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Stratified medicine

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https://www.readbyqxmd.com/read/28523476/impact-of-a-patient-navigator-program-on-hospital-based-and-outpatient-utilization-over-180%C3%A2-days-in-a-safety-net-health-system
#1
Richard B Balaban, Fang Zhang, Catherine E Vialle-Valentin, Alison A Galbraith, Marguerite E Burns, Marc R Larochelle, Dennis Ross-Degnan
BACKGROUND: With emerging global payment structures, medical systems need to understand longer-term impacts of care transition strategies. OBJECTIVE: To determine the effect of a care transition program using patient navigators (PNs) on health service utilization among high-risk safety-net patients over a 180-day period. DESIGN: Randomized controlled trial conducted October 2011 through April 2013. PARTICIPANTS: Patients admitted to the general medicine service with ≥1 readmission risk factor: (1) age ≥ 60; (2) in-network inpatient admission within prior 6 months; (3) index length of stay ≥ 3 days; or (4) admission diagnosis of heart failure or (5) chronic obstructive pulmonary disease...
May 18, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28522319/association-between-gestational-weight-gain-and-perinatal-outcomes-in-women-with-chronic-hypertension
#2
Lynn M Yee, Aaron B Caughey, Yvonne W Cheng
BACKGROUND: Gestational weight gain above or below the 2009 Institute of Medicine guidelines has been associated with adverse maternal and neonatal outcomes. Although it has been well established that excess gestational weight gain is associated with the development of gestational hypertension and preeclampsia, the relationship between gestational weight gain and adverse perinatal outcomes among women with pregestational (chronic) hypertension is less clear. OBJECTIVE: The objective of this study was to examine the relationship between gestational weight gain above and below IOM guidelines and perinatal outcomes in a large, population-based cohort of women with chronic hypertension...
May 15, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28522089/sleep-stage-distribution-in-persons-with-mild-traumatic-brain-injury-a-polysomnographic-study-according-to-american-academy-of-sleep-medicine-standards
#3
Tatyana Mollayeva, Angela Colantonio, J David Cassidy, Lee Vernich, Rahim Moineddin, Colin M Shapiro
OBJECTIVE AND BACKGROUND: Sleep stage disruption in persons with mild traumatic brain injury (mTBI) has received little research attention. We examined deviations in sleep stage distribution in persons with mTBI relative to population age- and sex-specific normative data and the relationships between such deviations and brain injury-related, medical/psychiatric, and extrinsic factors. PATIENTS AND METHODS: We conducted a cross-sectional polysomnographic investigation in 40 participants diagnosed with mTBI (mean age 47...
June 2017: Sleep Medicine
https://www.readbyqxmd.com/read/28517991/self-knowledge-and-risk-in-stratified-medicine
#4
Joshua Hordern
This article considers why and how self-knowledge is important to communication about risk and behaviour change by arguing for four claims. First, it is doubtful that genetic knowledge should properly be called 'self-knowledge' when its ordinary effects on self-motivation and behaviour change seem so slight. Second, temptations towards a reductionist, fatalist, construal of persons' futures through a 'molecular optic' should be resisted. Third, any plausible effort to change people's behaviour must engage with cultural self-knowledge, values and beliefs, catalysed by the communication of genetic risk...
April 2017: New Bioethics: a Multidisciplinary Journal of Biotechnology and the Body
https://www.readbyqxmd.com/read/28517990/risk-and-benefit-in-personalised-medicine-an-end-user-view
#5
Alastair Kent
Personalised, or stratified, medicine is creating opportunities for the development of targeted therapies for many hitherto unmet clinical needs. For patients and families this is a cause for optimism. But it is unlikely that these novel therapies will provide complete cures. Rather they will address some but not all symptoms of a condition. In such circumstances, early engagement with patients and families will ensure that developments are targeted at those aspects of a condition which really matter, not just those that are easy to count...
April 2017: New Bioethics: a Multidisciplinary Journal of Biotechnology and the Body
https://www.readbyqxmd.com/read/28511612/ngs-analysis-on-tumor-tissue-and-cfdna-for-genotype-directed-therapy-in-metastatic-nsclc-patients-between-hope-and-hype
#6
Alexander T Falk, Simon Heeke, Véronique Hofman, Virginie Lespinet, Camille Ribeyre, Olivier Bordone, Michel Poudenx, Josiane Otto, Georges Garnier, Olivier Castelnau, Joël Guigay, Sylvie Leroy, Charles-Hugo Marquette, Paul Hofman, Marius Ilié
The advent of genomic based precision medicine led to the implementation of biomarker testing in metastatic non-small cell lung cancer (NSCLC) patients. Next generation sequencing (NGS) has been recently implemented to routine diagnostic requirements in lung oncology. Areas covered: Two cases of patients with metastatic NSCLC for whom NGS analysis performed on both tumor and liquid biopsy has not improved the clinical course of their disease are reported. These cases illustrate the difficulty of the so-called "personalized or precision" medicine in clinical routine practice for metastatic NSCLC...
