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https://www.readbyqxmd.com/read/27907959/status-epilepticus-in-the-intensive-care-unit
#1
Adriana Bermeo-Ovalle, Thomas Bleck
Status epilepticus (SE) is a common neurologic emergency and a frequent reason for admission to the intensive care unit. During the last decade, the advent and availability of diagnostic tools for the recognition of nonconvulsive SE has highlighted an even higher incidence of this condition among the critically ill. New alternatives in treatment have also become available within recent years. The recommendation of early escalation toward the use of general anesthetics in the treatment of convulsive SE follows the theory that the duration of the event defines the aggressiveness of the condition and the potential for long-term neuronal injury...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27906760/improving-the-quality-of-ward-based-surgical-care-with-a-human-factors-intervention-bundle
#2
Maximilian J Johnston, Sonal Arora, Dominic King, Ara Darzi
OBJECTIVE: This study aimed to explore the impact of a human factors intervention bundle on the quality of ward-based surgical care in a UK hospital. SUMMARY OF BACKGROUND DATA: Improving the culture of a surgical team is a difficult task. Engagement with stakeholders before intervention is key. Studies have shown that appropriate supervision can enhance surgical ward safety. METHODS: A pre-post intervention study was conducted. The intervention bundle consisted of twice-daily attending ward rounds, a "chief resident of the week" available at all times on the ward, an escalation of care protocol and team contact cards...
November 30, 2016: Annals of Surgery
https://www.readbyqxmd.com/read/27905916/study-protocol-a-dose-escalating-phase-2-study-of-oral-lisdexamfetamine-in-adults-with-methamphetamine-dependence
#3
Nadine Ezard, Adrian Dunlop, Brendan Clifford, Raimondo Bruno, Andrew Carr, Alexandra Bissaker, Nicholas Lintzeris
BACKGROUND: The treatment of methamphetamine dependence is a continuing global health problem. Agonist type pharmacotherapies have been used successfully to treat opioid and nicotine dependence and are being studied for the treatment of methamphetamine dependence. One potential candidate is lisdexamfetamine, a pro-drug for dexamphetamine, which has a longer lasting therapeutic action with a lowered abuse potential. The purpose of this study is to determine the safety of lisdexamfetamine in this population at doses higher than those currently approved for attention deficit hyperactivity disorder or binge eating disorder...
December 1, 2016: BMC Psychiatry
https://www.readbyqxmd.com/read/27903942/the-reckoning-point-as-a-marker-for-formal-palliative-and-end-of-life-care-in-mexican-american-families
#4
Bronwynne C Evans, David W Coon
Palliative and end-of-life care (PEOLC) in Mexican American (MA) caregiving families remains unexplored. Its onset was uncovered in our mixed methods, multisite, interdisciplinary, qualitative descriptive study of 116 caregivers, most of whom had provided long-term informal home care for chronically ill, disabled older family members. This subanalysis used Life Course Perspective to examine the "point of reckoning" in these families, where an older person is taken in for care, or care escalates until one recognizes oneself as the primary caregiver...
November 2016: Journal of Family Nursing
https://www.readbyqxmd.com/read/27898208/-design-and-implementation-of-an-outpatient-parenteral-antimicrobial-therapy-program-in-primary-care-the-experience-at-a-second-level-hospital
#5
M Ruiz-Campuzano, E García-Vázquez, J J Hernández-Roca, J Gómez-Gómez, M Canteras-Jordana, E Mené-Fenor, A Hernández-Torres, A Peláez-Ballesta
OBJECTIVE: Outpatient parenteral antimicrobial therapy (OPAT) programs are a good assistance option in a wide variety of infectious diseases. Our aim was to design and implement an OPAT program in the area of influence of a second-level hospital, with no Home Hospitalization Service available, being necessary close collaboration between hospitalization and Primary Care teams, describe our cohort, analyse the antimicrobial treatment indicated and evaluate the prognostic and risk factors associated with readmission and mortality...
