Ilene L Hollin, Tanvir Hussain, Katherine B Dietz, Jennifer P Halbert, Jill A Marsteller, Lisa A Cooper
BACKGROUND: Project ReD CHiP (reducing disparities and controlling hypertension in primary care) care management was a clinic-based intervention that aimed to improve blood pressure control through improved care coordination and provide self-management support to patients from racially and socioeconomically. OBJECTIVE: To evaluate the cost-effectiveness of ReD CHiP care management versus standard care to treat hypertension in diverse communities. RESEARCH DESIGN: Microsimulation model from a health care sector perspective over 15 years...
December 12, 2017: Medical Care
https://www.readbyqxmd.com/read/29239595/explaining-the-absence-of-surgical-procedure-regulation
#6
Jonathan J Darrow
Each year in the United States, surgeons perform approximately 64 million surgical procedures, ranging from tooth extraction to open heart surgery. Yet, notwithstanding the frequency of surgical procedures and their often critical importance to patient health, no state or federal agency either approves the use of new surgical procedures or directly regulates existing procedures. The absence of surgical procedure regulation differs from the regulation of new pharmaceutical products, which can be introduced into interstate commerce only after the Food and Drug Administration (FDA) has reviewed "adequate and well-controlled [clinical] investigations" and concluded the data from those studies sufficiently establish the drug's safety and efficacy...
2017: Cornell Journal of Law and Public Policy
https://www.readbyqxmd.com/read/29238919/a-novel-fully-automatic-multilevel-thresholding-technique-based-on-optimized-intuitionistic-fuzzy-sets-and-tsallis-entropy-for-mr-brain-tumor-image-segmentation
#7
Taranjit Kaur, Barjinder Singh Saini, Savita Gupta
In the present paper, a hybrid multilevel thresholding technique that combines intuitionistic fuzzy sets and tsallis entropy has been proposed for the automatic delineation of the tumor from magnetic resonance images having vague boundaries and poor contrast. This novel technique takes into account both the image histogram and the uncertainty information for the computation of multiple thresholds. The benefit of the methodology is that it provides fast and improved segmentation for the complex tumorous images with imprecise gray levels...
December 13, 2017: Australasian Physical & Engineering Sciences in Medicine
https://www.readbyqxmd.com/read/29238308/duration-of-absence-from-work-is-related-to-psychopathology-personality-and-sociodemographic-variables-in-a-longitudinal-cohort
#8
Alex Gamma, Roman Schleifer, Ingeborg Warnke, Vladeta Ajdacic-Gross, Wulf Rössler, Jules Angst, Michael Liebrenz
Objective: To examine, in a non-clinical sample, the association of psychopathology, personality, sociodemographic information, and psychosocial indicators of non-occupational functioning with the duration of absence from work in the past 12 months. Method: A longitudinal community cohort of 591 adults from Switzerland was analyzed using multilevel ordered logistic regression, with several alternative models as robustness checks. Psychopathology was assessed using the total score (Global Severity Index) of the Symptom Check List-90 Revised...
2017: Frontiers in Psychiatry
https://www.readbyqxmd.com/read/29237921/impact-of-proton-pump-inhibitors-on-the-pharmacodynamic-effect-and-clinical-outcomes-in-patients-receiving-dual-antiplatelet-therapy-after-percutaneous-coronary-intervention-a-propensity-score-analysis
#9
Pei Zhu, Zhan Gao, Xiao-Fang Tang, Jing-Jing Xu, Yin Zhang, Li-Jian Gao, Jue Chen, Shu-Bin Qiao, Yue-Jin Yang, Run-Lin Gao, Bo Xu, Jin-Qing Yuan
BACKGROUND: Prior studies have reported controversial conclusions regarding the risk of adverse cardiovascular events in patients using proton-pump inhibitors (PPIs) combined with clopidogrel therapy, causing much uncertainty in clinical practice. We sought to evaluate the safety of PPIs use among high-risk cardiovascular patients who underwent percutaneous coronary intervention (PCI) in a long-term follow-up study. METHODS: A total of 7868 consecutive patients who had undergone PCI and received dual antiplatelet therapy (DAPT) at a single center from January 2013 to December 2013 were enrolled...
December 20, 2017: Chinese Medical Journal
https://www.readbyqxmd.com/read/29237578/the-effectiveness-of-exercise-therapy-on-scapular-position-and-motion-in-individuals-with-scapular-dyskinesis-systematic-review-protocol
#10
Afsun Nodehi Moghadam, Kianoush Abdi, Mohsen Shati, Shohreh Noorizadeh Dehkordi, Abbas Ali Keshtkar, Zahra Mosallanezhad
BACKGROUND: Scapular dyskinesis is an alteration in normal scapular position and motion. Some researchers believe that altered kinematics of the scapula subsequent to dysfunction or weakness of scapular stabilizing muscles contributes to impingement syndrome. Scapular muscle exercises are included in the rehabilitation of patients with subacromial impingement syndrome and scapular dyskinesis because the muscular system is one of the major contributors of scapular positioning both at rest and during shoulder movement, but there is considerable uncertainty relating to the relative effectiveness of such approaches on changing scapular position and motion...
