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https://www.readbyqxmd.com/read/28817366/trajectory-of-dyspnea-and-respiratory-distress-among-patients-in-the-last-month-of-life
#1
Margaret L Campbell, Jason M Kiernan, John Strandmark, Hossein N Yarandi
BACKGROUND: The trajectory of dyspnea has been reported among patients approaching the end of life. However, patients near death have been dropped from longitudinal studies or excluded altogether because of an inability to self-report; proxy estimates have been reported. It is not known whether dyspnea or respiratory distress remains stable, escalates, or abates as patients reach last days. OBJECTIVE: Determine trajectory of dyspnea (self-reported) and respiratory distress (observed) among patients who were approaching death...
August 17, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28816142/vorinostat-and-concurrent-stereotactic-radiosurgery-for-non-small-cell-lung-cancer-brain-metastases-a-phase-1-dose-escalation-trial
#2
Clara Y H Choi, Heather A Wakelee, Joel W Neal, Mary C Pinder-Schenck, Hsiang-Hsuan Michael Yu, Steven D Chang, John R Adler, Leslie A Modlin, Griffith R Harsh, Scott G Soltys
PURPOSE: To determine the maximum tolerated dose (MTD) of vorinostat, a histone deacetylase inhibitor, given concurrently with stereotactic radiosurgery (SRS) to treat non-small cell lung cancer (NSCLC) brain metastases. Secondary objectives were to determine toxicity, local failure, distant intracranial failure, and overall survival rates. MATERIALS AND METHODS: In this multicenter study, patients with 1 to 4 NSCLC brain metastases, each ≤2 cm, were enrolled in a phase 1, 3 + 3 dose escalation trial...
September 1, 2017: International Journal of Radiation Oncology, Biology, Physics
https://www.readbyqxmd.com/read/28814898/reducing-rectal-injury-in-men-receiving-prostate-cancer-radiation-therapy-current-perspectives
#3
REVIEW
Nicholas A Serrano, Noah S Kalman, Mitchell S Anscher
Dose escalation is now the standard of care for the treatment of prostate cancer with radiation therapy. However, the rectum tends to be the dose-limiting structure when treating prostate cancer, given its close proximity. Early and late toxicities can occur when the rectum receives large doses of radiation therapy. New technologies allow for prevention of these toxicities. In this review, we examine the evidence that supports various dose constraints employed to prevent these rectal injuries from occurring...
2017: Cancer Management and Research
https://www.readbyqxmd.com/read/28800811/violence-in-the-emergency-department-a-global-problem
#4
REVIEW
Allison Tadros, Christopher Kiefer
Violence against health care workers is an unfortunately common event. Because of several inherent factors, emergency departments are particularly vulnerable. Once an incident occurs, it often goes unreported and leads to both physical and mental trauma. Health care workers should learn to recognize the cues that patients are escalating toward violence and be familiar with various options for sedating agitated patients. If sedation is not successful, physical restraint may become necessary. There are measures that can be taken that may help minimize the likelihood of violence toward health care workers...
September 2017: Psychiatric Clinics of North America
https://www.readbyqxmd.com/read/28800797/a-modern-day-fight-club-the-stabilization-and-management-of-acutely-agitated-patients-in-the-emergency-department
#5
REVIEW
Andrew New, Veronica Theresa Tucci, Juan Rios
This article is an overview of the treatment and management of acutely agitated patients as they present in the emergency department or emergency psychiatric facility. This article focuses on how a patient encounter may unfold and what issues need to be considered along the way. Verbal de-escalation is emphasized as a standard of care, including the offering of environmental changes and medications when indicated. Approved medications are reviewed as well as the proper use of restraints.
