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Escalation of care

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https://www.readbyqxmd.com/read/29674508/combined-braf-and-hsp90-inhibition-in-patients-with-unresectable-braf-v600e-mutant-melanoma
#1
Zeynep Eroglu, Yian Ann Chen, Geoffrey T Gibney, Jeffrey S Weber, Ragini R Kudchadkar, Nikhil I Khushalani, Joseph Markowitz, Andrew S Brohl, Leticia F Tetteh, Howida Ramadan, Gina Arnone, Jiannong Li, Xiuhua Zhao, Ritin Sharma, Lancia N F Darville, Bin Fang, Inna Smalley, Jane L Messina, John M Koomen, Vernon K Sondak, Keiran S M Smalley
PURPOSE: BRAF inhibitors are clinically active in patients with advanced BRAFV600 -mutant melanoma, although acquired resistance remains common. Preclinical studies demonstrated that resistance could be overcome using concurrent treatment with the HSP90 inhibitor XL888. METHODS: Vemurafenib (960 mg PO BID) combined with escalating doses of XL888 (30, 45, 90 or 135 mg PO twice weekly) was investigated in 21 patients with advanced BRAFV600 -mutant melanoma. Primary endpoints were safety and determination of a maximum tolerated dose...
April 19, 2018: Clinical Cancer Research: An Official Journal of the American Association for Cancer Research
https://www.readbyqxmd.com/read/29672125/submassive-pulmonary-embolism
#2
Parth M Rali, Gerard J Criner
Pulmonary Embolism (PE) presents a spectrum of hemodynamic consequences ranging from being asymptomatic to a life-threatening medical emergency. Management of sub massive and massive PE often involves clinicians from multiple specialties that can potentially delay the development of a unified treatment plan. Additionally, patients with submassive PE can deteriorate after their presentation and require escalation of care. Underlying comorbidities like chronic obstructive pulmonary disease (COPD), cancer, congestive heart failure and interstitial lung disease can impact the patient's hemodynamic ability to tolerate submassive PE...
April 19, 2018: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29667921/glycemic-control-of-type-2-diabetes-mellitus-across-stages-of-renal-impairment-information-for-primary-care-providers
#3
Lili Tong, Sharon Adler
Chronic kidney disease (CKD) is a frequent complication of type 2 diabetes mellitus (T2DM) and elevates individuals' risk for cardiovascular disease, the leading cause of morbidity and mortality in T2DM. Achieving and maintaining tight glycemic control is key to preventing development or progression of CKD; however, improving glycemic control may be limited by effects of renal impairment on the efficacy and safety of T2DM treatments, necessitating dosing adjustments and careful evaluation of contraindications...
April 18, 2018: Postgraduate Medicine
https://www.readbyqxmd.com/read/29667699/lean-perspectives-a-case-for-implementing-parent-child-relational-problem-screening
#4
Bryson C Okeoma
The purpose of the current study was to make a case for instituting parent-child relational problem (PCRP) screening as a standard of care in pediatric inpatient psychiatric units due to increasing evidence that PCRP may be an underreported problem that affects more adolescents than currently realized. Adolescents who are admitted to the hospital for mood exacerbation, suicidal ideation, self-harm behavior, or behavioral escalation may improve and be discharged. However, these adolescents often are readmitted, which may be associated with parent-child relational factors...
April 17, 2018: Journal of Psychosocial Nursing and Mental Health Services
https://www.readbyqxmd.com/read/29666880/-influence-of-staffing-levels-on-conflicts-in-inpatient-psychiatric-care
#5
A Nienaber, A Heinz, M A Rapp, F Bermpohl, M Schulz, J Behrens, M Löhr
Acute psychiatric wards are an important element in the mental healthcare of people at risk for acute harm to others or self-harm. Unfortunately, aggression, violence (conflict) and the use of coercion (containment) are still part of psychiatric care. The decisive factor for the correct handling of these situations is the quantity as well as the quality of the employees. Therefore, the present study dealt with the care situation on acute psychiatric wards. The hypothesis is that both the number of beds on the acute psychiatric ward and the number of caregivers have an impact on the occurrence of conflict and containment...
