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https://www.readbyqxmd.com/read/28448664/assessment-of-lower-doses-of-intravitreous-bevacizumab-for-retinopathy-of-prematurity-a-phase-1-dosing-study
#1
David K Wallace, Raymond T Kraker, Sharon F Freedman, Eric R Crouch, Amy K Hutchinson, Amit R Bhatt, David L Rogers, Michael B Yang, Kathryn M Haider, Deborah K VanderVeen, R Michael Siatkowski, Trevano W Dean, Roy W Beck, Michael X Repka, Lois E Smith, William V Good, Mary Elizabeth Hartnett, Lingkun Kong, Jonathan M Holmes
Importance: Intravitreous bevacizumab (0.25 to 0.625 mg) is increasingly used to treat type 1 retinopathy of prematurity (ROP), but there remain concerns about systemic toxicity. A much lower dose may be effective while reducing systemic risk. Objective: To find a dose of intravitreous bevacizumab that was lower than previously used for severe ROP, was effective in this study, and could be tested in future larger studies. Design, Setting, and Participants: Between May 2015 and September 2016, 61 premature infants with type 1 ROP in 1 or both eyes were enrolled in a masked, multicenter, phase 1 dose de-escalation study...
April 27, 2017: JAMA Ophthalmology
https://www.readbyqxmd.com/read/28446572/evaluation-of-the-accelerate-pheno%C3%A2-system-for-fast-identification-and-antimicrobial-susceptibility-testing-from-positive-blood-culture-in-gram-negative-bloodstream-infection
#2
Matthias Marschal, Johanna Bachmaier, Ingo Autenrieth, Philipp Oberhettinger, Matthias Willmann, Silke Peter
Bloodstream infections (BSI) are an important cause of morbidity and mortality. Increasing rates of antimicrobial resistant pathogens limit treatment options, prompting an empirical use of broad-range antibiotics. Fast and reliable diagnostic tools are needed to provide adequate therapy in a timely manner and to enable a de-escalation of treatment.The Accelerate Pheno™ system (Accelerate Diagnostics, USA) is a fully automated test system that performs both identification (ID) and antimicrobial susceptibility testing (AST) directly from positive blood cultures within approx...
April 26, 2017: Journal of Clinical Microbiology
https://www.readbyqxmd.com/read/28446212/doctors-preferences-in-de-escalating-dmards-in-rheumatoid-arthritis-a-discrete-choice-experiment
#3
T Martijn Kuijper, Riëtte Folmer, Elly A Stolk, Johanna M W Hazes, Jolanda J Luime
BACKGROUND: Current guidelines suggest reduction of DMARDs can be considered in RA patients in remission. Objectives were (1) to estimate the relative importance of patient characteristics rheumatologists consider in their decision to de-escalate (2) to assess whether heterogeneity exists among rheumatologists with respect to de-escalation and (3) to identify the preferred de-escalation strategy. METHODS: A discrete choice experiment (DCE) was conducted. All rheumatologists and trainees in The Netherlands were invited to participate...
April 26, 2017: Arthritis Research & Therapy
https://www.readbyqxmd.com/read/28438294/a-model-using-concomitant-markers-for-predicting-outcome-in-human-papillomavirus-positive-oropharyngeal-cancer
#4
Cinzia Bersani, Michael Mints, Nikolaos Tertipis, Linnea Haeggblom, Lars Sivars, Andreas Ährlund-Richter, Andrea Vlastos, Cecilia Smedberg, Nathalie Grün, Eva Munck-Wikland, Anders Näsman, Torbjörn Ramqvist, Tina Dalianis
OBJECTIVE: Head-neck cancer therapy has become intensified. With radiotherapy alone, 3-year disease-free survival (DFS) is 80% for HPV-positive TSCC/BOTSCC and better for patients with favorable characteristics, suggesting therapy could be tapered for some, decreasing side-effects. Therefore, we built a model to predict progression-free survival for patients with HPV-positive TSCC and BOTSCC. MATERIAL AND METHODS: TSCC/BOTSCC patients treated curatively between 2000 and 2011, with HPV16 DNA/E7 mRNA positive tumors examined for CD8(+) TILs, HPV16 mRNA and HLA class I expression were included...
