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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
#1
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
#2
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
#3
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
#4
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
#5
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
https://www.readbyqxmd.com/read/28709012/de-escalation-of-aggressive-behaviour-in-healthcare-settings-concept-analysis
#6
REVIEW
Nutmeg Hallett, Geoffrey L Dickens
BACKGROUND: De-escalation is the recommended first-line response to potential violence and aggression in healthcare settings. Related scholarly activity has increased exponentially since the 1980s, but there is scant research about its efficacy and no guidance on what constitutes the gold standard for practice. OBJECTIVES: To clarify the concept of de-escalation of violence and aggression as described within the healthcare literature. DESIGN: Concept analysis guided by Rodgers' evolutionary approach...
July 4, 2017: International Journal of Nursing Studies
https://www.readbyqxmd.com/read/28705675/use-of-evidence-based-recommendations-in-an-antibiotic-care-bundle-for-the-intensive-care-unit
#7
Nico T Mutters, Giulia De Angelis, Giovanni Restuccia, Francesca Di Muzio, Jeroen Schouten, Marlies Hulscher, Massimo Antonelli, Evelina Tacconelli
PURPOSE: To drive decisions on antibiotic therapy in the intensive care unit (ICU), we developed an antibiotic care bundle (ABC-Bundle) with evidence-based recommendations (EBRs) for antibiotic prescriptions. METHODS: We conducted a 3-step prospective study. First, a systematic review of the literature reporting EBRs for antibiotic usage in the ICU was performed. Second, we developed an ABC-Bundle through a 2-round, RAND-modified Delphi method with an international expert panel, including the most relevant EBRs on a 9-point Likert scale...
July 10, 2017: International Journal of Antimicrobial Agents
https://www.readbyqxmd.com/read/28694235/clinical-benefits-of-antimicrobial-de-escalation-in-adults-with-community-onset-monomicrobial-escherichia-coli-klebsiella-species-and-proteus-mirabilis-bacteremia
#8
Ching-Chi Lee, Jiun-Ling Wang, Chung-Hsun Lee, Yuan-Pin Hung, Ming-Yuan Hong, Hung-Jen Tang, Wen-Chien Ko
The clinical benefits of an antimicrobial de-escalation strategy were compared with those of a no-switch strategy in bacteremic patients. Adults with community-onset monomicrobial Escherichia coli, Klebsiella species and Proteus mirabilis bacteremia treated empirically using broad-spectrum beta-lactams, including third-generation cephalosporins (GCs), fourth-GC or carbapenems, were treated definitively with first- or second-GCs (de-escalation group), the same regimens as empirical antibiotics (no-switch group), or antibiotics with a broader-spectrum than empirical antibiotics (escalation group)...
July 7, 2017: International Journal of Antimicrobial Agents
https://www.readbyqxmd.com/read/28694014/de-escalating-and-escalating-systemic-therapy-of-early-breast-cancer
#9
Ian E Smith, Alicia F C Okines
No abstract text is available yet for this article.
July 7, 2017: Breast: Official Journal of the European Society of Mastology
https://www.readbyqxmd.com/read/28693625/a-role-for-antimicrobial-stewardship-in-clinical-sepsis-pathways-a-prospective-interventional-study
#10
John Burston, Suman Adhikari, Andrew Hayen, Heather Doolan, Melissa L Kelly, Kathy Fu, Tomas O Jensen, Pamela Konecny
OBJECTIVE To evaluate the impact of early infectious diseases (ID) antimicrobial stewardship (AMS) intervention on inpatient sepsis antibiotic management. DESIGN Interventional, nonrandomized, controlled study. SETTING Tertiary-care referral hospital, Sydney, Australia. PATIENTS Consecutive, adult, non-intensive care unit (non-ICU) inpatients triggering an institutional clinical sepsis pathway from May to August 2015. INTERVENTION All patients reviewed by an ID Fellow within 24 hours of sepsis pathway trigger underwent case review and clinic file documentation of recommendations...
July 11, 2017: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/28693449/multiparametric-magnetic-resonance-imaging-in-mucosal-primary-head-and-neck-cancer-a-prospective-imaging-biomarker-study
#11
Christopher N Rumley, Mark T Lee, Lois Holloway, Robba Rai, Myo Min, Dion Forstner, Allan Fowler, Gary Liney
BACKGROUND: Radical radiotherapy, with or without concomitant chemotherapy forms the mainstay of organ preservation approaches in mucosal primary head and neck cancer. Despite technical advances in cancer imaging and radiotherapy administration, a significant proportion of patients fail to achieve a complete response to treatment. For those patients who do achieve a complete response, acute and late toxicities remain a cause of morbidity. A critical need therefore exists for imaging biomarkers which are capable of informing patient selection for both treatment intensification and de-escalation strategies...
