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https://www.readbyqxmd.com/read/28802774/a-rule-based-dose-finding-design-for-use-in-stroke-rehabilitation-research-methodological-development
#1
E Colucci, A Clark, C E Lang, V M Pomeroy
BACKGROUND: Dose-optimisation studies as precursors to clinical trials are rare in stroke rehabilitation. OBJECTIVE: To develop a rule-based, dose-finding design for stroke rehabilitation research. DESIGN: 3+3 rule-based, dose-finding study. Dose escalation/de-escalation was undertaken according to preset rules and a mathematical sequence (modified Fibonacci sequence). The target starting daily dose was 50 repetitions for the first cohort...
January 20, 2017: Physiotherapy
https://www.readbyqxmd.com/read/28800797/a-modern-day-fight-club-the-stabilization-and-management-of-acutely-agitated-patients-in-the-emergency-department
#2
REVIEW
Andrew New, Veronica Theresa Tucci, Juan Rios
This article is an overview of the treatment and management of acutely agitated patients as they present in the emergency department or emergency psychiatric facility. This article focuses on how a patient encounter may unfold and what issues need to be considered along the way. Verbal de-escalation is emphasized as a standard of care, including the offering of environmental changes and medications when indicated. Approved medications are reviewed as well as the proper use of restraints.
September 2017: Psychiatric Clinics of North America
https://www.readbyqxmd.com/read/28797822/mental-health-nurses-emotions-exposure-to-patient-aggression-attitudes-to-and-use-of-coercive-measures-cross-sectional-questionnaire-survey
#3
Rahul Jalil, Jorg W Huber, Judith Sixsmith, Geoffrey L Dickens
BACKGROUND: Mental health nurses are exposed to patient aggression, and required to manage and de-escalate aggressive incidents; coercive measures such as restraint and seclusion should only be used as a last resort. An improved understanding of links between nurses' exposure to aggression, attitudes to, and actual involvement in, coercive measures, and their emotions (anger, guilt, fear, fatigue, sadness), could inform preparation and education for prevention and management of violence...
July 31, 2017: International Journal of Nursing Studies
https://www.readbyqxmd.com/read/28794513/rheumatoid-arthritis-dmard-de-escalation-let-the-patient-guide-you
#4
Yoshiya Tanaka
No abstract text is available yet for this article.
August 10, 2017: Nature Reviews. Rheumatology
https://www.readbyqxmd.com/read/28790283/-postoperative-atelectasis-and-pneumonia-after-general-thoracic-surgery
#5
Yasushi Hoshikawa, Daisuke Tochii
Atelectasis and pneumonia are common postoperative complications occurred in patients undergoing general thoracic surgery. Strategies to reduce the risk of postoperative pulmonary complications including these 2 disorders consist of smoking cessation, optimization of underlying chronic obstructive pulmonary disease( COPD), adequate pain control, intensive oral care, and so on. Preoperative treatments for patients with COPD are the same as those for COPD patients being not about to have surgery, which mainly consist of long-acting bronchodilators and pulmonary rehabilitation...
July 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/28782646/%C3%AE-lacta-%C3%A2-test-performance-for-detection-of-extended-spectrum-%C3%AE-lactamase-producing-gram-negative-bacilli-directly-on-bronchial-aspirates-samples-a-validation-study
#6
Salah Gallah, Yahia Benzarara, Jacques Tankovic, Paul-Louis Woerther, Hayat Bensekri, Jean-Luc Mainardi, Guillaume Arlet, Sophie Vimont, Marc Garnier
OBJECTIVES: Incidence of Extended Spectrum β-Lactamase-producing Gram Negative Bacilli (ESBL-P-GNB)-related infections is worryingly increasing worldwide. ESBL-P-GNB detection directly on bronchial aspirate samples (BAS) performed for suspected pneumonia may help save empirical carbapenems. Our objectives were to optimize β-LACTA(®) test (BLT) realization and evaluate BLT performance for ESBL-P-GNB detection directly on BAS. METHODS: 1) BLT technical optimization using BAS of different matrix types spiked with increasing concentrations of CTX-M-15-producing Klebsiella pneumoniae; 2) in vitro validation of BLT diagnostic performance on 17 ESBL enzymes, belonging to CTX-M, SHV, TEM, OXA, GES, VEB, and PER groups; 3) clinical validation of BLT performance on 126 BAS prospectively collected from 7 Intensive Care Units...