May 2017: Oral Oncology
https://www.readbyqxmd.com/read/28434660/reduced-dose-radiotherapy-for-human-papillomavirus-associated-squamous-cell-carcinoma-of-the-oropharynx-a-single-arm-phase-2-study
#5
Allen M Chen, Carol Felix, Pin-Chieh Wang, Sophia Hsu, Vincent Basehart, Jordan Garst, Phillip Beron, Deborah Wong, Michael H Rosove, Shyam Rao, Heather Melanson, Edward Kim, Daphne Palmer, Lihong Qi, Karen Kelly, Michael L Steinberg, Patrick A Kupelian, Megan E Daly
BACKGROUND: Head and neck cancers positive for human papillomavirus (HPV) are exquisitely radiosensitive. We investigated whether chemoradiotherapy with reduced-dose radiation would maintain survival outcomes while improving tolerability for patients with HPV-positive oropharyngeal carcinoma. METHODS: We did a single-arm, phase 2 trial at two academic hospitals in the USA, enrolling patients with newly diagnosed, biopsy-proven stage III or IV squamous-cell carcinoma of the oropharynx, positive for HPV by p16 testing, and with Zubrod performance status scores of 0 or 1...
April 20, 2017: Lancet Oncology
https://www.readbyqxmd.com/read/28434659/hpv-related-oropharyngeal-carcinoma-de-escalation-protocols
#6
Ricard Mesía, Miren Taberna
No abstract text is available yet for this article.
April 20, 2017: Lancet Oncology
https://www.readbyqxmd.com/read/28418614/efficacy-and-safety-of-low-dose-heparin-in-hemodialysis
#7
Mariana Murea, Gregory B Russell, Pirouz Daeihagh, Anita M Saran, Karan Pandya, Mark Cabrera, John M Burkart, Barry I Freedman
INTRODUCTION: The dose of unfractionated heparin (UFH) administered during hemodialysis (HD) varies widely. This prospective study evaluated the safety and efficacy of UFH dose de-escalation. METHODS: Sixty-six prevalent patients on HD receiving UFH per standard-dose protocol (load dose [LD] 50-75 units/kg, maintenance dose [MD] 500-1000 units/hour) had heparin prescription converted to low-dose protocol (start LD 15 units/kg and MD 500 units/hour; dose adjusted in small increments based on assessments of extracorporeal blood circuit)...
April 18, 2017: Hemodialysis International
https://www.readbyqxmd.com/read/28414662/weil-s-disease-from-a-local-new-orleans-bar
#8
H P Kahn, L Bateman
INTRODUCTION: Leptospirosis is a zoonotic infection that typically presents with fever, myalgias, nausea, and vomiting after contact with contaminated waters or infected animals (typically rodents); and their excrements. Conditions favorable to the transmission of leptospirosis are common in LA and, without treatment, leptospirosis can lead to both liver and renal failure, meningitis, pulmonary hemorrhage and ultimately death. CASE: A 56 year old woman with no past medical history presented to the Emergency Department with weakness, myalgias, jaundice and decreased urine output for one week...
March 2017: Journal of the Louisiana State Medical Society: Official Organ of the Louisiana State Medical Society
https://www.readbyqxmd.com/read/28413497/antibiotic-de-escalation-principle-in-elderly-patients-with-chronic-obstructive-pulmonary-disease-complicated-with-severe-pneumonia
#9
Baohong Xiao, Mei Wang, Xiaoling Hu, Jinfeng Li, Fangfang Wang, Jiaxing Sun
The present study investigated the clinical effect of antibiotic de-escalation therapy in elderly patients with chronic obstructive pulmonary disease (COPD) complicated with severe pneumonia. According to the parity method of hospitalization number, 86 cases were selected and divided into the observation and control group with 43 cases each. Based on empirical antibiotic application, levofloxacin and cephalosporin antibiotics were used in the control group. After treatment for 3 days, the regimen was adjusted to antibiotics active against Gram-positive (G+) and Gram-negative (G-) bacteria such as the third or fourth generation cephalosporin antibiotics, combined with aminoglycoside, or macrolide antibiotics according to their effects...
April 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28412887/preventing-and-de-escalating-aggressive-behavior-among-adult-psychiatric-patients-a-systematic-review-of-the-evidence
#10
Bradley N Gaynes, Carrie L Brown, Linda J Lux, Kimberly A Brownley, Richard A Van Dorn, Mark J Edlund, Emmanuel Coker-Schwimmer, Rachel Palmieri Weber, Brian Sheitman, Theodore Zarzar, Meera Viswanathan, Kathleen N Lohr
OBJECTIVE: The project goal was to compare the effectiveness of strategies to prevent and de-escalate aggressive behaviors among psychiatric patients in acute care settings, including interventions for reducing use of seclusion and restraint. METHODS: Relevant databases were systematically reviewed for comparative studies of violence prevention and de-escalation strategies involving adult psychiatric patients in acute care settings. Studies (trials and cohort studies) were required to report on aggression or seclusion or restraint outcomes...