December 13, 2017: JMIR Research Protocols
https://www.readbyqxmd.com/read/29236732/variable-manifestations-diverse-seroreactivity-and-post-treatment-persistence-in-non-human-primates-exposed-to-borrelia-burgdorferi-by-tick-feeding
#11
Monica E Embers, Nicole R Hasenkampf, Mary B Jacobs, Amanda C Tardo, Lara A Doyle-Meyers, Mario T Philipp, Emir Hodzic
The efficacy and accepted regimen of antibiotic treatment for Lyme disease has been a point of significant contention among physicians and patients. While experimental studies in animals have offered evidence of post-treatment persistence of Borrelia burgdorferi, variations in methodology, detection methods and limitations of the models have led to some uncertainty with respect to translation of these results to human infection. With all stages of clinical Lyme disease having previously been described in nonhuman primates, this animal model was selected in order to most closely mimic human infection and response to treatment...
2017: PloS One
https://www.readbyqxmd.com/read/29233397/assessment-of-student-pharmacists-ethical-decision-making
#12
Jaclyn R Myers, Mary E Kiersma, Kimberly S Plake
INTRODUCTION: In previous research, investigators have expressed concern about the ethical ambivalence of pharmacists in decision-making. The objectives of this study were to examine student pharmacists': 1) attitudes and responses regarding specific common ethical situations and 2) perceived level of difficulty in making ethical decisions. METHODS: A self-administered 38-item survey was given to second and third year student pharmacists at Purdue University. The survey comprised five sections, including: 1) attitudes towards common ethical situations, 2) responses to specific ethical scenarios, 3) emergency lending, 4) perceived level of difficulty in resolving ethical dilemmas, and 5) demographics...
November 2017: Currents in Pharmacy Teaching & Learning
https://www.readbyqxmd.com/read/29230487/-osteoporosis-in-private-accident-insurance
#13
REVIEW
Holm-Torsten Klemm, Wolfgang Albers, Andreas Krumbiegel, Wolfgang Willauschus
Osteoporosis is a multifactorial disease resulting in reduced bone strength and increased bone fragility. The cause of osteoporosis is underexplored. The manifestation of osteoporosis makes a significant contribution to the development of bone fractures. In the medical assessment, the question arises to what extent osteoporosis is considered to be a previous disability or in particular as a contributory factor. In particular, there are some uncertainties relating to the degree of possible participation, as there are only insufficient scientific evaluation systems...
December 11, 2017: Der Unfallchirurg
https://www.readbyqxmd.com/read/29228950/indacaterol-glycopyrronium-is-cost-effective-compared-to-salmeterol-fluticasone-in-copd-flame-based-modelling-in-a-swedish-population
#14
Leif Bjermer, Job F M van Boven, Madlaina Costa-Scharplatz, Dorothy L Keininger, Florian S Gutzwiller, Karin Lisspers, Ronan Mahon, Petter Olsson, Nicolas Roche
BACKGROUND: This study assessed the cost-effectiveness of indacaterol/glycopyrronium (IND/GLY) versus salmeterol/fluticasone (SFC) in chronic obstructive pulmonary disease (COPD) patients with moderate to very severe airflow limitation and ≥1 exacerbation in the preceding year. METHODS: A previously published and validated patient-level simulation model was adapted using clinical data from the FLAME trial and real-world cost data from the ARCTIC study. Costs (total monetary costs comprising drug, maintenance, exacerbation, and pneumonia costs) and health outcomes (life-years (LYs), quality-adjusted life-years (QALYs)) were projected over various time horizons (1, 5, 10 years, and lifetime) from the Swedish payer's perspective and were discounted at 3% annually...
December 11, 2017: Respiratory Research
https://www.readbyqxmd.com/read/29227919/a-subject-specific-biomechanical-control-model-for-the-prediction-of-cervical-spine-muscle-forces
#15
Maxim Van den Abbeele, Fan Li, Vincent Pomero, Dominique Bonneau, Baptiste Sandoz, Sébastien Laporte, Wafa Skalli
BACKGROUND: The aim of the present study is to propose a subject-specific biomechanical control model for the estimation of active cervical spine muscle forces. METHODS: The proprioception-based regulation model developed by Pomero et al. (2004) for the lumbar spine was adapted to the cervical spine. The model assumption is that the control strategy drives muscular activation to maintain the spinal joint load below the physiological threshold, thus avoiding excessive intervertebral displacements...
