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M Gruß, F Salomon
In intensive care units far-reaching decisions are often made at short notice that require the consent of the informed patient. If this is not possible due to the patient's condition, physicians and legal representatives must ascertain the previously expressed or presumed will of the patient and act accordingly. The legal principles are specified in the Patient Advance Directives Act and the Patient Rights Act. Any indications for medical treatment need a clearly defined aim of the therapy, which can be questioned during the progress of the disease...
September 29, 2016: Der Anaesthesist
Konstantinos E Panagiotopoulos, Eleni E Panagiotopoulou, Konstantinos Katsaros, Georgios Noikokirakis, Maria Mpouziou, Angeliki Stamelou, Savvas Toumanidis
BACKGROUND: Community based registries are particularly valuable tools to Preventive Cardiology as they summarize epidemiological data of ischemic heart disease risk factors, medications and lifestyle characteristics. METHODS: We enrolled 1191 patients, from an outpatient community based cardiology network, dedicated to cover medically, office based professionals. We recorded demographic and lifestyle characteristics, risk factors for ischemic heart disease, all clinical entities diagnosed and therapies which were prescribed for hypertension and lipid disorders specifically...
November 15, 2016: International Journal of Cardiology
Henry J Steadman, David Morrissette
Since 1988, a major development to reduce lethal encounters between police and persons displaying signs of mental illness has been the adoption by many police departments of crisis intervention teams (CITs). Created in Memphis, Tennessee, CIT programs incorporate deescalation training, police-friendly drop-off centers, and linkage to community treatment programs. The authors summarize issues discussed at a recent Substance Abuse and Mental Health Services Administration workshop at which participants highlighted the importance of going beyond CIT training to most effectively include police in a crisis care continuum model...
October 1, 2016: Psychiatric Services: a Journal of the American Psychiatric Association
Nawal Salahuddin, Lama Amer, Mini Joseph, Alya El Hazmi, Hassan Hawa, Khalid Maghrabi
Introduction. Deescalation refers to either discontinuation or a step-down of antimicrobials. Despite strong recommendations in the Surviving Sepsis Guidelines (2012) to deescalate, actual practices can vary. Our objective was to identify variables that are associated with deescalation failure. Methods. In this prospective study of patients with sepsis/septic shock, patients were categorized into 4 groups based on antibiotic administration: no change in antibiotics, deescalation, escalation (where antibiotics were changed to those with a broader spectrum of antimicrobial coverage), or mixed changes (where both escalation to a broader spectrum of coverage and discontinuation of antibiotics were carried out)...
2016: Critical Care Research and Practice
Stanley Cohen
No abstract text is available yet for this article.
January 5, 2016: Annals of Internal Medicine
Nahla Mansour Al-Ali, Ibrahim Al Faouri, Tahany Fareed Al-Niarat
BACKGROUND: Nurses' attitudes toward workplace violence are still inadequately explored, and possess an impact in preventing, and managing the violent incidents and the quality of nursing care. Creating a demand for an effective intervention program to improve nurses' knowledge of and attitudes toward workplace violence. OBJECTIVE: To study the impact of the training program on nurses' attitudes toward workplace violence in a military hospital in Jordan. METHODS: One group before-after design was employed...
May 2016: Applied Nursing Research: ANR
Justin Egidius Swartz, Ajit Joe Pothen, Pauline Maria Wilhelmina van Kempen, Inge Stegeman, Fleurieke Karlijn Formsma, Ellen Maria Van Cann, Stefan Martin Willems, Wilko Grolman
BACKGROUND: Hypoxia induces stabilization of the transcription factor HIF-1alpha (HIF-1α), associated with (chemo-)radiotherapy resistance in oropharyngeal squamous cell carcinoma (SCC). We investigated the effect of HIF-1α expression on survival in relation to human papillomavirus (HPV) status in oropharyngeal SCC. METHODS: We conducted an immunohistochemical analysis of HIF-1α protein expression and downstream targets carbonic anhydrase-IX (CA-IX) and glucose transporter-1 (GLUT-1) in 274 patients with oropharyngeal SCC...
September 2016: Head & Neck
Jackie L Nam
PURPOSE OF REVIEW: Early effective treatment has led to major improvements in patients with rheumatoid arthritis. This review aims to address the treatment of early rheumatoid arthritis, in particular the different therapeutic strategies evaluated in clinical trials to achieve optimal disease control. RECENT FINDINGS: The use of biological disease-modifying antirheumatic drugs (bDMARDs) has significantly improved patient outcomes. Overall, studies using bDMARD induction have shown early clinical improvements, with high proportions achieving remission with minimal radiographic progression...
May 2016: Current Opinion in Rheumatology
Marie T Sickinger, Bastian von Tresckow, Carsten Kobe, Peter Borchmann, Andreas Engert, Nicole Skoetz
BACKGROUND: Hodgkin lymphoma (HL) is one of the most common malignancies in young adults and one of the most curable cancers worldwide. With interim PET-scan, HL treatment is in the process of being modified: a negative or positive interim PET separates good and poor responders to initial therapy; therefore, deescalated or escalated additional treatment is currently being evaluated in clinical trials. METHODS: The Cochrane Library, MEDLINE and conference proceedings were searched until 05...
May 2016: Critical Reviews in Oncology/hematology
(no author information available yet)
No abstract text is available yet for this article.