April 17, 2018: Der Nervenarzt
https://www.readbyqxmd.com/read/29664873/effects-of-a-picu-status-asthmaticus-de-escalation-pathway-on-length-of-stay-and-albuterol-use
#6
Steven Brennan, Lia Lowrie, Jamie Wooldridge
OBJECTIVES: Evaluate the effects of an asthma de-escalation clinical pathway on selected outcomes for patients admitted to a PICU with status asthmaticus. DESIGN: Time series quality improvement trial. SETTING: PICU in a tertiary care children's hospital. PATIENTS: Children age 2-18 years old with a known diagnosis of asthma presenting with status asthmaticus. INTERVENTION: One-hundred five admissions to a PICU for status asthmaticus were treated according to a new de-escalation pathway between August 15, 2015, and August 30, 2016...
April 16, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29664761/initial-clinical-experience-with-a-flexible-peripheral-21-g-needle-device
#7
Alain Tremblay, Renelle Myers, Eve-Lea Beaudoin, Martina Bonifazi, Antoine Delage, Marc Fortin, Christopher A Hergott, Paul R MacEachern, Tawimas Shaipanich, Benjamin Shieh, Stefano Gasparini, Stephen Lam
BACKGROUND: Bronchoscopic techniques can be used to safely sample peripheral lung nodules (PLN), and transbronchial needle aspiration (TBNA) can further increase the diagnostic yield. Current needle devices not necessarily designed for this indication have limitations. We report our initial experience with a new flexible nitinol peripheral TBNA needle specifically designed for such sampling. METHODS: Retrospective case review describing the first clinical cases performed with a commercially available 21-G peripheral TBNA device in 4 centers...
April 16, 2018: Journal of Bronchology & Interventional Pulmonology
https://www.readbyqxmd.com/read/29662681/willingness-to-trade-off-an-intermediate-factor-in-patient-decision-making-regarding-escalating-care
#8
Elizabeth K Seng, Amy S Grinberg, Liana Fraenkel
This study aimed to evaluate treatment necessity, treatment concern, and willingness to engage in decisional trade-offs in the context of treatment escalation decision-making. Participants ( n  = 147) recruited online were randomized to read a vignette about escalating care in psoriasis in a 2 (high treatment concern vs moderate treatment concern) × 2 (high perceived treatment necessity vs moderate perceived treatment necessity) design. High treatment concern was associated with choosing to defer treatment escalation and being unwilling to engage in decisional trade-offs if disease risk changed...
January 2018: Health Psychology Open
https://www.readbyqxmd.com/read/29661167/creating-an-optimality-index-netherlands-a-validation-study
#9
Suzanne M Thompson, Marianne J Nieuwenhuijze, Luc Budé, Raymond de Vries, Lisa Kane Low
BACKGROUND: At present, the maternity care system in the Netherlands is being reorganized into an integrated model of care, shifting the focus of midwives to include increasing numbers of births in hospital settings and clients with medium risk profiles. In light of these changes, it is useful for midwives to have a tool which may help them in reflecting upon care practices that promote physiological childbirth practices. The Optimality Index-US is an evidence based tool, designed to measure optimal perinatal care processes and outcomes...
April 16, 2018: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/29659552/improving-pharmacists-targeting-of-patients-for-medication-review-and-deprescription
#10
Vanessa Marvin, Emily Ward, Barry Jubraj, Mark Bower, Iñaki Bovill
Background: In an acute hospital setting, a multi-disciplinary approach to medication review can improve prescribing and medicine selection in patients with frailty. There is a need for a clear understanding of the roles and responsibilities of pharmacists to ensure that interventions have the greatest impact on patient care. Aim: To use a consensus building process to produce guidance for pharmacists to support the identification of patients at risk from their medicines, and to articulate expected actions and escalation processes...
