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https://www.readbyqxmd.com/read/28625166/impact-of-gram-stain-results-on-initial-treatment-selection-in-patients-with-ventilator-associated-pneumonia-a-retrospective-analysis-of-two-treatment-algorithms
#1
Jumpei Yoshimura, Takahiro Kinoshita, Kazuma Yamakawa, Asako Matsushima, Naoki Nakamoto, Toshimitsu Hamasaki, Satoshi Fujimi
BACKGROUND: Ventilator-associated pneumonia (VAP) is a common and serious problem in intensive care units (ICUs). Several studies have suggested that the Gram stain of endotracheal aspirates is a useful method for accurately diagnosing VAP. However, the usefulness of the Gram stain in predicting which microorganisms cause VAP has not been established. The purpose of this study was to evaluate whether a Gram stain of endotracheal aspirates could be used to determine appropriate initial antimicrobial therapy for VAP...
June 19, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28619290/sparing-dysphagia-aspiration-related-structures-using-novel-hybrid-volumetric-modulated-arc-therapy
#2
Sitaraman BalajiSubramanian, Karunakaran Balaji, Moorthi Thirunavukarasu, Sumana Premkumar
PURPOSE: Studies using split field IMRT to spare dysphagia/aspiration related structures (DARS) have raised concern regarding dose uncertainty at matchline. This study explores the utility of hybrid VMAT in sparing the DARS and assesses matchline dose uncertainty in postoperative oral cavity cancer patients and compares it with VMAT. METHODS & MATERIALS: Ten postoperative oral cavity cancer patients were planned with h-VMAT and VMAT using the same planning CT dataset...
June 12, 2017: Physica Medica: PM
https://www.readbyqxmd.com/read/28609825/the-use-of-the-bethesda-system-for-reporting-thyroid-cytopathology-in-korea-a-nationwide-multicenter-survey-by-the-korean-society-of-endocrine-pathologists
#3
Mi Mi Kim, Hyo Jin Park, Hye Sook Min, Hyeong Ju Kwon, Chan Kwon Jung, Seoung Wan Chae, Hyun Ju Yoo, Yoo Duk Choi, Mi Ja Lee, Jeong Ja Kwak, Dong Eun Song, Dong Hoon Kim, Hye Kyung Lee, Ji Yeon Kim, Sook Hee Hong, Jang Sihn Sohn, Hyun Seung Lee, So Yeon Park, Soon Won Hong, Mi Kyung Shin
Background: The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has standardized the reporting of thyroid cytology specimens. The objective of the current study was to evaluate the nationwide usage of TBSRTC and assess the malignancy rates in each category of TBSRTC in Korea. Materials and Methods: Questionnaire surveys were used for data collection on the fine needle aspiration (FNA) of thyroid nodules at 74 institutes in 2012. The incidences and follow-up malignancy rates of each category diagnosed from January to December, 2011, in each institute were also collected and analyzed...
June 14, 2017: Journal of Pathology and Translational Medicine
https://www.readbyqxmd.com/read/28609359/pancreatic-cysts-controversies-advances-diagnoses-and-therapies
#4
Jodie A Barkin, Jamie S Barkin
Pancreatic cysts are commonly found on cross-sectional imaging. The question arises in determining which lesions are premalignant or malignant and may require further testing, intervention, or follow-up. In pancreatic cysts without obvious malignancy on imaging, we approach them using the Four "S" Criteria. These are (1) symptoms that may be originating from the pancreatic cyst; (2) size of the cyst 2 cm or larger and/or main pancreatic duct greater than 5 mm; (3) survival of the patient, based on comorbidity index to determine surgical fitness; and then endoscopic ultrasound with fine needle aspiration (FNA) recommended to determine (4) solid component presence in the cyst, namely, nodule or thick walls, as well as to perform FNA to obtain cyst content...
July 2017: Pancreas
https://www.readbyqxmd.com/read/28609009/triage-of-the-indeterminate-thyroid-aspirate-what-are-the-options-for-the-practicing-cytopathologist
#5
Ayse M Onenerk, Marc P Pusztaszeri, Sule Canberk, William C Faquin
Fine-needle aspiration (FNA) plays a key role in the early evaluation of patients with thyroid nodules; however, from 15% to 30% of FNA specimens are cytologically indeterminate. Molecular testing has proven useful when applied to indeterminate thyroid FNAs, and its use has been endorsed in the American Thyroid Association guidelines. In addition to the noncommercial ("in-house") application of v-Raf murine sarcoma viral oncogene homolog B1 (BRAF), rat sarcoma (RAS), rearranged in transformation/papillary thyroid carcinoma (RET/PTC), and peroxisome proliferator-activated receptor γ/paired box gene 8 (PPARγ/PAX8) testing, there are currently 3 commercially available molecular panels that vary in their relative reported performances, strengths, and limitations...
