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https://www.readbyqxmd.com/read/29349757/management-of-the-axilla-in-early-breast-cancer
#1
Monica G Valero, Mehra Golshan
Management of the axilla in early breast cancer patients has significantly evolved in the last several decades. With the arrival of the sentinel lymph node biopsy, surgical practice for axillary staging in patients with early breast cancer has become gradually less invasive and formal axillary lymph node dissection has been confined to selected patients. Over the last two decades, evidence from randomized clinical trials have allowed for the de-escalation of axillary surgery in the management of early stage breast cancer...
2018: Cancer Treatment and Research
https://www.readbyqxmd.com/read/29345517/pet-adapted-therapy-for-advanced-hodgkin-lymphoma-systematic-review
#2
Irina Amitai, Ronit Gurion, Liat Vidal, Eldad J Dann, Pia Raanani, Anat Gafter-Gvili
INTRODUCTION: Positron emission tomography-computed tomography (PET-CT) performed after two chemotherapy cycles (PET-2) has become an accepted prognostic tool in Hodgkin lymphoma (HL). We evaluated the effect of PET-adapted strategy on outcome in advanced stage HL. METHODS: In August 2017, we searched electronic databases, conference proceedings and ongoing trials. We included all studies in which treatment modification for advanced HL was performed based on the results of the interim PET scan...
January 18, 2018: Acta Oncologica
https://www.readbyqxmd.com/read/29343563/robotic-crabs-reveal-that-female-fiddler-crabs-are-sensitive-to-changes-in-male-display-rate
#3
Sophie L Mowles, Michael D Jennions, Patricia R Y Backwell
Males often produce dynamic, repetitive courtship displays that can be demanding to perform and might advertise male quality to females. A key feature of demanding displays is that they can change in intensity: escalating as a male increases his signalling effort, but de-escalating as a signaller becomes fatigued. Here, we investigated whether female fiddler crabs, Uca mjoebergi, are sensitive to changes in male courtship wave rate. We performed playback experiments using robotic male crabs that had the same mean wave rate, but either escalated, de-escalated or remained constant...
January 2018: Biology Letters
https://www.readbyqxmd.com/read/29341844/empiric-antibiotics-for-sepsis
#4
Sara A Buckman, Isaiah R Turnbull, John E Mazuski
BACKGROUND: Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. Early recognition and treatment are the cornerstones of management. METHODS: Review of the English-language literature. RESULTS: For both sepsis and septic shock "antimicrobials [should be] be initiated as soon as possible and within one hour" (Surviving Sepsis Campaign). The risk of progression from severe sepsis to septic shock increases 8% for each hour before antibiotics are started...
January 17, 2018: Surgical Infections
https://www.readbyqxmd.com/read/29338536/p2y12-receptor-inhibitors-an-evolution-in-drug-design-to-prevent-arterial-thrombosis
#5
Danny Kupka, Dirk Sibbing
P2Y12 inhibitors are a critical component of dual antiplatelet therapy (DAPT) - a combination of a P2Y12 receptor inhibitor and aspirin - which is the superior strategy to prevent arterial thrombosis in patients with acute coronary syndromes (ACS) and undergoing stent implantation. Areas covered: Basic science articles, clinical studies, and reviews from 1992-2017 were searched using Pubmed library to collet impactful literature. After an introduction to the purinergic receptor biology, this review summarizes current knowledge on P2Y12 receptor inhibitors including their specific pharmacodynamic as well as pharmacokinetic and drug interaction features...
January 17, 2018: Expert Opinion on Drug Metabolism & Toxicology
https://www.readbyqxmd.com/read/29334728/changing-treatment-paradigms-for-the-management-of-inflammatory-bowel-disease
#6
REVIEW
Jong Pil Im, Byong Duk Ye, You Sun Kim, Joo Sung Kim
Inflammatory bowel disease (IBD) is a chronic and progressive inf lammatory condition of the gastrointestinal tract causing bowel damage, hospitalizations, surgeries, and disability. Although there has been much progress in the management of IBD with established and evolving therapies, most current approaches have failed to change the natural course. Therefore, the treatment approach and follow-up of patients with IBD have undergone a significant change. Usage of immunosuppressants and/or biologics early during the course of the disease, known as top-down or accelerated step-up approach, was shown to be superior to conventional management in patients who had been recently diagnosed with IBD...