September 2017: Psychiatric Clinics of North America
https://www.readbyqxmd.com/read/28798031/repeated-lu-177-psma-617-radioligand-therapy-using-treatment-activities-up-to-9-3-gbq
#6
Hendrik Rathke, Frederik L Giesel, Paul Flechsig, Klaus Kopka, Walter Mier, Markus Hohenfellner, Uwe Haberkorn, Clemens Kratochwil
Current treatment protocols for (177)Lu-PSMA-617 therapies were cautiously derived from dosimetry data, but their practical appropriateness have not yet been proven clinically. We retrospectively report our clinical observations using four different treatment activities. Methods: Forty patients with advanced prostate cancer and positive uptake in PSMA-imaging were treated in fractions of 4 GBq / 80 nmol, 6 GBq / 120 nmol, 7.4 GBq / 150 nmol or 9.3 GBq / 150 nmol (177)Lu-activity / precursor-amount (n = 10, respectively) every 2 months...
August 10, 2017: Journal of Nuclear Medicine: Official Publication, Society of Nuclear Medicine
https://www.readbyqxmd.com/read/28797498/interventions-to-enhance-testing-linkage-to-care-and-treatment-uptake-for-hepatitis-c-virus-infection-among-people-who-inject-drugs-a-systematic-review
#7
Sahar Bajis, Gregory J Dore, Behzad Hajarizadeh, Evan B Cunningham, Lisa Maher, Jason Grebely
BACKGROUND: The burden of hepatitis C virus (HCV) infection is escalating among people who inject drugs (PWID), yet testing and treatment remains suboptimal. The aim of this systematic review was to evaluate the effectiveness of interventions to enhance HCV testing, linkage to care, and treatment uptake among PWID. METHODS: A systematic literature search of Medline (Ovid 1946 - present), Embase, Global Health, Cochrane Central Register of Controlled Trials, PsycINFO, Clinical Trials Registry, and Web of Science was conducted covering interventional studies published before 20 July 2016...
August 7, 2017: International Journal on Drug Policy
https://www.readbyqxmd.com/read/28794646/bronchial-thermoplasty-implementing-best-practice-in-the-era-of-cost-containment
#8
Laren D Tan, Nicholas Kenyon, Ken Y Yoneda, Samuel Louie
Increasing dependence on advanced technologies in the 21st century has created a dilemma between the practice and business of medicine. From information technology to robotic surgery, new technologies have expanded treatment possibilities and have potentially improved patient outcomes and safety. Simultaneously, their escalating costs limit access for certain patients and health care facilities. Nevertheless, medical decisions should not simply be based on cost. Input from physicians and other health care specialists as well as adherence to best practice position statements, are vital to implementing truly cost-effective strategies in medicine...
2017: Journal of Asthma and Allergy
https://www.readbyqxmd.com/read/28791786/emergency-department-provider-perspectives-on-benzodiazepine-opioid-co-prescribing-a-qualitative-study
#9
Howard S Kim, Danielle M McCarthy, Jason A Hoppe, D Mark Courtney, Bruce L Lambert
OBJECTIVE: Benzodiazepines and opioids are prescribed simultaneously (i.e. "co-prescribed") in many clinical settings, despite guidelines advising against this practice and mounting evidence that concomitant use of both medications increases overdose risk. This study sought to characterize the contexts in which benzodiazepine-opioid co-prescribing occurs and providers' reasons for co-prescribing. METHODS: We conducted focus groups with ED providers (resident and attending physicians, advanced practice providers, and pharmacists) from three hospitals using semi-structured interviews to elicit perspectives on benzodiazepine-opioid co-prescribing...
August 9, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28790283/-postoperative-atelectasis-and-pneumonia-after-general-thoracic-surgery
#10
Yasushi Hoshikawa, Daisuke Tochii
Atelectasis and pneumonia are common postoperative complications occurred in patients undergoing general thoracic surgery. Strategies to reduce the risk of postoperative pulmonary complications including these 2 disorders consist of smoking cessation, optimization of underlying chronic obstructive pulmonary disease( COPD), adequate pain control, intensive oral care, and so on. Preoperative treatments for patients with COPD are the same as those for COPD patients being not about to have surgery, which mainly consist of long-acting bronchodilators and pulmonary rehabilitation...