August 3, 2017: Clinical Microbiology and Infection
https://www.readbyqxmd.com/read/28781151/2016-guideline-strategies-for-the-use-of%C3%A2-antifungal-agents-in-patients-with-hematological-malignancies-or-hematopoietic-stem-cell-transplantation-recipients-in-taiwan
#7
REVIEW
Bor-Sheng Ko, Wei-Ting Chen, Hsiang-Chi Kung, Un-In Wu, Jih-Luh Tang, Ming Yao, Yee-Chun Chen, Hwei-Fang Tien, Shan-Chwen Chang, Yin-Ching Chuang, Dong-Tsamn Lin
The Infectious Diseases Society of Taiwan (IDST), the Hematology Society of Taiwan, the Taiwan Society of Blood and Marrow Transplantation, Medical Foundation in Memory of Dr. Deh-Lin Cheng, Foundation of Professor Wei-Chuan Hsieh for Infectious Diseases Research and Education, and CY Lee's Research Foundation for Pediatric Infectious Diseases and Vaccines cooperatively published this guideline for the use of antifungal agents in hematological patients with invasive fungal diseases (IFDs) in Taiwan. The guideline is the first one endorsed by IDST focusing on selection of antifungal strategies, including prophylaxis, empirical (or symptom-driven) and pre-emptive (or diagnostic-driven) strategy...
July 25, 2017: Journal of Microbiology, Immunology, and Infection, Wei Mian Yu Gan Ran za Zhi
https://www.readbyqxmd.com/read/28771784/a-qualitative-study-of-decision-making-on-phase-iii-randomized-clinical-trial-participation-in-pediatric-oncology-adolescents-and-parents-perspectives-and-preferences
#8
Marianne Vie Ingersgaard, Morten Tulstrup, Kjeld Schmiegelow, Hanne Baekgaard Larsen
AIM: To explore parents' and adolescents' motives for accepting/declining participation in the ALL2008 trials and adolescents' involvement in the decision-making process. BACKGROUND: Children and adolescents with acute lymphoblastic leukemia treated on the Nordic Society of Paediatric Haematology and Oncology ALL2008 protocol were eligible for two randomizations testing 6-mercaptopurine treatment intensifications to improve efficacy and Asparaginase de-escalation to reduce toxicity...
August 3, 2017: Journal of Advanced Nursing
https://www.readbyqxmd.com/read/28769126/initial-treatment-of-patients-with-primary-breast-cancer-evidence-controversies-consensus-spectrum-of-opinion-of-german-specialists-at-the-15th-international-st-%C3%A2-gallen-breast-cancer-conference-vienna-2017
#9
Michael Untch, Jens Huober, Christian Jackisch, Andreas Schneeweiss, Sara Y Brucker, Peter Dall, Carsten Denkert, Peter A Fasching, Tanja Fehm, Bernd Gerber, Wolfgang Janni, Thorsten Kühn, Diana Lüftner, Volker Möbus, Volkmar Müller, Achim Rody, Peter Sinn, Marc Thill, Christoph Thomssen, Nadia Harbeck, Cornelia Liedtke
The St. Gallen International Consensus Conference on the treatment of patients with primary breast cancer has been held regularly (every second year in the last six years) for more than 30 years. This year, the findings of the International St. Gallen Consensus Panel and their implications for clinical practice were again discussed by a German working group of leading breast cancer specialists. Five of the breast cancer specialists from Germany were also members of this year's St. Gallen panel. A comparison between the St...
June 2017: Geburtshilfe und Frauenheilkunde
https://www.readbyqxmd.com/read/28760399/tas-102-plus-bevacizumab-for-patients-with-metastatic-colorectal-cancer-refractory-to-standard-therapies-c-task-force-an-investigator-initiated-open-label-single-arm-multicentre-phase-1-2-study
#10
Yasutoshi Kuboki, Tomohiro Nishina, Eiji Shinozaki, Kentaro Yamazaki, Kohei Shitara, Wataru Okamoto, Takeshi Kajiwara, Toshihiko Matsumoto, Takahiro Tsushima, Nobuo Mochizuki, Shogo Nomura, Toshihiko Doi, Akihiro Sato, Atsushi Ohtsu, Takayuki Yoshino
BACKGROUND: In patients with heavily treated metastatic colorectal cancer, TAS-102-a combination of trifluridine and tipiracil-has shown a significant overall survival benefit compared with placebo. In preclinical models, TAS-102 plus bevacizumab has shown enhanced activity against colorectal cancer xenografts compared with that for either drug alone. In this phase 1/2 study, we assessed the activity and safety of TAS-102 plus bevacizumab. METHODS: We did this investigator-initiated, open-label, single-arm, multicentre, phase 1/2 trial of TAS-102 plus bevacizumab in four cancer centres in Japan...