April 16, 2018: Pharmacy (Basel, Switzerland)
https://www.readbyqxmd.com/read/29650404/stereotactic-ablative-radiotherapy-after-concomitant-chemoradiotherapy-in-non-small-cell-lung-cancer-a-tite-crm-phase-1-trial
#11
Jérôme Doyen, Michel Poudenx, Jocelyn Gal, Josiane Otto, Caroline Guerder, Arash O Naghavi, Anais Gérard, Axel Leysalle, Charlotte Cohen, Bernard Padovani, Antoine Ianessi, Renaud Schiappa, Emmanuel Chamorey, Pierre-Yves Bondiau
BACKGROUND AND PURPOSE: Platinum based chemoradiotherapy is the standard of care for inoperable non-small cell lung cancer (NSCLC). With evidence that NSCLC can have a dose dependent response with stereotactic ablative radiotherapy (SABR), we hypothesize that a SABR boost on residual tumor treated with chemoradiotherapy could increase treatment efficacy. The purpose of this study was to determine feasibility of such an approach. MATERIAL AND METHODS: A prospective phase I trial was performed including 26 patients...
April 9, 2018: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
https://www.readbyqxmd.com/read/29629405/evaluation-of-systemic-corticosteroids-in-patients-with-an-acute-exacerbation-of-copd-and-a-diagnosis-of-pneumonia
#12
Tyler Scholl, Tyree H Kiser, Sheryl F Vondracek
Background: Chronic obstructive pulmonary disease (COPD) and pneumonia are leading causes of morbidity and mortality and are frequently comorbid. Studies of systemic corticosteroids in pneumonia have shown conflicting outcomes, whereas studies in acute exacerbations of COPD (AECOPD) have shown significant benefits. No studies have evaluated systemic corticosteroids in patients with both an AECOPD and pneumonia. Purpose: To evaluate the use of systemic corticosteroids in patients with both an AECOPD and pneumonia...
January 24, 2018: Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation
https://www.readbyqxmd.com/read/29626019/diagnosis-and-management-of-sepsis
#13
Tom Evans
Sepsis is a common condition with high morbidity and mortality. Although many patients may require critical care, this article considers the features of sepsis that are of most relevance to acute general physicians. Recently updated definitions of sepsis and septic shock have been proposed which better identify patients who are likely to have a poor outcome, and therefore give an opportunity to escalate care. Despite these advances, there is still no molecular signature able to diagnose sepsis. Pathogenesis is complex, with many immune and non-immune mediators involved...
March 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/29624025/hepatic-encephalopathy-and-cirrhotic-cardiomyopathy-in-intensive-care-unit
#14
Giuliana Scarpati, Edoardo DE Robertis, Ciro Esposito, Ornella Piazza
Acute and chronic liver diseases may escalate to hepatic encephalopathy (HE) and multiple organ failure, requiring admission and organ support in Intensive Care Unit (ICU). Hepatic dysfunction in ICU is a broad and complex topic; unfortunately, up to now, the understanding of its underlying pathophysiology is far from complete. HE and cirrhotic cardiomyopathy (CCM) need timely diagnostic and therapeutic measures aiming at the identification and elimination of causative factors, to improve patients' prognosis...
April 5, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29622934/joint-care-can-outweigh-costs-of-nonkin-competition-in-communal-breeders
#15
Kat Bebbington, Eleanor A Fairfield, Lewis G Spurgin, Sjouke A Kingma, Hannah Dugdale, Jan Komdeur, David S Richardson
Competition between offspring can greatly influence offspring fitness and parental investment decisions, especially in communal breeders where unrelated competitors have less incentive to concede resources. Given the potential for escalated conflict, it remains unclear what mechanisms facilitate the evolution of communal breeding among unrelated females. Resolving this question requires simultaneous consideration of offspring in noncommunal and communal nurseries, but such comparisons are missing. In the Seychelles warbler Acrocephalus sechellensis, we compare nestling pairs from communal nests (2 mothers) and noncommunal nests (1 mother) with singleton nestlings...