June 2017: Cancer
https://www.readbyqxmd.com/read/28608456/is-axillary-surgery-beneficial-for-patients-with-adenoid-cystic-carcinoma-of-the-breast
#6
Jessemae L Welsh, Michael G Keeney, Tanya L Hoskin, Katrina N Glazebrook, Judy C Boughey, Sejal S Shah, Tina J Hieken
BACKGROUND AND OBJECTIVES: Adenoid cystic carcinoma (ACC) is a rare, typically triple-negative, breast cancer reported to have a favorable prognosis and low rate of nodal metastasis. No consensus guidelines exist for axillary staging and treatment. METHODS: We identified all patients with ACC evaluated at our institution from January 1994 to August 2016. Patient, tumor, and treatment variables were abstracted and analyzed. RESULTS: We identified 20 pure ACCs (0...
June 12, 2017: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28607765/paediatric-bone-and-joint-infection
#7
REVIEW
Alexios D Iliadis, Manoj Ramachandran
Despite advances in understanding and management, paediatric osteoarticular infections continue to pose diagnostic difficulties for clinicians. Delays in diagnosis can lead to potentially devastating morbidity.No single investigation, including joint aspiration, is sufficiently reliable to diagnose conclusively paediatric bone and joint infection. Diagnosis should be based on a combination of clinical signs, imaging and laboratory investigations. Algorithms should supplement, and not replace, clinical decision making in all cases...
January 2017: EFORT open reviews
https://www.readbyqxmd.com/read/28603647/multicentric-study-of-endobronchial-ultrasound-transbronchial-needle-aspiration-for-lung-cancer-staging-in-italy
#8
Nicola Rotolo, Andrea Imperatori, Mario Nosotti, Luigi Santambrogio, Alessandro Palleschi, Lorenzo Dominioni, Giorgio Crosta, Pierfranco Foccoli, Gianluca Pariscenti, Eliseo Passera, Luigi Bortolotti, Giovanni Falezza, Maurizio Infante, Elisa Daffrè, Maria Cattoni, Lorenzo Rosso
BACKGROUND: Multi-institutional studies of endobronchial-ultrasound transbronchial needle aspiration (EBUS-TBNA) for mediastinal staging in lung cancer are scarce. It is unclear if the high diagnostic performance of EBUS-TBNA reported by experts' guidelines can be generally achieved. METHODS: This is a retrospective study performed in five tertiary referral centers of thoracic surgery in Italy, to assess the EBUS-TBNA diagnostic performance in patients with non-small cell lung cancer (NSCLC)...
May 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28603646/ten-year-experience-with-endobronchial-ultrasound-guided-transbronchial-needle-aspiration-single-center-results-in-mediastinal-diagnostic-and-staging
#9
Lorenzo Rosso, Stefano Ferrero, Paolo Mendogni, Eleonora Bonaparte, Rosaria Carrinola, Alessandro Palleschi, Ilaria Righi, Matteo Montoli, Francesco Damarco, Davide Tosi
BACKGROUND: Endobronchial ultrasonography with transbronchial needle aspiration (EBUS-TBNA) is recognized as an accurate and minimal invasive procedure for diagnosis and staging of lung cancer and lymph nodal malignancies. EBUS is recommended as the first choice procedure for mediastinal staging in lung cancer in international guidelines. METHODS: A retrospective evaluation was performed on single center experience with EBUS-TBNA in our thoracic surgery department in a 10-year time frame...