August 2015: Clinical Advances in Hematology & Oncology: H&O
Stanley Cohen
No abstract text is available yet for this article.
January 5, 2016: Annals of Internal Medicine
Sarah Lindstrom Johnson, Nadine Finigan, Catherine Bradshaw, Denise Haynie, Tina L Cheng
Family socialization, which includes parental control and support, plays an important role in reducing the likelihood of adolescent involvement in conflict. This study examined the strategies that urban parents living in neighborhoods with high crime rates suggest to help their adolescent children avoid or deescalate conflict. Data come from 48 African American parent/adolescent dyads recruited through the youths' middle school. Dyads responded to three video-taped scenarios depicting youth in potential conflict situations...
September 2013: Journal of Adolescent Research
Kristin C Turza, Amani D Politano, Laura H Rosenberger, Lin M Riccio, Matthew McLeod, Robert G Sawyer
BACKGROUND: Overuse of broad-spectrum antibiotics results in microbial resistance and financially is a healthcare burden. Antibiotic de-escalation refers to starting treatment of a presumed infection with broad-spectrum antibiotics and narrowing drug spectrum based on culture sensitivities. A study was designed to evaluate antibiotic de-escalation at a tertiary care center. We hypothesized that antibiotic de-escalation would not be associated with increased patient mortality rates or worsening of the primary infection...
February 2016: Surgical Infections
Annette Lebeau, Thorsten Kühn
PURPOSE OF REVIEW: Ductal carcinoma in situ (DCIS) accounts for approximately 20% of mammographically diagnosed breast cancers. Currently, there is a trend to consider DCIS as a lesion for which treatment deescalation is advocated to avoid overtreatment, that is, radiotherapy in addition to breast-conserving surgery or even surgery at all. RECENT FINDINGS: The long-term follow-up updates of the four first-generation randomized trials comparing lumpectomy with and without radiation therapy have confirmed that radiation halves the local failure rates...
February 2016: Current Opinion in Obstetrics & Gynecology
P Polák, M Vrba, Z Bortlíček, J Juránková, M Freibergerová, P Husa, J Kamelander, M Dastych
OBJECTIVE: To provide basic clinical, laboratory, and microbiological characteristics of adult patients with campylobacteriosis admitted to the Department of Infectious Diseases University Hospital Brno (UHB), in 2011-2013. MATERIALS AND METHODS: A retrospective analysis of clinical and laboratory parameters of 160 patients hospitalized with campylobacteriosis at the Department of Infectious Diseases, UHB from 1 January 2011 to 31 December 2013. RESULTS: There was no lethality or bacteremia reported in the study group of 160 adult patients (n=160) with campylobacteriosis...
September 2015: Epidemiologie, Mikrobiologie, Imunologie
T Martijn Kuijper, Femke B G Lamers-Karnebeek, Johannes W G Jacobs, Johanna M W Hazes, Jolanda J Luime
OBJECTIVE: To evaluate the risk of having a disease flare in patients with rheumatoid arthritis (RA) with low disease activity (LDA) or in remission when deescalating (tapering or stopping) disease-modifying antirheumatic drug (DMARD) therapy. METHODS: A search in medical databases including publications from January 1950 to February 2015 was performed. Included were trials and observational studies in adults with RA who were in LDA or remission, evaluating ≥ 20 patients tapering or stopping DMARD...
November 2015: Journal of Rheumatology
Jakob Jankowski, Cathy Bennett, Janusz A Jankowski
We undertook two of the largest evidence-based reviews in clinical medicine to assess the rationale for the management of gastroesophageal reflux disease, Barrett esophagus (BE), dysplasia, and early invasive esophageal adenocarcinoma. These reviews involved over 150 world experts in 4 continents, and over 20 000 papers were assessed. Quality assessment of the publications was made using Grading of Recommendations Assessment, Development and Evaluation, and of over 240 questions formulated, we were able to answer 30% with an agreement of at least 80%...
2015: Polskie Archiwum Medycyny Wewnętrznej
Joseph J Carreno, Rachel M Kenney, Mary Bloome, Jane McDonnell, Jennifer Rodriguez, Allison Weinmann, Paul E Kilgore, Susan L Davis
PURPOSE: Improvements in medication use achieved by pharmacy generalists using a care bundle approach to antimicrobial stewardship are reported. METHODS: A six-month prospective, repeated-treatment, quasi-experimental study involving three month-long intervention periods and three month-long control periods was conducted in the setting of an existing antimicrobial stewardship program at a large hospital. The intervention involved prospective audit and feedback conducted by pharmacy generalists who were trained in an antimicrobial stewardship care bundle approach...
August 1, 2015: American Journal of Health-system Pharmacy: AJHP
Benjamin N Stein, Randall S Pellish, Kimberly D Thompson, Veronica Baptista, Corey A Siegel
Biological drugs have significantly improved the quality of life of patients with inflammatory bowel disease. However, after 15 years of using these drugs in practice, we just now are beginning to better understand how to use them most effectively. It has become evident that antitumor necrosis factor agents, such as infliximab, have variable drug clearance across individuals, mostly related to the disease burden at the time of an infusion. In this case report, we demonstrate how therapeutic drug monitoring can be used to personalize a dosing regimen to ensure appropriate induction, and to safely deescalate therapy after remission is achieved...
January 2016: Journal of Clinical Gastroenterology
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