December 6, 2017: Clinical Biomechanics
https://www.readbyqxmd.com/read/29225694/non-small-cell-lung-cancer-treatment-r-evolution-ten-years-of-advances-and-more-to-come
#16
REVIEW
Luca Toschi, Sabrina Rossi, Giovanna Finocchiaro, Armando Santoro
Diagnostic and treatment algorithms in non-small cell lung cancer (NSCLC) are evolving at a never-before-seen pace. Histological subtyping to maximise treatment efficacy and avoid toxicity has marked the beginning of the revolution, opening the way to molecular characterisation to guide genomically driven treatments with targeted agents, led by Epidermal Growth Factor Receptor (EGFR) and Anaplastic Lymphoma Kinase (ALK) inhibitors. More recently, agents against the Program Death 1 receptor (PD-1) and ligand 1 (PD-L1) have entered the clinical arena, offering new hope to NSCLC patients, although several uncertainties remain to be elucidated...
2017: Ecancermedicalscience
https://www.readbyqxmd.com/read/29224048/comparison-between-whole-body-and-head-and-neck-neurovascular-coils-for-3-t-magnetic-resonance-proton-resonance-frequency-shift-thermography-guidance-in-the-head-and-neck-region
#17
Daniel Thomas Ginat, Gregory J Anthony, Gregory Christoforidis, Aytekin Oto, Leonard Dalag, Steffen Sammet
The purpose of this study is to compare the image quality of magnetic resonance (MR) treatment planning images and proton resonance frequency (PRF) shift thermography images and inform coil selection for MR-guided laser ablation of tumors in the head and neck region. Laser ablation was performed on an agar phantom and monitored via MR PRF shift thermography on a 3-T scanner, following acquisition of T1-weighted (T1W) planning images. PRF shift thermography images and T2-weighted (T2W) planning images were also performed in the neck region of five normal human volunteers...
December 9, 2017: Lasers in Medical Science
https://www.readbyqxmd.com/read/29223612/predictive-value-of-focused-assessment-with-sonography-for-trauma-fast-for-laparotomy-in-unstable-polytrauma-egyptians-patients
#18
Adel Hamed Elbaih, Sameh T Abu-Elela
PURPOSE: The emergency physicians face significant clinical uncertainty when multiple trauma patients arrive in the emergency department (ED). The priorities for assessment and treatment of polytrauma patients are established in the primary survey. Focused assessment with sonography for trauma (FAST) is very essential clinical skill during trauma resuscitation. Use of point of care ultrasound among the trauma team working in the primary survey in emergency care settings is lacking in Suez Canal University Hospitals even ultrasound machine not available in ED...
November 23, 2017: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
https://www.readbyqxmd.com/read/29222833/association-between-measures-of-treatment-quality-and-disease-progression-in-prostate-cancer-radiotherapy-an-exploratory-analysis-from-the-trog-03-04-radar-trial
#19
Marco Marcello, Martin A Ebert, Annette Haworth, Allison Steigler, Angel Kennedy, Max Bulsara, Rachel Kearvell, David J Joseph, James W Denham
INTRODUCTION: Quality assurance methods are incorporated into multicentre radiotherapy clinical trials for ensuring consistent application of trial protocol and quantifying treatment uncertainties. The study's purpose was to determine whether post-treatment disease progression is associated with measures of the quality of radiotherapy treatment. METHODS: The TROG 03.04 RADAR trial tested the impact of androgen deprivation on prostate cancer patients receiving dose-escalated external beam radiation therapy...
December 8, 2017: Journal of Medical Imaging and Radiation Oncology
https://www.readbyqxmd.com/read/29222670/venetoclax-for-treating-chronic-lymphocytic-leukaemia-an-evidence-review-group-perspective-of-a-nice-single-technology-appraisal
#20
REVIEW
Hema Mistry, Chidozie Nduka, Martin Connock, Jill Colquitt, Theodoros Mantopoulos, Emma Loveman, Renata Walewska, James Mason
Venetoclax is licensed to treat relapsed or refractory (R/R) chronic lymphocytic leukaemia (CLL). As part of the Single Technology Appraisal (STA) ID944, the National Institute for Health and Care Excellence (NICE) invited AbbVie, the manufacturer, to submit evidence on the use of venetoclax, within its licensed indication. The Evidence Review Group (ERG), Warwick Evidence, was asked to provide an independent and critical review of the submitted evidence. Evidence came from three single-arm trials in CLL patients with or without 17p deletion [del(17p])/TP53 chromosomal abnormalities...
December 8, 2017: PharmacoEconomics
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