July 28, 2017: Lancet Oncology
https://www.readbyqxmd.com/read/28745693/-efficiency-of-different-celecoxib-regimens-in-patients-with-active-axial-spondyloarthritis-results-of-the-4-week-pilot-open-label-comparative-single-center-study-aim
#11
I Z Gaydukova, К A Gamayunova, K D Dorogoykina, A P Rebrov
AIM: To compare the efficiency and safety of two celecoxib regimens in the short-term treatment of patients with axial spondyloarthritis (axSpA). SUBJECTS AND METHODS: Examinations were made in 40 patients with axSpA (the 2009 ASAS criteria; age, 38.5±12.1 years; 29 (72.5%) men; axSpA duration, 6.67±5.8 years; BASDAI ≥4.0), who were randomly divided into two groups: 1) 20 patients who received celecoxib 400 mg/day for 30 days; 2) 20 patients who took celecoxib 600 mg/day for 7 days, then the drug was continued at a dose of 200 mg/day for 1 month...
2017: Terapevticheskiĭ Arkhiv
https://www.readbyqxmd.com/read/28733933/immunohistochemical-analysis-of-h3k27me3-demonstrates-global-reduction-in-group-a-childhood-posterior-fossa-ependymoma-and-is-a-powerful-predictor-of-outcome
#12
Pooja Panwalkar, Jonathan Clark, Vijay Ramaswamy, Debra Hawes, Fusheng Yang, Christopher Dunham, Stephen Yip, Juliette Hukin, Yilun Sun, Matthew J Schipper, Lukas Chavez, Ashley Margol, Melike Pekmezci, Chan Chung, Adam Banda, Jill M Bayliss, Sarah J Curry, Mariarita Santi, Fausto J Rodriguez, Matija Snuderl, Matthias A Karajannis, Amanda M Saratsis, Craig M Horbinski, Anne-Sophie Carret, Beverly Wilson, Donna Johnston, Lucie Lafay-Cousin, Shayna Zelcer, David Eisenstat, Marianna Silva, Katrin Scheinemann, Nada Jabado, P Daniel McNeely, Marcel Kool, Stefan M Pfister, Michael D Taylor, Cynthia Hawkins, Andrey Korshunov, Alexander R Judkins, Sriram Venneti
Posterior fossa ependymomas (EPN_PF) in children comprise two morphologically identical, but biologically distinct tumor entities. Group-A (EPN_PFA) tumors have a poor prognosis and require intensive therapy. In contrast, group-B tumors (EPN_PFB) exhibit excellent prognosis and the current consensus opinion recommends future clinical trials to test the possibility of treatment de-escalation in these patients. Therefore, distinguishing these two tumor subtypes is critical. EPN_PFA and EPN_PFB can be distinguished based on DNA methylation signatures, but these assays are not routinely available...
July 21, 2017: Acta Neuropathologica
https://www.readbyqxmd.com/read/28733718/antimicrobial-resistance-in-the-next-30%C3%A2-years-humankind-bugs-and-drugs-a-visionary-approach
#13
REVIEW
Matteo Bassetti, Garyphallia Poulakou, Etienne Ruppe, Emilio Bouza, Sebastian J Van Hal, Adrian Brink
PURPOSE: To describe the current standards of care and major recent advances with regard to antimicrobial resistance (AMR) and to give a prospective overview for the next 30 years in this field. METHODS: Review of medical literature and expert opinion were used in the development of this review. RESULTS: There is undoubtedly a large clinical and public health burden associated with AMR in ICU, but it is challenging to quantify the associated excess morbidity and mortality...
July 21, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28733440/dose-transition-pathways-the-missing-link-between-complex-dose-finding-designs-and-simple-decision-making
#14
Christina Yap, Lucinda J Billingham, Ying Kuen Cheung, Charlie Craddock, John O'Quigley
The ever increasing pace of development of novel therapies mandates efficient methodologies for assessment of their tolerability and activity. Evidence increasingly support the merits of model-based dose-finding designs in identifying the recommended Phase II dose compared to conventional rule-based designs such as the 3+3 but despite this, their use remains limited. Here, we propose a useful tool, Dose Transition Pathways (DTP), which helps overcome several commonly-faced practical and methodological challenges in the implementation of model-based designs...
July 21, 2017: Clinical Cancer Research: An Official Journal of the American Association for Cancer Research
https://www.readbyqxmd.com/read/28732563/risk-factors-and-outcomes-for-the-acquisition-of-carbapenem-resistant-gram-negative-bacillus-bacteremia-a-retrospective-propensity-matched-case-control-study
#15
Shih-Wen Ting, Chen-Hsiang Lee, Jien-Wei Liu
BACKGROUND/PURPOSE: A substantial number of carbapenem-resistant Gram-negative bacilli (CR GNB) have been identified among the etiologic multidrug-resistant GNB in healthcare-associated infections. For achieving a better therapeutic outcome by minimizing inappropriate empirical antibiotic treatment before blood culture and susceptibility testing results are available, it is very important to identify patients who are at risk for the development of CR GNB bacteremia. METHODS: Retrospective analysis of propensity-score matched (PSM) adult patients with CR GNB bacteremia (PSM-group 1 [n = 95]) and those with non-CR GNB bacteremia (PSM-group 2 [n = 190])...