November 28, 2016: Revista Española de Quimioterapia: Publicación Oficial de la Sociedad Española de Quimioterapia
https://www.readbyqxmd.com/read/27892723/optimization-and-stratification-of-multiple-sclerosis-treatment-in-fast-developing-economic-countries-a-perspective-from-qatar
#6
Dirk Deleu, Boulenouar Mesraoua, Hisham El Khider, Beatriz Canibano, Gayane Melikyan, Hassan Al Hail, Noha Mhjob, Anjushri Bhagat, Faiza Ibrahim, Yolande Hanssens
OBJECTIVE: The introduction of disease-modifying therapies (DMTs) - with varying degrees of efficacy for reducing annual relapse rate and disability progression - has considerably transformed the therapeutic landscape of relapsing-remitting multiple sclerosis (RRMS). We aim to develop rational evidence-based treatment recommendations and algorithms for the management of clinically isolated syndrome (CIS) and RRMS conform to the healthcare system in a fast-developing economic country such as Qatar...
November 28, 2016: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/27890073/switching-to-nilotinib-versus-imatinib-dose-escalation-in-patients-with-chronic-myeloid-leukaemia-in-chronic-phase-with-suboptimal-response-to-imatinib-lasor-a-randomised-open-label-trial
#7
Jorge E Cortes, Carmino Antonio De Souza, Manuel Ayala, Jose Luis Lopez, Eduardo Bullorsky, Sandip Shah, Xiaojun Huang, K Govind Babu, Kudrat Abdulkadyrov, José Salvador Rodrigues de Oliveira, Zhi-Xiang Shen, Tomasz Sacha, Israel Bendit, Zhizhou Liang, Tina Owugah, Tomasz Szczudlo, Sadhvi Khanna, Rafik Fellague-Chebra, Philipp D le Coutre
BACKGROUND: Optimal management of patients with chronic myeloid leukaemia in chronic phase with suboptimal cytogenetic response remains undetermined. This study aimed to investigate the safety and efficacy of switching to nilotinib vs imatinib dose escalation for patients with suboptimal cytogenetic response on imatinib. METHODS: We did a phase 3, open-label, randomised trial in patients with chronic myeloid leukaemia in chronic phase with suboptimal cytogenetic response to imatinib according to the 2009 European LeukemiaNet criteria, in Latin America, Europe, and Asia (59 hospitals and care centres in 12 countries)...
December 2016: Lancet Haematology
https://www.readbyqxmd.com/read/27889038/treatment-of-the-primary-tumor-in-anal-canal-cancers
#8
REVIEW
Rob Glynne-Jones, Sheela Rao
Radical concurrent chemoradiotherapy with 5-fluorouracil and mitomycin C (MMC) remains the standard of care for squamous cell carcinoma of the anus. Phase III trials over 2 decades have used combined radiation doses of 50 to 60 Gy with concurrent fluoropyrimidines, MMC, or cisplatin in various doses and schedules. Modern radiotherapy techniques allow the production of highly conformal plans, decreasing radiation doses to the organs at risk and ensuring a shorter overall treatment time without the need for treatment breaks...
January 2017: Surgical Oncology Clinics of North America
https://www.readbyqxmd.com/read/27886577/high-flow-nasal-cannula-oxygen-therapy-vs-conventional-oxygen-therapy-in-cardiac-surgical-patients-a-meta-analysis
#9
Youfeng Zhu, Haiyan Yin, Rui Zhang, Jianrui Wei
INTRODUCTION: The use of high-flow nasal cannula (HFNC) for the treatment of many diseases has gained increasing popularity. In the present meta-analysis, we aimed to assess the efficacy and safety of HFNCs compared with conventional oxygen therapy (COT) in adult postextubation cardiac surgical patients. METHOD: We reviewed the Embase, PubMed, Cochrane Central Register of Controlled Trials, Wanfang databases, and the China National Knowledge Infrastructure. Two investigators independently collected the data and assessed the quality of each study...
November 9, 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/27883296/adjuvant-trastuzumab-a-10-year-overview-of-its-benefit
#10
Matteo Lambertini, Noam F Pondé, Cinzia Solinas, Evandro de Azambuja
Anti-HER2 targeted therapy is one of the key advances in the treatment of breast cancer that have occurred in the last 20 years. In the adjuvant setting, the use of trastuzumab has led to prolonged and sustained survival benefit with very little toxicity as also confirmed by the 10-year follow-up results from the pivotal trials. Despite the survival improvement, several key issues are not entirely resolved in this field. These issues have led to multiple research efforts in de-escalating or escalating the standard treatment with chemotherapy and 1 year of adjuvant trastuzumab...