May 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28590353/proposed-clinical-pathway-for-non-operative-management-of-high-grade-pediatric-pancreatic-injuries-based-on-a-multicenter-analysis-a-pediatric-trauma-society-collaborative
#10
Bindi J Naik-Mathuria, Eric H Rosenfeld, Adam Vogel, Ankush Gosain, Randall Burd, Richard A Falcone, Rajan Thakkar, Barbara Gaines, David Mooney, Mauricio Escobar, Mubeen Jafri, Anthony Stallion, Denise B Klinkner, Robert Russell, Brendan Campbell, Rita V Burke, Jeffrey Upperman, David Juang, Shawn St Peter, Stephon J Fenton, Marianne Beaudin, Hale Wills, Stephanie Polites, Adam Pattyn, Christine Leeper, Laura V Veras, Ilan Maizlin, Shefali Thaker, Alexis Smith, Megan Waddell, Joseph Drews, James Gilmore, Lindsey Armstrong, Alexis Alex Ler, Suzanne Moody, Brandon Behrens, Laurence Carmant
BACKGROUND: Guidelines for non-operative management (NOM) of high-grade pancreatic injuries in children have not been established, and wide practice variability exists. The purpose of this study was to evaluate common clinical strategies across multiple pediatric trauma centers in order to develop a consensus-based standard clinical pathway. METHODS: A multicenter, retrospective review was conducted of children with high-grade (AAST grade III-V) pancreatic injuries treated with NOM between 2010-15...
June 6, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28589088/a-2016-italian-survey-about-guidelines-and-clinical-management-of-thyroid-nodules
#11
Roberto Negro, Roberto Attanasio, Franco Grimaldi, Andrea Frasoldati, Rinaldo Guglielmi, Enrico Papini
BACKGROUND: While thyroid nodules are frequent in endocrine clinical practice, patients are often asymptomatic and euthyroid, and death is rare in cases of malignancy. OBJECTIVES: To evaluate the perception of current international guidelines regarding thyroid nodule management among Italian endocrinologists, and to compare daily clinical practice with suggested recommendations. METHODS: Italian Association of Clinical Endocrinologists (AME) members were invited to participate in a Web-based survey...
April 2017: European Thyroid Journal
https://www.readbyqxmd.com/read/28588423/dysphagia-screening-after-acute-stroke-a-quality-improvement-project-using-criteria-based-clinical-audit
#12
Jorun Sivertsen, Birgitte Graverholt, Birgitte Espehaug
BACKGROUND: Dysphagia is common after stroke and represents a major risk factor for developing aspiration pneumonia. Early detection can reduce the risk of pulmonary complications and death. Despite the fact that evidence-based guidelines recommend screening for swallowing deficit using a standardized screening tool, national audits has identified a gap between practice and this recommendation. The aim was to determine the level of adherence to an evidence-based recommendation on swallow assessment and to take actions to improve practice if necessary...
2017: BMC Nursing
https://www.readbyqxmd.com/read/28572521/the-feeding-paradox-in-advanced-dementia-a-local-perspective
#13
J Kh Luk, F Hw Chan, E Hui, C Y Tse
Feeding problems are common in older people with advanced dementia. When eating difficulties arise tube feeding is often initiated, unless there is a valid advance directive that refuses enteral feeding. Tube feeding has many pitfalls and complications. To date, no benefits in terms of survival, nutrition, or prevention of aspiration pneumonia have been demonstrated. Careful hand feeding is an alternative to tube feeding with advanced dementia. In Hong Kong, the Hospital Authority has established clear ethical guidelines for careful hand feeding...
June 2017: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
https://www.readbyqxmd.com/read/28571145/morphological-changes-in-bone-marrow-post-imatinib-therapy-in-chronic-phase-cml-a-follow-up-study-on-sequential-bone-marrow-aspirates-and-biopsies
#14
Neha Chopra Narang, Usha Rusia, Meera Sikka, Mrinalini Kotru
INTRODUCTION: Imatinib mesylate is used extensively for first line treatment of Chronic Myeloid Leukemia (CML). However, not many studies have documented morphological changes in bone marrow biopsies produced during Imatinib therapy with reference to myelofibrosis. AIM: To document the morphological changes produced in the bone marrow during Imatinib therapy. MATERIALS AND METHODS: This longitudinal study followed up 75 Philadelphia Chromosome Positive Chronic Myeloid Leukemia with chronic phase(Ph+ CML- CP) patients sequentially, receiving 400-600mg Imatinib over a period of 12 or more months...
April 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28562388/procedural-sedation-in-the-icu-and-emergency-department
#15
Nikhil Chawla, Adjoa Boateng, Ranjit Deshpande
PURPOSE OF REVIEW: Procedures are increasingly being performed in the acute care setting, outside of the operating rooms (OR). This article aims to review the current literature on out-of-OR procedural sedation with a focus on the ICU and emergency department, highlighting the following topics: multidisciplinary team approach, choice of pharmacologic agent, sedation scales, current safety guidelines, anticipating complications, appropriate monitoring and necessary resources. RECENT FINDINGS: Subjective assessment of sedation using sedation scales is controversial...