June 23, 2017: Journal of Microbiology, Immunology, and Infection, Wei Mian Yu Gan Ran za Zhi
https://www.readbyqxmd.com/read/28719715/long-term-recurrence-free-survival-after-an-unplanned-reduction-in-radiotherapy-for-hpv-positive-oropharyngeal-scc-two-cases-and-a-review-of-the-literature
#16
Jason Liu, David Goldenberg, Salah Almokadem, Henry Crist, Heath B Mackley
There is currently no clear distinction between the treatment of HPV-positive and HPV-negative oropharyngeal squamous cell carcinoma (OPSCC). HPV-positive OPSCC has been demonstrated to be more radiosensitive than its HPV-negative counterpart. Despite this, patients with HPV-positive OPSCC continue to receive a full dose of radiation (70 Gy) outside clinical trials. However, this high dose comes with considerable morbidities, including severe mucositis, dysphagia, and xerostomia. We describe the cases of 2 patients with HPV-positive OPSCC who received two cycles of high-dose cisplatin at 100 mg/m(2) on 3 separate days, along with concurrent radiotherapy at 50 Gy in 25 fractions for one and 46 Gy in 23 fractions for the other...
July 2017: Ear, Nose, & Throat Journal
https://www.readbyqxmd.com/read/28719249/applying-sensory-modulation-to-mental-health-inpatient-care-to-reduce-seclusion-and-restraint-a-case-control-study
#17
Charlotte Andersen, Anne Kolmos, Kjeld Andersen, Volkmar Sippel, Elsebeth Stenager
BACKGROUND: Clinical training in managing conflicts and preventing violence seldom contains sensory modulation (SM) as a method to de-escalate and prevent restraint and seclusion. Sensory-based interventions promote adaptive regulation of arousal and emotion. SM is a complementary approach that is associated with reduced rates of seclusion and restraint in mental healthcare, but there is need for more research in this area. AIMS: Using SM to reduce restraint and seclusion in inpatient mental health care...
July 18, 2017: Nordic Journal of Psychiatry
https://www.readbyqxmd.com/read/28717396/intraoperative-radiotherapy-review-of-techniques-and-results
#18
REVIEW
Avinash Pilar, Meetakshi Gupta, Sarbani Ghosh Laskar, Siddhartha Laskar
Intraoperative radiotherapy (IORT) is a technique that involves precise delivery of a large dose of ionising radiation to the tumour or tumour bed during surgery. Direct visualisation of the tumour bed and ability to space out the normal tissues from the tumour bed allows maximisation of the dose to the tumour while minimising the dose to normal tissues. This results in an improved therapeutic ratio with IORT. Although it was introduced in the 1960s, it has seen a resurgence of popularity with the introduction of self-shielding mobile linear accelerators and low-kV IORT devices, which by eliminating the logistical issues of transport of the patient during surgery for radiotherapy or building a shielded operating room, has enabled its wider use in the community...
2017: Ecancermedicalscience
https://www.readbyqxmd.com/read/28717037/impact-of-a-carbapenem-antimicrobial-stewardship-program-on-patient-outcomes
#19
Valerie Xue Fen Seah, Rina Yue Ling Ong, Ashley Shi Yuan Lim, Chia Yin Chong, Natalie Woon Hui Tan, Koh Cheng Thoon
Antimicrobial stewardship programs (ASPs) aim to improve appropriate antimicrobials use. However, concerns of the negative consequences from accepting ASP interventions exist, particularly when de-escalation or discontinuation of broad-spectrum antibiotics are recommended. Hence, we sought to evaluate the impact on clinical outcomes when ASP interventions for inappropriate carbapenem use were accepted or rejected by primary providers.We retrospectively reviewed all carbapenem prescriptions deemed inappropriate according to institutional guidelines with ASP interventions between July 2011 and December 2014...
July 17, 2017: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/28709439/enhanced-antimicrobial-de-escalation-for-pneumonia-in-mechanically-ventilated-patients-a-cross-over-study
#20
Tracy Trupka, Kristen Fisher, Scott T Micek, Paul Juang, Marin H Kollef
BACKGROUND: Antibiotics are commonly administered to hospitalized patients with infiltrates for possible bacterial pneumonia, often leading to unnecessary treatment and increasing the risk for resistance emergence. Therefore, we performed a study to determine if an enhanced antibiotic de-escalation practice could improve antibiotic utilization in mechanically ventilated patients with suspected pneumonia cared for in an academic closed intensive care unit (ICU). METHODS: This was a prospective cross-over trial comparing routine antibiotic management (RAM) and enhanced antimicrobial de-escalation (EAD) performed within two medical ICUs (total 34 beds) at Barnes-Jewish Hospital, an academic referral center...
July 15, 2017: Critical Care: the Official Journal of the Critical Care Forum
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