January 2018: Korean Journal of Internal Medicine
https://www.readbyqxmd.com/read/29331262/can-interrogation-of-tumour-characteristics-lead-us-to-safely-omit-adjuvant-radiotherapy-in-patients-with-early-breast-cancer
#7
I S Bhattacharya, A M Kirby, J M Bliss, C E Coles
Adjuvant radiotherapy after breast-conserving surgery has been an important component of the standard of care for early breast cancer. Improvements in breast cancer care have resulted in a substantial reduction in local relapse rates over recent decades. Although the proportional benefits of adjuvant radiotherapy are similar for different prognostic risk groups of patients, the absolute benefits depend on the risk of relapse and therefore vary considerably between prognostic groups. Radiotherapy is not without risk and for some patients at very low risk of relapse the risks of radiotherapy may outweigh the benefit, leading to potential overtreatment...
January 10, 2018: Clinical Oncology: a Journal of the Royal College of Radiologists
https://www.readbyqxmd.com/read/29324932/the-neurophysiological-and-evolutionary-considerations-of-close-combat-a-modular-approach
#8
Kostas Dervenis, Evangelos Tsialogiannis
Close Combat may be identified as a physical confrontation involving armed or unarmed fighting, lethal and/or non-lethal methods, or even simply escape from and/or de-escalation of the confrontation. Our model hypothesizes that distinct areas of the brain are utilized for specific levels of violence, based on evolutionary criteria, and that these levels of violence bring into effect distinct physiological criteria and kinesiology. This model is outlined similar to Paul D. MacLean's triune brain theory, but incorporates distinct processes inherent to the autonomic nervous system (i...
September 2017: Hellenic Journal of Nuclear Medicine
https://www.readbyqxmd.com/read/29324302/addressing-the-paradox-of-increasing-mastectomy-rates-in-an-era-of-de-escalation-of-therapy-communication-strategies
#9
REVIEW
Mona P Tan, Edibaldo Silva
Breast conservation therapy (BCT) was established as the preferred modality of surgical treatment for early stage breast cancer in the early 1990's. Yet, rising mastectomy rates have been observed over the last decade. This increase is a cause for concern as recent large population-based studies have consistently reported improved breast cancer-specific survival and local control rates with BCT, in comparison with mastectomy. There is a pressing need to formulate strategies to effectively inform both patients and practitioners about current data, in the hope of reversing rising mastectomy rates to optimise survival outcomes...
January 8, 2018: Breast: Official Journal of the European Society of Mastology
https://www.readbyqxmd.com/read/29322236/-urosepsis
#10
Mathias W Pletz, Sebastian Weis, Christina Forstner, Florian Wagenlehner
Urosepsis is defined as a severe disease due to organ failure caused by a urinary tract infection. An empirical antibiotic therapy should be instigated within the first hour after diagnosis. Urine cultures and blood cultures should be performed before antibiotic treatment. Further diagnostics should be carried out at an early stage to enable an interventional focus control in the case of urinary tract obstruction or abscess formation, if necessary. Gram-negative pathogens are most frequently isolated. Extended spectrum beta-lactamase (ESBL) forming bacteria as a cause of urosepsis are increasing...
January 10, 2018: Der Urologe. Ausg. A
https://www.readbyqxmd.com/read/29310494/effectiveness-of-vancomycin-or-beta-lactam-therapy-in-ampicillin-susceptible-enterococcus-spp-bloodstream-infections
#11
Jesse M Fletcher, Shawn J Kram, Christina B Sarubbi, Deverick J Anderson, Bridgette L Kram
BACKGROUND: De-escalation to a beta-lactam improves outcomes for patients with a methicillin-susceptible Staphylococcus aureus bloodstream infection (BSI). Whether a similar strategy is appropriate for enterococcal species is less clear. OBJECTIVE: To determine whether definitive antibiotic selection affects outcomes for patients with an ampicillin-susceptible enterococcal BSI. METHODS: This retrospective cohort study included patients over 18 years of age receiving definitive therapy with vancomycin or a beta-lactam for one or more blood cultures positive for Enterococcus spp...
