271 results match your criteria improve difficult-to-manage


Palmitoylethanolamide (PEA) in the treatment of neuropathic pain: a case study.

Authors:
Despina Kamper

Nutr Health 2021 Jul 21:2601060211019669. Epub 2021 Jul 21.

Western Sydney University, Torrens University, Sydney, Nutrition Australia.

Background: Neuropathic pain is a condition caused by a lesion or disease of the somatosensory nervous system. It may present as debilitating pain with a sensation of burning and electric-like symptoms and is often difficult to manage effectively. Although pharmacological medications are the first line of treatment, multidisciplinary teams are sometimes required to provide appropriate treatment to improve quality of life and overall wellbeing. Read More

View Article and Full-Text PDF

Dosimetry-guided virtual surgical planning in the reconstruction of mandibular osteoradionecrosis.

Br J Oral Maxillofac Surg 2021 Feb 23. Epub 2021 Feb 23.

Newcastle Upon Tyne Hospitals, Freeman Hospital, Freeman Road, High Heaton, Newcastle Upon Tyne, NE7 7GA.

Patients with osteoradionecrosis (ORN) of the mandible pose additional challenges to the attending clinician when it comes to major reconstructive head and neck surgery. We present a novel technique to assist in the virtual surgical planning of mandibular ORN, which involves deforming previously delivered radiation dosimetry data on to the virtual mandible to aid in the assessment of surgical resection margins. This is a retrospective case series of patients whose treatment involved a traditional virtual surgical planning approach or dosimetry-guided virtual surgical planning. Read More

View Article and Full-Text PDF
February 2021

The Role of Biologics in the Management of Asthma in the Pediatric Patient.

J Pediatr Pharmacol Ther 2021 28;26(5):427-436. Epub 2021 Jun 28.

The management of pediatric patients with asthma continues to be a major health issue. For many patients, traditional therapies have been very effective, but for a large number of patients asthma remains poorly controlled. This leads to significant morbidity and impairment to quality of life. Read More

View Article and Full-Text PDF

A narrative review of clinical studies of herbal treatment of difficult to manage asthma.

Complement Ther Clin Pract 2021 Jun 16;44:101433. Epub 2021 Jun 16.

School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, 2007, Australia; Respiratory Cellular and Molecular Biology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, 2037, Australia. Electronic address:

Asthma can be complex and difficult to manage. Patients often seek alternative treatment options, including Traditional Chinese Medicine (TCM). The paradigms that inform TCM treatments include a philosophy focusing on modifying the whole body status ('bian zheng') to treat the lungs. Read More

View Article and Full-Text PDF

Oral antibiotics for chronic blepharitis.

Cochrane Database Syst Rev 2021 06 9;6:CD013697. Epub 2021 Jun 9.

Byers Eye Institute, Stanford University, Palo Alto, California, USA.

Background: Posterior blepharitis is common and causes ocular surface and lid damage as well as discomfort. It affects 37% to 47% of all ophthalmology patients; its incidence increasing with age. It is a multifactorial disease associated with multiple other pathologies, such as rosacea, meibomianitis, and infections. Read More

View Article and Full-Text PDF

Dilemmas in management of osteoporosis in patients with complete androgen insensitivity syndrome.

BMJ Case Rep 2021 May 12;14(5). Epub 2021 May 12.

Department of Endocrinology, Diabetes & Metabolism, Walter Reed National Military Medical Center, Bethesda, Maryland, USA

Complete androgen insensitivity syndrome (CAIS)-resulting in 46,XY karyotype, but female phenotype-is a disorder of sex development and primary amenorrhea, but its effect on bone mineral density (BMD) is singular and difficult to manage. Androgens are an important modulator of bone remodeling and health, and the androgen receptor (AR) is pivotal for signaling within the bone cells. CAIS results in a severely disrupted AR throughout the body, causing an elevated risk of early osteoporosis. Read More

View Article and Full-Text PDF

Dairy cow health and management in the transition period: The need to understand the human dimension.

Res Vet Sci 2021 Jul 27;137:94-101. Epub 2021 Apr 27.

Department of Veterinary Health and Animal Sciences, Harper Adams University, Newport, Shropshire TF10 8NB, United Kingdom.