May 27, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28552675/the-era-of-3rs-implementation-in-developmental-and-reproductive-toxicity-dart-testing-current-overview-and-future-perspectives
#16
REVIEW
Manon Beekhuijzen
Since adoption of the first globally implemented guidelines for developmental and reproductive toxicity (DART) testing for pharmaceuticals, industrial chemicals and agrochemicals, many years passed without major updates. However in recent years, significant changes in these guidelines have been made or are being implemented. These changes have been guided by the ethical drive to reduce, refine and replace (3R) animal testing, as well as the addition of endocrine disruptor relevant endpoints. Recent applied improvements have focused on reduction and refinement...
May 25, 2017: Reproductive Toxicology
https://www.readbyqxmd.com/read/28542233/is-survival-improved-by-the-use-of-niv-and-peg-in-amyotrophic-lateral-sclerosis-als-a-post-mortem-study-of-80-als-patients
#17
Christian Burkhardt, Christoph Neuwirth, Andreas Sommacal, Peter M Andersen, Markus Weber
BACKGROUND: Non-invasive ventilation (NIV) and percutaneous gastrostomy (PEG) are guideline-recommended interventions for symptom management in amyotrophic lateral sclerosis (ALS). Their effect on survival is controversial and the impact on causes of death is unknown. OBJECTIVE: To investigate the effect of NIV and PEG on survival and causes of death in ALS patients. METHODS: Eighty deceased ALS patients underwent a complete post mortem analysis for causes of death between 2003 and 2015...
2017: PloS One
https://www.readbyqxmd.com/read/28535578/coasting-withholding-gonadotrophins-for-preventing-ovarian-hyperstimulation-syndrome
#18
REVIEW
Arianna D'Angelo, Nazar N Amso, Rudaina Hassan
BACKGROUND: Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic and potentially life threatening condition resulting from excessive ovarian stimulation. Reported incidence of moderate to severe OHSS ranges from 0.6% to 5% of in vitro fertilization (IVF) cycles. The factors contributing to OHSS have not been completely explained. The release of vasoactive substances secreted by the ovaries under human chorionic gonadotrophin (hCG) stimulation may play a key role in triggering this syndrome...
May 23, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28511234/indications-results-and-clinical-impact-of-endoscopic-ultrasound-eus-guided-sampling-in-gastroenterology-european-society-of-gastrointestinal-endoscopy-esge-clinical-guideline-updated-january-2017
#19
Jean-Marc Dumonceau, Pierre H Deprez, Christian Jenssen, Julio Iglesias-Garcia, Alberto Larghi, Geoffroy Vanbiervliet, Guruprasad P Aithal, Paolo G Arcidiacono, Pedro Bastos, Silvia Carrara, László Czakó, Gloria Fernández-Esparrach, Paul Fockens, Àngels Ginès, Roald F Havre, Cesare Hassan, Peter Vilmann, Jeanin E van Hooft, Marcin Polkowski
For pancreatic solid lesions, ESGE recommends performing endoscopic ultrasound (EUS)-guided sampling as first-line procedure when a pathological diagnosis is required. Alternatively, percutaneous sampling may be considered in metastatic disease.Strong recommendation, moderate quality evidence.In the case of negative or inconclusive results and a high degree of suspicion of malignant disease, ESGE suggests re-evaluating the pathology slides, repeating EUS-guided sampling, or surgery.Weak recommendation, low quality evidence...
May 16, 2017: Endoscopy
https://www.readbyqxmd.com/read/28510461/underlying-causes-of-persistent-and-recurrent-pneumonia-in-children-at-a-pulmonary-referral-hospital-in-tehran-iran
#20
Mohammad Reza Bolursaz, Ferial Lotfian, Hossein Ali Ghaffaripour, Maryam Hassanzad
BACKGROUND: There is limited data on recurrent or persistent pneumonia in children, particularly in the developing world. This is a retrospective, cross-sectional study of children with recurrent or persistent pneumonia admitted to the Pediatric Department of Massih Daneshvari Hospital, Tehran, Iran. METHODS: Children under 18 years of age, who were admitted to the hospital with pneumonia between 2007 and 2013, were investigated to find out the prevalence of recurrent and persistent pneumonia and to recognize their underlying diseases...
May 2017: Archives of Iranian Medicine
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