January 1, 2018: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/29305639/a-phase-i-study-for-adjuvant-chemotherapy-of-gemcitabine-plus-s-1-in-patients-with-biliary-tract-cancer-undergoing-curative-resection-without-major-hepatectomy-khbo1202
#12
Hiroaki Yanagimoto, Hideyoshi Toyokawa, Daisuke Sakai, Hiroshi Wada, Sohei Satoi, Tomohisa Yamamoto, Hiroaki Nagano, Masanori Toyoda, Tetsuo Ajiki, Hironaga Satake, Akihito Tsuji, Atsushi Miyamoto, Masanori Tsujie, Shigekazu Takemura, Kazuhiro Yanagihara, Tatsuya Ioka
PURPOSE: To determine the recommended dose (RD) of gemcitabine (GEM) plus S-1 (GS) in curatively resected biliary tract cancer (BTC) patients without major hepatectomy. METHODS: A standard 3 + 3 dose-escalation design was used with planned dose levels (mg/m2) of GEM (administered intravenously on days 1 and 8) and S-1 (administered orally twice daily on days 1-14, with a 1-week rest, every 3 weeks for up to 24 weeks) of 1000/80 (Level 2), 1000/65 (Level 1), 800/65 (Level - 1), and 800/50 (Level - 2)...
January 5, 2018: Cancer Chemotherapy and Pharmacology
https://www.readbyqxmd.com/read/29303621/cost-effectiveness-of-de-escalation-from-micafungin-versus-escalation-from-fluconazole-for-invasive-candidiasis-in-china
#13
Dechang Chen, Xianyao Wan, Eliza Kruger, Can Chen, Xiaomeng Yue, Liang Wang, Jiuhong Wu
AIMS: Guidelines on treating invasive candidiasis recommend initial treatment with a broad-spectrum echinocandin (e.g., micafungin); then switching to fluconazole if isolates prove sensitive (de-escalation strategy). This study aimed to evaluate the cost-effectiveness of de-escalation from micafungin versus escalation from fluconazole from a Chinese public payers perspective. MATERIALS AND METHODS: Cost-effectiveness was estimated using a decision analytic model, in which patients begin treatment with fluconazole 400 mg/day (escalation) or micafungin 100 mg/day (de-escalation)...
January 5, 2018: Journal of Medical Economics
https://www.readbyqxmd.com/read/29295017/client-violence-against-youth-care-workers-findings-of-an-exploratory-study-of-workforce-issues-in-residential-treatment
#14
Yvonne Smith, Lex Colletta, Anna E Bender
Residential treatment centers (RTCs) for youth are plagued by high turnover of youth care workers who provide round-the-clock treatment and supervision to youth with severe affective and behavioral problems. This article presents findings from a 15-month ethnographic study of workforce issues in one RTC related to youth care workers' exposure to client violence (CV). Findings are based on 65 semistructured interviews and 490 hours of participant observation with consenting employees. Participants reported CV incidents, including punching, kicking, biting, hair pulling, choking, threats or assaults with a weapon, and other physical and sexualized violence...
December 1, 2017: Journal of Interpersonal Violence
https://www.readbyqxmd.com/read/29290229/antibiotic-treatment-of-lower-respiratory-tract-infections
#15
R Cohen, F Angoulvant, S Biscardi, F Madhi, F Dubos, Y Gillet
Lower respiratory tract infections, i.e., bronchitis, bronchiolitis, and pneumonia, are the second leading cause of antibiotic prescriptions. The vast majority of these infections are due to viruses and are self-limited diseases: most patients recover spontaneously. These two facts explain that antibiotic prescriptions must be limited to some clinical situations for which the diagnosis has to be done early. The first message of this manuscript is to strengthen non-antibiotic prescriptions in many situations such as bronchitis and bronchiolitis...