November 24, 2016: Expert Review of Anticancer Therapy
https://www.readbyqxmd.com/read/27882835/health-care-costs-for-patients-with-heart-failure-escalate-nearly-3-fold-in-final-months-of-life
#11
Engels N Obi, Jason P Swindle, Stuart J Turner, Patricia A Russo, Aylin Altan
BACKGROUND: Heart failure (HF) is a severe chronic disease with growing prevalence and health care burden as well as high mortality. End-of-life cost data for patients with HF may inform disease and medication therapy management. OBJECTIVES: To (a) characterize a real-world sample of patients with HF who died; (b) estimate health care costs for 6 months and semiannually for 24 months, before death; and (c) examine associations between patient characteristics and predeath health care costs...
December 2016: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/27880665/the-current-treatment-landscape-candidiasis
#12
Matteo Bassetti, Maddalena Peghin, Jean-Francois Timsit
The epidemiology of Candida species infection has changed over recent decades, influenced by local hospital-related factors, patient predisposing conditions and type of antifungal agents administered. A shift from Candida albicans as the predominant pathogen towards an increasing prevalence of the species Candida glabrata and Candida parapsilosis amongst critically ill patients has been documented. Changes in Candida species distribution may impact treatment recommendations due to differences in susceptibility to antifungal agents among species...
November 2016: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/27875708/does-restriction-of-public-health-care-dental-benefits-affect-the-volume-severity-or-cost-of-dental-related-hospital-visits
#13
David Salomon, R Eric Heidel, Antonia Kolokythas, Michael Miloro, Thomas Schlieve
PURPOSE: On July 1, 2012, the Illinois legislature passed the Save Medicaid Access and Resources Together (SMART) Act, which restricts adult public dental insurance coverage to emergency-only treatment. The purpose of this study was to measure the effect of this restriction on the volume, severity, and treatment costs of odontogenic infections in an urban hospital. MATERIALS AND METHODS: A retrospective cohort study of patients presenting for odontogenic pain or infection at the University of Illinois Hospital was performed...
October 29, 2016: Journal of Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/27875542/educational-outreach-with-an-integrated-clinical-tool-for-nurse-led-non-communicable-chronic-disease-management-in-primary-care-in-south-africa-a-pragmatic-cluster-randomised-controlled-trial
#14
Lara R Fairall, Naomi Folb, Venessa Timmerman, Carl Lombard, Krisela Steyn, Max O Bachmann, Eric D Bateman, Crick Lund, Ruth Cornick, Gill Faris, Thomas Gaziano, Daniella Georgeu-Pepper, Merrick Zwarenstein, Naomi S Levitt
BACKGROUND: In many low-income countries, care for patients with non-communicable diseases (NCDs) and mental health conditions is provided by nurses. The benefits of nurse substitution and supplementation in NCD care in high-income settings are well recognised, but evidence from low- and middle-income countries is limited. Primary Care 101 (PC101) is a programme designed to support and expand nurses' role in NCD care, comprising educational outreach to nurses and a clinical management tool with enhanced prescribing provisions...
November 2016: PLoS Medicine
https://www.readbyqxmd.com/read/27867308/effect-of-n-methyl-d-aspartate-receptor-antagonist-dextromethorphan-on-opioid-analgesia-in-pediatric-intensive-care-unit
#15
Mohammed Naeem, Hala Al Alem, Ali Al Shehri, Majed Al-Jeraisy
Objective. Pain control is an essential goal in the management of critical children. Narcotics are the mainstay for pain control. Patients frequently need escalating doses of narcotics. In such cases an adjunctive therapy may be beneficial. Dextromethorphan (DM) is NMDA receptor antagonist and may prevent tolerance to narcotics; however, its definitive role is still unclear. We sought whether dextromethorphan addition could decrease the requirements of fentanyl to control pain in critical children. Design. Double-blind, randomized control trial (RCT)...
2016: Pain Research & Management: the Journal of the Canadian Pain Society
https://www.readbyqxmd.com/read/27866835/over-using-chemotherapy-in-the-adjuvant-setting
#16
Giuseppe Curigliano, Carmen Criscitiello, Angela Esposito, Giancarlo Pruneri
Avoidance of unnecessary or ineffective treatment should be one of the main goals in adjuvant breast oncology today. Unfortunately, both patients and doctors hunt for tiny statistical differences in survival curves. This search could not only lead to an oncological approach of unlimited addition that we will not be able to afford, but would also end inevitably in indeterminate overtreatment with substantial risks of unexpected toxic effects eating away whatever progress we might make. "Do not harm" remains the main principle in medicine...