May 17, 2017: Expert Review of Anticancer Therapy
https://www.readbyqxmd.com/read/28502669/biomimetic-tendon-extracellular-matrix-composite-gradient-scaffold-enhances-ligament-to-bone-junction-reconstruction
#7
Huanhuan Liu, Long Yang, Erchen Zhang, Rui Zhang, Dandan Cai, Shouan Zhu, Jisheng Ran, Varitsara Bunpetch, Youzhi Cai, Boon Chin Heng, Yejun Hu, Xuesong Dai, Xiao Chen, Hongwei Ouyang
Management of ligament/tendon-to-bone-junction healing remains a formidable challenge in the field of orthopedic medicine to date, due to deficient vascularity and multi-tissue transitional structure of the junction. Numerous strategies have been employed to improve ligament-bone junction healing, including delivery of stem cells, bioactive factors, and synthetic materials, but these methods are often inadequate at recapitulating the complex structure-function relationships at native tissue interfaces. Here, we developed an easily-fabricated and effective biomimetic composite to promote the regeneration of ligament-bone junction by physically modifying the tendon extracellular matrix (ECM) into a Random-Aligned-Random composite using ultrasound treatment...
May 11, 2017: Acta Biomaterialia
https://www.readbyqxmd.com/read/28497027/data-based-radiation-oncology-design-of-clinical-trials-in-the-toxicity-biomarkers-era
#8
REVIEW
David Azria, Ariane Lapierre, Sophie Gourgou, Dirk De Ruysscher, Jacques Colinge, Philippe Lambin, Muriel Brengues, Tim Ward, Søren M Bentzen, Hubert Thierens, Tiziana Rancati, Christopher J Talbot, Ana Vega, Sarah L Kerns, Christian Nicolaj Andreassen, Jenny Chang-Claude, Catharine M L West, Corey M Gill, Barry S Rosenstein
The ability to stratify patients using a set of biomarkers, which predict that toxicity risk would allow for radiotherapy (RT) modulation and serve as a valuable tool for precision medicine and personalized RT. For patients presenting with tumors with a low risk of recurrence, modifying RT schedules to avoid toxicity would be clinically advantageous. Indeed, for the patient at low risk of developing radiation-associated toxicity, use of a hypofractionated protocol could be proposed leading to treatment time reduction and a cost-utility advantage...
2017: Frontiers in Oncology
https://www.readbyqxmd.com/read/28495145/medication-discrepancy-rates-among-medicaid-recipients-at-hospital-discharge
#9
Tracy D Perry, Ann Marie Nye, Steven W Johnson
OBJECTIVES: To compare the rate of discrepancies per patient for medications changed during hospitalization in patients with and without prescription provider comments at hospital discharge. Secondary objectives included comparing 35-day readmission rates, describing the overall medication discrepancy rate stratified by age group and type of discrepancy, collecting average number of medication changes, and reporting percentage change in admission medications at discharge. METHODS: This single-center prospective cohort included NC Medicaid recipients discharged from East Carolina University Family Medicine service from November 1, 2015, to January 31, 2016...
May 8, 2017: Journal of the American Pharmacists Association: JAPhA
https://www.readbyqxmd.com/read/28493608/the-epidemiology-of-emergency-department-trauma-discharges-in-the-united-states
#10
Charles J DiMaggio, Jacob B Avraham, David C Lee, Spiros G Frangos, Stephen P Wall
OBJECTIVE: Injury related morbidity and mortality is an important emergency medicine and public health challenge in the United States (US). Here we describe the epidemiology of traumatic injury presenting to US emergency departments, define changes in types and causes of injury among the elderly and the young, characterize the role of trauma centers and teaching hospitals in providing emergency trauma care, and estimate the overall economic burden of treating such injuries. METHODS: We conducted a secondary retrospective, repeated cross-sectional study of the Nationwide Emergency Department Data Sample (NEDS), the largest all-payer emergency department survey database in the US...