April 17, 2017: Psychiatric Services: a Journal of the American Psychiatric Association
https://www.readbyqxmd.com/read/28412043/assessment-of-high-priced-systemic-antifungal-prescriptions
#11
C Poulat, Y Nivoix, A Launoy, P Lutun, P Bachellier, S Rohr, M-L Woehl, D Levêque, V Bru, R Herbrecht, B Gourieux
OBJECTIVES: To assess compliance with international guidelines for costly antifungal prescriptions and to compare these results with a first study performed in 2007. METHODS: Retrospective study including all costly antifungal prescriptions made in surgical and medical intensive care units and in a hepatobiliary, pancreatic, and digestive surgery unit. Prescriptions were assessed in terms of indication, dosage, and antifungal de-escalation. RESULTS: Seventy-four treatments were analyzed...
April 12, 2017: Médecine et Maladies Infectieuses
https://www.readbyqxmd.com/read/28408529/targeted-alpha-therapy-of-mcrpc-with-225-actinium-psma-617-dosimetry-estimate-and-empirical-dose-finding
#12
Clemens Kratochwil, Frank Bruchertseifer, Hendrik Rathke, Marcus Bronzel, Christos Apostolidis, Wilko Weichert, Uwe Haberkorn, Frederick Lars Giesel, Alfred Morgenstern
To develop a treatment protocol for (225)Ac-PSMA-617 alpha-radiation therapy in advanced stage, metastatic castration-resistant prostate cancer patients with PSMA-positive tumor phenotype. Methods: A dosimetry estimate was calculated based on time-activity-curves derived from serially performed (177)Lu-PSMA-617 scans extrapolated to the physical half-life of (225)Ac, assuming instant decay of instable daughter nuclides. Salvage therapies empirically conducted with 50kBq/kg (n = 4), 100kBq/kg (n = 4), 150kBq/kg (n = 2), 200kBq/kg (n = 4) (225)Ac-PSMA-617 were evaluated retrospectively regarding toxicity and treatment response...
April 13, 2017: Journal of Nuclear Medicine: Official Publication, Society of Nuclear Medicine
https://www.readbyqxmd.com/read/28395369/antibiotics-prescriptions-in-the-neonatal-intensive-care-unit-how-to-overcome-everyday-challenges
#13
D Donà, E Mozzo, V Mardegan, U Trafojer, P Lago, S Salvadori, E Baraldi, C Giaquinto
Antimicrobial prescriptions in neonatal intensive care units (NICUs) represent a point of concern for the emergence of MDROs and for morbidity associated with prolonged antibiotic exposure (e.g., invasive candidiasis, necrotizing enterocolitis, and late-onset sepsis). Antimicrobial stewardship programs (ASPs) have shown to be a valuable tool for the prevention of resistance with the goals of optimizing clinical outcomes while decreasing unnecessary prescribing. The most frequent ASP strategies include the correct collection and interpretation of microbiological specimens, prescription of the narrowest-spectrum antibiotic appropriate for a particular case, and de-escalation or discontinuation of therapy in defined situations...
April 10, 2017: American Journal of Perinatology
https://www.readbyqxmd.com/read/28395232/laser-interstitial-thermotherapy-application-for-breast-surgery-current-situation-and-new-trends
#14
REVIEW
Yohan Kerbage, Nacim Betrouni, Pierre Collinet, Henri Azaïs, Serge Mordon, Anne-Sophie Dewalle-Vignion, Benjamin Merlot
While breast specialists debate on therapeutic de-escalation in breast cancer, the treatment of benign lesions is also discussed in relation to new percutaneous ablation techniques. The purpose of these innovations is to minimize potential morbidity. Laser Interstitial ThermoTherapy (LITT) is an option for the ablation of targeted nodules. This review evaluated the scientific publications investigating the LITT approach in malignant and benign breast disease. Three preclinical studies and eight clinical studies (2 studies including fibroadenomas and 6 studies including breast cancers) were reviewed...