November 17, 2016: Breast: Official Journal of the European Society of Mastology
https://www.readbyqxmd.com/read/27864449/what-are-the-critical-steps-in-processing-blood-cultures-a-prospective-audit-evaluating-current-practice-of-reporting-blood-cultures-in-a-centralised-laboratory-serving-secondary-care-hospitals
#17
Manjula Meda, James Clayton, Reela Varghese, Jayakeerthi Rangaiah, Clive Grundy, Farnaz Dashti, David Garner, Katherine Groves, Karen Fitzmaurice, E Hutley
AIMS: To assess current procedures of processing positive blood cultures against national standards with an aim to evaluate its clinical impact and to determine the utility of currently available rapid identification and susceptibility tests in processing of blood cultures. METHODS: Blood cultures from three secondary care hospitals, processed at a centralised laboratory, were prospectively audited. Data regarding processing times, communication with prescribers, changes to patient management and mortality within 30 days of a significant blood culture were collected in a preplanned pro forma for a 4-week period...
November 18, 2016: Journal of Clinical Pathology
https://www.readbyqxmd.com/read/27863085/pharmacokinetics-of-dabrafenib-in-a-patient-with-metastatic-melanoma-undergoing-haemodialysis
#18
John J Park, Alan V Boddy, Xiaoman Liu, David Harris, Vincent Lee, Richard F Kefford, Matteo S Carlino
The combination of dabrafenib and trametinib is a standard of care for the management of BRAF mutant metastatic melanoma. Clinical trials excluded patients with end-stage kidney disease (ESKD) and as such no data are available regarding the safety, efficacy and pharmacokinetics of these drugs in such patients. Here, we present the case of a 78 year-old male patient with ESKD managed with haemodialysis (HD), treated with dabrafenib and trametinib at reduced doses. The patient has had a partial response, and this response continues at 9 months since our last follow up without any dose escalation...
November 10, 2016: Pigment Cell & Melanoma Research
https://www.readbyqxmd.com/read/27856941/the-quest-to-extend-health-services-to-vulnerable-substance-users-in-rio-de-janeiro-brazil-in-the-context-of-an-unfolding-economic-crisis
#19
Noa Krawczyk, Deanna Kerrigan, Francisco Inácio Bastos
Calls to address crack-cocaine use in Brazil among homeless and street-frequenting populations who are in urgent need of health services have questioned the capacity of the Brazilian Unified Health System to attend to the nation's most marginalized citizens. In recent years, Brazil has launched several actions to escalate care for substance users, yet many obstacles hindering accessibility and effectiveness of services remain. Paradoxically, these actions have been implemented in the context of a growing economic crisis, and expanding services for a population of poor and stigmatized substance users while cutting other government programs tends to elicit harsh criticism from citizens...
November 16, 2016: International Journal of Health Services: Planning, Administration, Evaluation
https://www.readbyqxmd.com/read/27853997/a-phase-i-trial-investigating-pulsatile-erlotinib-in-combination-with-gemcitabine-and-oxaliplatin-in-advanced-biliary-tract-cancers
#20
Laura W Goff, Dana B Cardin, Jennifer G Whisenant, Liping Du, Tatsuki Koyama, Kimberly B Dahlman, Safia N Salaria, Ruth T Young, Kristen K Ciombor, Jill Gilbert, Stephen James Smith, Emily Chan, Jordan Berlin
Advanced biliary tract cancers (ABTC) are among the deadliest malignancies with limited treatment options after progression on standard-of-care chemotherapy, which includes gemcitabine (GEM) and oxaliplatin (OX). The epidermal growth factor receptor inhibitor erlotinib has been explored in ABTC with modest efficacy. Erlotinib given continuously may antagonize the action of chemotherapy against cycling tumor cells, but pulsatile dosing of erlotinib with chemotherapy may improve efficacy. The purpose of this study was to assess the safety of pulsatile erlotinib with GEMOX...
November 16, 2016: Investigational New Drugs
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