May 11, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28472808/idiopathic-pulmonary-fibrosis-molecular-endotypes-of-fibrosis-stratifying-existing-and-emerging-therapies
#11
Daniele Magnini, Giuliano Montemurro, Bruno Iovene, Linda Tagliaboschi, Rafael Emanuele Gerardi, Erminia Lo Greco, Teresa Bruni, Alessio Fabbrizzi, Francesco Lombardi, Luca Richeldi
Idiopathic pulmonary fibrosis (IPF) is a specific form of chronic, progressive fibrosing interstitial pneumonia of unknown causes. Current diagnostic criteria are based on radiological, clinical, and histopathological features but, unfortunately, still many patients remain undiagnosed. Two currently approved therapies, pirfenidone and nintedanib, slow down disease progression but failed to block or revert it. On the other hand, many of the therapeutic agents tested in several clinical trials have not given satisfactory answers, probably due to the pathological heterogeneity of the disease...
May 5, 2017: Respiration; International Review of Thoracic Diseases
https://www.readbyqxmd.com/read/28472006/concomitant-bacterial-meningitis-in-infants-with-urinary-tract-infection
#12
Joanna Thomson, Andrea T Cruz, Lise E Nigrovic, Stephen B Freedman, Aris C Garro, Paul T Ishimine, Dina M Kulik, Neil G Uspal, Kendra L Grether-Jones, Aaron S Miller, David Schnadower, Samir S Shah
To determine age-stratified prevalence of concomitant bacterial meningitis in infants ≤ 60 days with a urinary tract infection (UTI), we performed a 23-center retrospective study of 1,737 infants with UTI. Concomitant bacterial meningitis was rare, but more common in infants 0-28 days (0.9%, 95% CI: 0.4-1.9%) compared with infants 29-60 days (0.2%, 95% CI: 0-0.8%).
May 2, 2017: Pediatric Infectious Disease Journal
https://www.readbyqxmd.com/read/28469077/p63-ureteric-bud-tip-cells-are-progenitors-of-intercalated-cells
#13
Samir S El-Dahr, Yuwen Li, Jiao Liu, Elleny Gutierrez, Kathleen S Hering-Smith, Sabina Signoretti, Jean-Christophe Pignon, Satrajit Sinha, Zubaida Saifudeen
During renal branching morphogenesis, ureteric bud tip cells (UBTC) serve as the progenitor epithelium for all cell types of the collecting duct. While the transcriptional circuitry of ureteric bud (UB) branching has been intensively studied, the transcriptional control of UBTC differentiation has been difficult to ascertain. This is partly due to limited knowledge of UBTC-specific transcription factors that mark the progenitor state. Here, we identify the transcription factor p63 (also known as TP63), a master regulator of basal stem cells in stratified epithelia, as a specific marker of mouse and human UBTC...
May 4, 2017: JCI Insight
https://www.readbyqxmd.com/read/28451583/pregnancy-an-underutilized-window-of-opportunity-to-improve-long-term-maternal-and-infant-health-an-appeal-for-continuous-family-care-and-interdisciplinary-communication
#14
REVIEW
Birgit Arabin, Ahmet A Baschat
Physiologic adaptations during pregnancy unmask a woman's predisposition to diseases. Complications are increasingly predicted by first-trimester algorithms, amplify a pre-existing maternal phenotype and accelerate risks for chronic diseases in the offspring up to adulthood (Barker hypothesis). Recent evidence suggests that vice versa, pregnancy diseases also indicate maternal and even grandparent's risks for chronic diseases (reverse Barker hypothesis). Pub-Med and Embase were reviewed for Mesh terms "fetal programming" and "pregnancy complications combined with maternal disease" until January 2017...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28451036/influence-of-shift-work-on-the-physical-work-capacity-of-tunisian-nurses-a-cross-sectional-study-in-two-university-hospitals
#15
Irtyah Merchaoui, Lamia Bouzgarrou, Ahlem Mnasri, Mounir Mghanem, Mohamed Akrout, Jacques Malchaire, Neila Chaari
INTRODUCTION: This study has been performed to determine the influence of rotating shift work on physical working capacity of Tunisian nurses and to design recommendations to managers so that they implement effective preventive measures. METHODS: It is a cross-sectional design using a standardized questionnaire and many physical capacity tests on a representative sample of 1181 nurses and nursing assistants from two university hospital centers of the school of Medicine of Monastir located in the Tunisian Sahel...