December 2017: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
https://www.readbyqxmd.com/read/29280762/brentuximab-vedotin-with-avd-shows-safety-in-the-absence-of-strong-cyp3a4-inhibitors-in-newly-diagnosed-hiv-associated-hodgkin-lymphoma
#16
Paul G Rubinstein, Page C Moore, Michelle A Rudek, David H Henry, Juan C Ramos, Lee Ratner, Erin Reid, Elad Sharon, Ariela Noy
OBJECTIVE: Brentuximab vedotin (BV) is an FDA approved anti-CD30 antibody drug conjugate potently active in Hodgkin lymphoma (HL). Trials of BV with doxorubicin, vinblastine, and dacarbazine (AVD-BV) excluded patients with HIV. We studied the safety of (AVD-BV) in newly diagnosed HIV-associated classical Hodgkin lymphoma (HIV-cHL). DESIGN AND METHODS: Patients diagnosed with Stage II-IV HIV-cHL received AVD-BV on days 1 and 15 every 28 days for 6 cycles. Anti-HIV medications with strong CYP3A4 inhibition were excluded...
December 26, 2017: AIDS
https://www.readbyqxmd.com/read/29278528/treatment-of-severe-skin-and-soft-tissue-infections-a-review
#17
Jason P Burnham, Marin H Kollef
PURPOSE OF REVIEW: To review the salient features of the management of severe skin and soft tissue infections (SSTIs), including toxic shock syndrome, myonecrosis/gas gangrene, and necrotizing fasciitis. RECENT FINDINGS: For severe SSTIs, intensive care, source control, and broad-spectrum antimicrobials are required for the initial phase of illness. There is an increasing focus on the utility of rapid diagnostic tests to help in selection and de-escalation of antimicrobials for SSTIs...
December 22, 2017: Current Opinion in Infectious Diseases
https://www.readbyqxmd.com/read/29276300/multilayer-model-of-pharmacy-participation-in-the-antimicrobial-stewardship-program-at-a-large-academic-medical-center
#18
Yanina Dubrovskaya, Marco R Scipione, Justin Siegfried, Shin-Pung Jen, Vinh Pham, John Papadopoulos, Arnold Decano, Tyler Lewis, Arash Dabestani
Purpose: Leveraging pharmacy personnel resources for the purpose of antimicrobial stewardship program (ASP) operations presents a challenging task. We describe our experience integrating all pharmacists into an ASP, and evaluate the impact on ASP interventions, antimicrobial utilization, rate of selected hospital-onset infections and readmission. Summary: During a study period (January 1 to December 31, 2015), a total of 14 552 ASP-related pharmacy interventions were performed (ASP clinical pharmacotherapy specialists [CPS] n = 4025; non-ASP CPS n = 4888; hospital pharmacists n = 5639)...
October 2017: Hospital Pharmacy
https://www.readbyqxmd.com/read/29276239/evaluation-of-antimicrobial-stewardship-related-alerts-using-a-clinical-decision-support-system
#19
Riane J Ghamrawi, Alexander Kantorovich, Seth R Bauer, Andrea M Pallotta, Jennifer K Sekeres, Steven M Gordon, Elizabeth A Neuner
Background: Information technology, including clinical decision support systems (CDSS), have an increasingly important and growing role in identifying opportunities for antimicrobial stewardship-related interventions. Objective: The aim of this study was to describe and compare types and outcomes of CDSS-built antimicrobial stewardship alerts. Methods: Fifteen alerts were evaluated in the initial antimicrobial stewardship program (ASP) review. Preimplementation, alerts were reviewed retrospectively. Postimplementation, alerts were reviewed in real-time...
November 2017: Hospital Pharmacy
https://www.readbyqxmd.com/read/29261480/best-practices-in-managing-child-and-adolescent-behavioral-health-emergencies
#20
Vera Feuer, Joshua Rocker, Babar M Saggu, Jason M Andrus
Behavioral health emergencies most commonly present as depression, suicidal behavior, aggression, and severe disorganization. Emergency clinicians should avoid relying solely on past medical history or previous psychiatric diagnoses that might prematurely rule out medical pathologies. Treatments for behavioral health emergencies consist of de-escalation interventions aimed at preventing agitation, aggression, and harm. This issue reviews medical pathologies and underlying causes that can result in psychiatric presentations and summarizes evidence-based practices to evaluate, manage, and refer patients with behavioral health emergencies...
January 2018: Pediatric Emergency Medicine Practice
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