July 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/28789825/the-effect-of-the-quality-of-vital-sign-recording-on-clinical-decision-making-in-a-regional-acute-care-trauma-ward
#11
Claire M Keene, Victor Y Kong, Damian L Clarke, Petra Brysiewicz
PURPOSE: Recording vital signs is important in the hospital setting and the quality of this documentation influences clinical decision making. The Modified Early Warning Score (MEWS) uses vital signs to categorise the severity of a patient's physiological derangement and illustrates the clinical impact of vital signs in detecting patient deterioration and making management decisions. This descriptive study measured the quality of vital sign recordings in an acute care trauma setting, and used the MEWS to determine the impact the documentation quality had on the detection of physiological derangements and thus, clinical decision making...
July 5, 2017: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
https://www.readbyqxmd.com/read/28782646/%C3%AE-lacta-%C3%A2-test-performance-for-detection-of-extended-spectrum-%C3%AE-lactamase-producing-gram-negative-bacilli-directly-on-bronchial-aspirates-samples-a-validation-study
#12
Salah Gallah, Yahia Benzarara, Jacques Tankovic, Paul-Louis Woerther, Hayat Bensekri, Jean-Luc Mainardi, Guillaume Arlet, Sophie Vimont, Marc Garnier
OBJECTIVES: Incidence of Extended Spectrum β-Lactamase-producing Gram Negative Bacilli (ESBL-P-GNB)-related infections is worryingly increasing worldwide. ESBL-P-GNB detection directly on bronchial aspirate samples (BAS) performed for suspected pneumonia may help save empirical carbapenems. Our objectives were to optimize β-LACTA(®) test (BLT) realization and evaluate BLT performance for ESBL-P-GNB detection directly on BAS. METHODS: 1) BLT technical optimization using BAS of different matrix types spiked with increasing concentrations of CTX-M-15-producing Klebsiella pneumoniae; 2) in vitro validation of BLT diagnostic performance on 17 ESBL enzymes, belonging to CTX-M, SHV, TEM, OXA, GES, VEB, and PER groups; 3) clinical validation of BLT performance on 126 BAS prospectively collected from 7 Intensive Care Units...
August 3, 2017: Clinical Microbiology and Infection
https://www.readbyqxmd.com/read/28781151/2016-guideline-strategies-for-the-use-of%C3%A2-antifungal-agents-in-patients-with-hematological-malignancies-or-hematopoietic-stem-cell-transplantation-recipients-in-taiwan
#13
REVIEW
Bor-Sheng Ko, Wei-Ting Chen, Hsiang-Chi Kung, Un-In Wu, Jih-Luh Tang, Ming Yao, Yee-Chun Chen, Hwei-Fang Tien, Shan-Chwen Chang, Yin-Ching Chuang, Dong-Tsamn Lin
The Infectious Diseases Society of Taiwan (IDST), the Hematology Society of Taiwan, the Taiwan Society of Blood and Marrow Transplantation, Medical Foundation in Memory of Dr. Deh-Lin Cheng, Foundation of Professor Wei-Chuan Hsieh for Infectious Diseases Research and Education, and CY Lee's Research Foundation for Pediatric Infectious Diseases and Vaccines cooperatively published this guideline for the use of antifungal agents in hematological patients with invasive fungal diseases (IFDs) in Taiwan. The guideline is the first one endorsed by IDST focusing on selection of antifungal strategies, including prophylaxis, empirical (or symptom-driven) and pre-emptive (or diagnostic-driven) strategy...
July 25, 2017: Journal of Microbiology, Immunology, and Infection, Wei Mian Yu Gan Ran za Zhi
https://www.readbyqxmd.com/read/28764273/prevalence-of-metabolic-syndrome-among-psychiatric-inpatients-a-hospital-based-study-from-kashmir
#14
Tajamul Hussain, Mushtaq Ahmad Margoob, Sheikh Shoib, Mahak Shafat, Rajesh Kumar Chandel
INTRODUCTION: Over the last fifty years there has been dramatic change in the human environment, behaviours and way-of-life. These changes have resulted in escalating rates of metabolic syndrome not only in general population but also among people with mental illness. Various factors, like the lack of exercise, use of psychotropic medications and inadequate medical care leads to the increased risk of metabolic changes among people with mental illness. Hence, there is a greater need to evaluate metabolic syndrome in this population...