2017: Pan African Medical Journal
https://www.readbyqxmd.com/read/28442293/effect-of-appropriate-combination-therapy-on-mortality-of-patients-with-bloodstream-infections-due-to-carbapenemase-producing-enterobacteriaceae-increment-a-retrospective-cohort-study
#16
Belén Gutiérrez-Gutiérrez, Elena Salamanca, Marina de Cueto, Po-Ren Hsueh, Pierluigi Viale, José Ramón Paño-Pardo, Mario Venditti, Mario Tumbarello, George Daikos, Rafael Cantón, Yohei Doi, Felipe Francisco Tuon, Ilias Karaiskos, Elena Pérez-Nadales, Mitchell J Schwaber, Özlem Kurt Azap, Maria Souli, Emmanuel Roilides, Spyros Pournaras, Murat Akova, Federico Pérez, Joaquín Bermejo, Antonio Oliver, Manel Almela, Warren Lowman, Benito Almirante, Robert A Bonomo, Yehuda Carmeli, David L Paterson, Alvaro Pascual, Jesús Rodríguez-Baño
BACKGROUND: The best available treatment against carbapenemase-producing Enterobacteriaceae (CPE) is unknown. The objective of this study was to investigate the effect of appropriate therapy and of appropriate combination therapy on mortality of patients with bloodstream infections (BSIs) due to CPE. METHODS: In this retrospective cohort study, we included patients with clinically significant monomicrobial BSIs due to CPE from the INCREMENT cohort, recruited from 26 tertiary hospitals in ten countries...
April 21, 2017: Lancet Infectious Diseases
https://www.readbyqxmd.com/read/28438380/the-role-of-muscle-strengthening-in-exercise-therapy-for-knee-osteoarthritis-a-systematic-review-and-meta-regression-analysis-of-randomized-trials
#17
REVIEW
Cecilie Bartholdy, Carsten Juhl, Robin Christensen, Hans Lund, Weiya Zhang, Marius Henriksen
OBJECTIVES: To analyze if exercise interventions for patients with knee osteoarthritis (OA) following the American College of Sports Medicine (ACSM) definition of muscle strength training differs from other types of exercise, and to analyze associations between changes in muscle strength, pain, and disability. METHODS: A systematic search in 5 electronic databases was performed to identify randomized controlled trials comparing exercise interventions with no intervention in knee OA, and reporting changes in muscle strength and in pain or disability assessed as standardized mean differences (SMD) with 95% confidence intervals (95% CI)...
March 18, 2017: Seminars in Arthritis and Rheumatism
https://www.readbyqxmd.com/read/28435485/impact-of-health-policy-changes-on-emergency-medicine-in-maryland-stratified-by-socioeconomic-status
#18
Laura Pimentel, David Anderson, Bruce Golden, Edward Wasil, Fermin Barrueto, Jon M Hirshon
INTRODUCTION: On January 1, 2014, the financing and delivery of healthcare in the state of Maryland (MD) profoundly changed. The insurance provisions of the Patient Protection and Affordable Care Act (ACA) began implementation and a major revision of MD's Medicare waiver ushered in a Global Budget Revenue (GBR) structure for hospital reimbursement. Our objective was to analyze the impact of these policy changes on emergency department (ED) utilization, hospitalization practices, insurance profiles, and professional revenue...
April 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28435240/risk-of-pneumonia-with-budesonide-containing-treatments-in-copd-an-individual-patient-level-pooled-analysis-of-interventional-studies
#19
Sally Hollis, Carin Jorup, Dan Lythgoe, Gunnar Martensson, Pontus Regnell, Göran Eckerwall
BACKGROUND: Concerns have been raised that treatment of COPD with inhaled corticosteroids may increase pneumonia risk. Responding to a request from the European Medicines Agency Pharmacovigilance Risk Assessment Committee, a pooled analysis of interventional studies compared pneumonia risk with inhaled budesonide-containing versus non-budesonide-containing treatments and the impact of other clinically relevant factors. METHODS: AstraZeneca-sponsored, parallel-group, double-blind, randomized controlled trials meeting the following criteria were included: >8 weeks' duration; ≥60 patients with COPD; inhaled budesonide treatment arm (budesonide/formoterol or budesonide); and non-budesonide-containing comparator arm (formoterol or placebo)...
2017: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/28431457/precision-medicine-and-pharmacogenetics-what-does-oncology-have-that-addiction-medicine-does-not
#20
Henry R Kranzler, Rachel V Smith, Robert Schnoll, Afaf Moustafa, Emma Greenstreet-Akman
BACKGROUND AND AIMS: Precision, personalized or stratified medicine, which promises to deliver the right treatment to the right patient, is a topic of international interest in both the lay press and the scientific literature. A key aspect of precision medicine is the identification of biomarkers that predict the response to medications (i.e. pharmacogenetics). We examined why, despite the great strides that have been made in biomarker identification in many areas of medicine, only in oncology has there been substantial progress in their clinical implementation...
April 21, 2017: Addiction
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