July 10, 2017: BMC Cancer
https://www.readbyqxmd.com/read/28690105/de-escalating-and-escalating-systemic-therapy-in-triple-negative-breast-cancer
#12
Lisa A Carey
Triple negative breast cancer has the highest relapse risk of all the clinical subsets, although the escalation of chemotherapy has benefited this subset substantially over recent years. Systemic options are limited to chemotherapy, which makes meaningful de-escalation or escalation of therapy more challenging but possible. Observational cohorts suggest a less than 10% risk of relapse and minimal if any benefit of chemotherapy in very small (<1 cm), node-negative triple negative disease. In higher risk, particularly node-positive disease, anthracycline/taxane-based regimens remain standard...
July 7, 2017: Breast: Official Journal of the European Society of Mastology
https://www.readbyqxmd.com/read/28687441/de-escalation-of-treatment-in-her2-positive-breast-cancer-determinants-of-response-and-mechanisms-of-resistance
#13
Jamunarani Veeraraghavan, Carmine De Angelis, Jorge S Reis-Filho, Tomás Pascual, Aleix Prat, Mothaffar F Rimawi, C Kent Osborne, Rachel Schiff
Overexpression and/or gene amplification of HER2, a crucial member of the HER family of four receptors, occur in about 15-20% of breast cancers and define an aggressive subtype of the disease. Activated HER homo and heterodimers govern a complex and redundant downstream signaling network that regulates cell survival and metastasis. Despite treatment with effective HER2-targeted therapies, many HER2-positive tumors fail to respond, or initially respond but eventually develop resistance. One of the upfront reasons for this treatment failure is failure to accurately select the tumors that are truly dependent on HER2 for survival and so would benefit the most from HER2-targeted therapy...
July 4, 2017: Breast: Official Journal of the European Society of Mastology
https://www.readbyqxmd.com/read/28684658/the-efficacy-of-40-mg-versus-dose-de-escalation-to-less-than-40-mg-of-afatinib-giotrif-as-the-first-line-therapy-for-patients-with-primary-lung-adenocarcinoma-harboring-favorable-epidermal-growth-factor-mutations
#14
Chien-Ying Liu, Cheng-Ta Yang, Chih-Liang Wang, Shih-Hong Li, Ping-Chih Hsu, Chih-Hung Chen, Ting-Yu Lin, Chih-Hsi Kuo, Yueh-Fu Fang, How-Wen Ko, Chih-Teng Yu, Tai-Yun Yang
The choice of a first-line therapy for lung cancer is a crucial decision that can impact the survival as well as the quality of life of a patient. Inhibitors of epidermal growth factor receptor (EGFR) such as afatinib, erlotinib, and gefitinib have previously been used to treat non-small cell lung cancer harboring favorable EGFR mutations. Although afatinib has greater efficacy than other EGFR inhibitors, adverse events related to its use can result in the discontinuation of the therapy. In this study, we compared the therapeutic efficacy in lung cancer patients of a regimen of 40 mg/day of afatinib with that of a lower dose regimen of <40 mg/day resulting either from a lower starting dose of 30 mg/day or dose adjustment...