April 7, 2017: Breast: Official Journal of the European Society of Mastology
https://www.readbyqxmd.com/read/28385370/thyroid-cancer-surgery-guidelines-in-an-era-of-de-escalation
#15
REVIEW
K J Kovatch, C W Hoban, A G Shuman
Well-differentiated thyroid carcinoma has seen a tremendous rise in global incidence over the past three decades, largely owing to widespread screening and identification of small, incidentally detected tumors. With this increased incidence has emerged a movement questioning whether all cases of thyroid cancer merit a treatment approach focused on oncologic completeness. Such trends towards thoughtful, evidence-based treatment de-escalation paradigms reflect better risk stratification of thyroid cancers, and recognition that not all detected disease poses a threat to health or survival...
March 16, 2017: European Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28384858/antimicrobial-resistance-surveillance-among-intensive-care-units-of-a-tertiary-care-hospital-in-southern-india
#16
Kailash Moolchandani, Apurba Sankar Sastry, R Deepashree, Sujatha Sistla, B N Harish, Jharna Mandal
INTRODUCTION: Hospital Acquired Infections (HAIs) are the rising threat in the health care facilities across the globe. As most Intesive Care Unit (ICU) patients are frequently on broad spectrum antimicrobials, this induces selective antibiotic pressure which leads to development of Antimicrobial Resistance (AMR) among the microorganisms of ICUs. AIM: To study the occurrence of different types of HAIs in patients admitted to various ICUs of JIPMER and the AMR pattern of the bacterial pathogens isolated from them...
February 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28383621/-violence-on-health-care-workers
#17
M Cannavò, N Fusaro, F Colaiuda, G Rescigno, M Fioravanti
OBJECTIVES: The Emergency Department (ED) is vulnerable for workplace violence, but little is known about this and its consequences. Objectives of this study were presence, characteristics and effects of violence from patients and visitors on health care workers in an Emergency Department (ED). MATERIALS AND METHODS: This study was about the Accident and Emergency Department, S. Pertini Hospital, (ASL RMB, Rome, Italy). Data were collected from November 2014 to January 2015 on frequency and type of violent behavior in the past five years experienced by staff members and their level of stress by an ad hoc questionnaire for the evaluation of violent events in health activities (QVS) and a questionnaire on perceived work-related stress (QES)...
March 2017: La Clinica Terapeutica
https://www.readbyqxmd.com/read/28376912/head-to-head-comparison-of-aggressive-conventional-therapy-and-three-biological-treatments-and-comparison-of-two-de-escalation-strategies-in-patients-who-respond-to-treatment-study-protocol-for-a-multicenter-randomized-open-label-blinded-assessor-phase-4-study
#18
Daniel Glinatsi, Marte S Heiberg, Anna Rudin, Dan Nordström, Espen A Haavardsholm, Bjorn Gudbjornsson, Mikkel Østergaard, Till Uhlig, Gerdur Grondal, Kim Hørslev-Petersen, Ronald van Vollenhoven, Merete L Hetland
BACKGROUND: New targeted therapies and improved treatment strategies have dramatically improved the outcomes of patients with rheumatoid arthritis (RA). However, it is unknown whether different early aggressive interventions can induce stable remission or a low-active disease state that can be maintained with conventional synthetic disease-modifying antirheumatic drug (csDMARD) therapy, and whether they differ in efficacy and safety. The Nordic Rheumatic Diseases Strategy Trials And Registries (NORD-STAR) study will assess and compare (1) the proportion of patients who achieve remission in a head-to-head comparison between csDMARD plus glucocorticoid therapy and three different biological DMARD (bDMARD) therapies with different modes of action and (2) two de-escalation strategies in patients who respond to first-line therapy...
April 4, 2017: Trials
https://www.readbyqxmd.com/read/28375168/severe-adenoviral-pneumonia-in-an-immunocompetent-host-with-persistent-fevers-treated-with-multiple-empiric-antibiotics-for-presumed-bacterial-co-infection-an-antibiotic-stewardship-perspective-on-de-escalation-derailed
#19
Burke A Cunha, John Gian, Natalie C Klein
We present a case of severe adenoviral pneumonia in a 20-year-old immunocompetent host with persistently high fevers. The patient was needlessly given multiple empiric antibiotics for non-existent bacterial co-infection. This case has important antibiotic stewardship lessons for practitioners in approaching fevers in the ICU.
April 4, 2017: Journal of Clinical Medicine
https://www.readbyqxmd.com/read/28370052/editorial-therapeutic-de-escalation-of-anti-tumour-necrosis-factor-therapy-is-less-enough
#20
EDITORIAL
K Papamichael, A S Cheifetz
No abstract text is available yet for this article.
May 2017: Alimentary Pharmacology & Therapeutics
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