June 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28757315/liver-transplant-related-anastomotic-biliary-strictures-a-novel-rapid-safe-radiation-sparing-and-cost-effective-management-approach
#15
Monique T Barakat, Robert J Huang, Nirav C Thosani, Abhishek Choudhary, Mohit Girotra, Subhas Banerjee
BACKGROUND AND AIMS: Biliary strictures after orthotopic liver transplantation (OLT) are typically managed by sequential ERCP procedures, with incremental dilation of the stricture and stent exchange (IDSE) and placement of new stents. This approach resolves >80% of strictures after 12 months, but requires costly, lengthy ERCPs with significant patient radiation exposure. Increasing awareness of the harmful effects of radiation, escalating health care costs, and decreasing reimbursement for procedures mandate maximal efficiency in performing ERCP...
July 27, 2017: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/28748278/-therapy-escalation-for-the-potential-organ-donor-are-all-intensive-care-measures-also-ethically-justifiable
#16
REVIEW
S-O Kuhn, K Hahnenkamp
The gap between the number of organs needed and the number available has dramatically increased in Germany in the last decade-for intensivists and transplantation specialists, it is challenging to cover the demand responsibly. It is therefore increasingly important to identify potential organ donors in order to realize organ donation. An escalation of intensive care measures is often required, which raises critical ethical questions. In Germany, organ donation is only allowed after brain death with prior informed consent from the deceased or his/her relatives...
July 26, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28742676/committee-opinion-no-711-opioid-use-and-opioid-use-disorder-in-pregnancy
#17
(no author information available yet)
Opioid use in pregnancy has escalated dramatically in recent years, paralleling the epidemic observed in the general population. To combat the opioid epidemic, all health care providers need to take an active role. Pregnancy provides an important opportunity to identify and treat women with substance use disorders. Substance use disorders affect women across all racial and ethnic groups and all socioeconomic groups, and affect women in rural, urban, and suburban populations. Therefore, it is essential that screening be universal...
August 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28742670/committee-opinion-no-711-summary-opioid-use-and-opioid-use-disorder-in-pregnancy
#18
(no author information available yet)
Opioid use in pregnancy has escalated dramatically in recent years, paralleling the epidemic observed in the general population. To combat the opioid epidemic, all health care providers need to take an active role. Pregnancy provides an important opportunity to identify and treat women with substance use disorders. Substance use disorders affect women across all racial and ethnic groups and all socioeconomic groups, and affect women in rural, urban, and suburban populations. Therefore, it is essential that screening be universal...
August 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28741362/gastroenterology-evolution-of-specialty-choice-in-recent-years
#19
José Curbelo, José-María Galván-Román, Fernando Sánchez-Lasheras, Jose María Romeo, Ana Fernández-Somoano, Tomás Villacampa, Jaime Baladrón
INTRODUCTION: Gastroenterology is one of the medical specialties offered to residency training candidates each year. This project analyzes the data associated with the choice of a Gastroenterology residency program in recent years. MATERIALS AND METHODS: Data related to specialty selection were obtained from official reports with regard to the allocation of residency places by the Spanish Ministry of Health, Social Services and Equality. Information was collected from various teaching centers via their training guides, the Spanish National Catalogue of Hospitals and the National Transplant Organization...
July 25, 2017: Revista Española de Enfermedades Digestivas
https://www.readbyqxmd.com/read/28738902/a-comparative-effectiveness-study-of-two-culturally-competent-models-of-diabetes-self-management-programming-for-latinos-from-low-income-households
#20
Janet Page-Reeves, Lidia Regino, Cristina Murray-Krezan, Molly Bleecker, Erik Erhardt, Mark Burge, Elaine Bearer, Shiraz Mishra
BACKGROUND: Diabetes risk is extremely high for Latinos from low-income households. Health guidelines recommend that individuals learn strategies to self-manage their diabetes, but getting people to adopt required lifestyle changes is challenging and many people are not able to prevent their pre-diabetes from escalating or effectively control their diabetes. Systematic reviews show that culturally competent self-management programs can significantly improve diabetes outcomes and different models for culturally competent programming have been developed...
July 24, 2017: BMC Endocrine Disorders
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