January 2018: Behavioral Ecology: Official Journal of the International Society for Behavioral Ecology
https://www.readbyqxmd.com/read/29615077/spire-combining-sgi-110-with-cisplatin-and-gemcitabine-chemotherapy-for-solid-malignancies-including-bladder-cancer-study-protocol-for-a-phase-ib-randomised-iia-open-label-clinical-trial
#16
Simon Crabb, Sarah J Danson, James W F Catto, Cathy McDowell, James N Lowder, Joshua Caddy, Denise Dunkley, Jessica Rajaram, Deborah Ellis, Stephanie Hill, David Hathorn, Amy Whitehead, Mihalis Kalevras, Robert Huddart, Gareth Griffiths
BACKGROUND: Urothelial bladder cancer (UBC) accounts for 10,000 new diagnoses and 5000 deaths annually in the UK (Cancer Research UK, http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bladder-cancer , Cancer Research UK, Accessed 26 Mar 2018). Cisplatin-based chemotherapy is standard of care therapy for UBC for both palliative first-line treatment of advanced/metastatic disease and radical neoadjuvant treatment of localised muscle invasive bladder cancer...
April 3, 2018: Trials
https://www.readbyqxmd.com/read/29610766/checking-procalcitonin-suitability-for-prognosis-and-antimicrobial-therapy-monitoring-in-burn-patients
#17
Luís Cabral, Vera Afreixo, Rita Meireles, Miguel Vaz, Catarina Chaves, Marisa Caetano, Luís Almeida, José Artur Paiva
Background: Due to greater infection susceptibility, sepsis is the main cause of death in burn patients. Quick diagnosis and patient stratification, early and appropriated antimicrobial therapy, and focus control are crucial for patients' survival. On the other hand, superfluous extension of therapy is associated with adverse events and arousal of microbial resistance. The use of biomarkers, necessarily coupled with close clinical examination, may predict outcomes, stratifying patients who need more intensive care, and monitor the efficacy of antimicrobial therapy, allowing faster de-escalation or stop, reducing the development of resistance and possibly the financial burden, without increasing mortality...
2018: Burns and Trauma
https://www.readbyqxmd.com/read/29608610/strategic-purchasing-and-health-system-efficiency-a-comparison-of-two-financing-schemes-in-thailand
#18
Walaiporn Patcharanarumol, Warisa Panichkriangkrai, Angkana Sommanuttaweechai, Kara Hanson, Yaowaluk Wanwong, Viroj Tangcharoensathien
Strategic purchasing is an essential health financing function. This paper compares the strategic purchasing practices of Thailand's two tax-financed health insurance schemes, the Universal Coverage Scheme (UCS) and the Civil Servant Medical Benefit Scheme (CSMBS), and identifies factors contributing to successful universal health coverage outcomes by analysing the relationships between the purchaser and government, providers and members. The study uses a cross-sectional mixed-methods design, including document review and interviews with 56 key informants...
2018: PloS One
https://www.readbyqxmd.com/read/29605480/emergency-department-boarding-and-adverse-hospitalization-outcomes-among-patients-admitted-to-a-general-medical-service
#19
Kito Lord, Vivek Parwani, Andrew Ulrich, Emily B Finn, Craig Rothenberg, Beth Emerson, Alana Rosenberg, Arjun K Venkatesh
OBJECTIVE: Overcrowding in the emergency department (ED) has been associated with patient harm, yet little is known about the association between ED boarding and adverse hospitalization outcomes. We sought to examine the association between ED boarding and three common adverse hospitalization outcomes: rapid response team activation (RRT), escalation in care, and mortality. METHOD: We conducted an observational analysis of consecutive patient encounters admitted from the ED to the general medical service between February 2013 and June 2015...
March 20, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29597185/diazepam-for-outpatient-treatment-of-nonconvulsive-status-epilepticus-in-pediatric-patients-with-angelman-syndrome
#20
Lila Worden, Olivia Grocott, Amanda Tourjee, Fonda Chan, Ronald Thibert
Nonconvulsive status epilepticus (NCSE) is present in multiple pediatric neurogenetic syndromes with epileptic encephalopathies. While intravenous (IV) medications are used inpatient for treatment of critical illness-related NCSE, there is no consensus on treatment of ambulatory NCSE. Up to 50% of patients with Angelman syndrome (AS) have NCSE with myoclonic or atypical absence status. Here we report our experience in pediatric patients with AS and NCSE treated outpatient with a tapering course of oral diazepam...
March 26, 2018: Epilepsy & Behavior: E&B
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