June 27, 2017: Oncotarget
https://www.readbyqxmd.com/read/28682681/de-escalation-strategies-in-human-epidermal-growth-factor-receptor-2-her2-positive-early-breast-cancer-bc-final-analysis-of-the-west-german-study-group-adjuvant-dynamic-marker-adjusted-personalized-therapy-trial-optimizing-risk-assessment-and-therapy-response
#15
Nadia Harbeck, Oleg Gluz, Matthias Christgen, Ronald Ernest Kates, Michael Braun, Sherko Küemmel, Claudia Schumacher, Jochem Potenberg, Stefan Kraemer, Anke Kleine-Tebbe, Doris Augustin, Bahriye Aktas, Helmut Forstbauer, Joke Tio, Raquel von Schumann, Cornelia Liedtke, Eva-Maria Grischke, Johannes Schumacher, Rachel Wuerstlein, Hans Heinrich Kreipe, Ulrike Anneliese Nitz
Purpose Human epidermal growth factor receptor 2 (HER2)-positive/hormone receptor (HR)-positive breast cancer is a distinct subgroup associated with lower chemotherapy sensitivity and slightly better outcome than HER2-positive/HR-negative disease. Little is known about the efficacy of the combination of endocrine therapy (ET) with trastuzumab or with the potent antibody-cytotoxic, anti-HER2 compound trastuzumab emtansine (T-DM1) with or without ET for this subgroup. The West German Study Group trial, ADAPT (Adjuvant Dynamic Marker-Adjusted Personalized Therapy Trial Optimizing Risk Assessment and Therapy Response Prediction in Early Breast Cancer) compares pathologic complete response (pCR) rates of T-DM1 versus trastuzumab with ET in early HER2-positive/HR-positive breast cancer...
July 6, 2017: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28676389/de-escalating-and-escalating-treatment-beyond-endocrine-therapy-in-patients-with-luminal-breast-cancer
#16
Amelia McCartney, Alessia Vignoli, Christopher Hart, Leonardo Tenori, Claudio Luchinat, Laura Biganzoli, Angelo Di Leo
Luminal breast cancers demonstrate significant molecular and clinical heterogeneity, despite the commonality of shared expression of the estrogen receptor (ER). To date, no clinical trial has prospectively investigated the optimal chemotherapy regime according to luminal type, highlighting a paucity of data furthermore required to guide treatment decisions. Current methods of predicting advantage from adjuvant chemotherapy lack refinement and can over-estimate the risk of relapse, inevitably leading to a proportion of patients being unnecessarily exposed to chemotherapy...
July 1, 2017: Breast: Official Journal of the European Society of Mastology
https://www.readbyqxmd.com/read/28675195/how-to-deal-with-violent-and-aggressive-patients-in-acute-medical-settings
#17
R H Harwood
Dealing with violence and aggression is an area where health professionals often feel uncertain. Standing at the interface between medicine, psychiatry and law, the best actions may not be clear, and guidelines neither consistently applicable nor explicit. An aggressive, violent or abusive patient may be behaving anti-socially or criminally. But in acute medical settings it is more likely that a medical, mental health or emotional problem, or some combination thereof, is the explanation and usually we will not know the relative contribution of each element...
June 2017: Journal of the Royal College of Physicians of Edinburgh
https://www.readbyqxmd.com/read/28673539/trial-designs-and-results-supporting-treatment-de-escalation-and-escalation
#18
Meredith M Regan, William T Barry
Trials for escalation and de-escalation of treatment aim to improve patient care, but from different sides of the same coin with respect to disease control and burdens of treatment. De-escalation of therapy is inherently a non-inferiority question. A design with random assignment to standard of care versus de-escalated therapy is typically implemented but ordinarily will require a large sample size. Some research questions of treatment de-escalation might be asked in select patient populations using single-arm designs...
June 30, 2017: Breast: Official Journal of the European Society of Mastology
https://www.readbyqxmd.com/read/28673537/de-escalating-and-escalating-surgery-in-the-management-of-early-breast-cancer
#19
Monica Morrow
In the setting of increased awareness regarding the need to address potential overtreatment in the management of breast cancer patients with favorable-prognosis disease, this article reviews three relevant instances in which the extent of surgery has been safely decreased: margin width in patients with ductal carcinoma in situ; axillary management in clinically node-negative women undergoing primary breast-conserving surgery; and the use of neoadjuvant chemotherapy followed by sentinel node biopsy for patients presenting with node-positive breast cancer...
June 30, 2017: Breast: Official Journal of the European Society of Mastology
https://www.readbyqxmd.com/read/28673224/fluid-resuscitation-in-critically-ill-patients-timing-and-dose-matters
#20
K Lall, G Roberts, U Buehner
Fluid management is a complex subject in healthcare, particularly when pertaining to critically ill patients. Following a literature search on international recommendations regarding fluid administration for shocked patients, an audit was undertaken at Rotorua Public Hospital, New Zealand, to assess how the local fluid resuscitation strategy could be improved. The first part of the audit looked at the fluid resuscitation approach used to treat shocked patients admitted to the ICU of Rotorua Hospital in 2014 and changes required to achieve best practice recommendations...
July 2017: Anaesthesia and Intensive Care
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