During the transition from the dry period to lactation the dairy cow undergoes a period of physiological, metabolic and immunological change, and is at greater risk of developing disease, to the detriment of health, welfare and production. Many studies have been undertaken to determine appropriate management strategies to improve health and welfare during the transition period, however the incidence of disease, particularly metabolic disease, in this period remains high. To date, a lack of research attention has been paid to the social factors which may affect the management of transition dairy cows. Read More

View Article and Full-Text PDF

Food waste hydrothermal carbonization: Study on the effects of reaction severities, pelletization and framework development using approaches of the circular economy.

Bioresour Technol 2021 Aug 16;333:125187. Epub 2021 Apr 16.

Environmental Engineering and Management, Department of Civil Engineering, Indian Institute of Technology Kharagpur, Kharagpur, West Bengal 721302, India. Electronic address:

Food waste (FW) is difficult to manage during thermal treatment. In this study hydrothermal carbonization (HTC) of FW was carried out at increasing temperatures and retention times using the approach of reaction severities (logR0 = 5.31-7. Read More

View Article and Full-Text PDF

Single-Session Acceptance and Commitment Therapy (ACT) Interventions for Patients with Chronic Health Conditions: A Systematic Review and Meta-Analysis.

J Contextual Behav Sci 2021 Apr 6;20:52-69. Epub 2021 Mar 6.

VA San Diego Healthcare System, San Diego, CA, USA.

Rationale: Chronic health conditions (CHCs) are costly and difficult to manage. Patients often struggle with behavioral adherence to complex treatment regimens and experience psychiatric distress. Acceptance and Commitment Therapy (ACT) is a transdiagnostic behavioral approach that aims to improve functioning and quality of life (QoL), which are important treatment outcomes for this population. Read More

View Article and Full-Text PDF

Treatment of anemia in difficult-to-manage patients with chronic kidney disease.

Kidney Int Suppl (2011) 2021 Apr 18;11(1):26-34. Epub 2021 Mar 18.

Division of Nephrology, Department of Medicine, NewYork-Presbyterian Queens, New York, New York, USA.

The management of anemia of chronic kidney disease (CKD) is often challenging. In particular, for patients with underlying inflammation, comorbid type 2 diabetes or cancer, those hospitalized, and recipients of a kidney transplant, the management of anemia may be suboptimal. Responsiveness to iron and/or erythropoiesis-stimulating agents, the mainstay of current therapy, may be reduced and the risk of adverse reactions to treatment is increased in these difficult-to-manage patients with anemia of CKD. Read More

View Article and Full-Text PDF

Evaluation of a multidisciplinary lipid clinic to improve the care of individuals with severe lipid conditions: a RE-AIM framework analysis.

Implement Sci Commun 2021 Mar 19;2(1):32. Epub 2021 Mar 19.

Genomic Medicine Institute, Geisinger, Danville, PA, USA.

Background: Individuals with complex dyslipidemia, or those with medication intolerance, are often difficult to manage in primary care. They require the additional attention, expertise, and adherence counseling that occurs in multidisciplinary lipid clinics (MDLCs). We conducted a program evaluation of the first year of a newly implemented MDLC utilizing the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to provide empirical data not only on program effectiveness, but also on components important to local sustainability and future generalizability. Read More

View Article and Full-Text PDF

Evaluating Cefiderocol in the Treatment of Multidrug-Resistant Gram-Negative Bacilli: A Review of the Emerging Data.

Infect Drug Resist 2020 29;13:4697-4711. Epub 2020 Dec 29.

Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy.

Infections due to multidrug-resistant Gram-negative bacteria (MDR-GNB), especially when carbapenem resistant, have been very difficult to manage in the last fifteen years, owing to the paucity of dependable therapeutic options. Cefiderocol is a siderophore cephalosporin recently approved by the Food and Drug Administration (FDA) and European Medicines Agency (EMA) that may have the potential to fill some of the remaining gaps in the treatment of MDR-GNB infections. Among others, cefiderocol demonstrated in vitro activity against carbapenem-resistant and metallo-β-lactamases producers. Read More

View Article and Full-Text PDF
December 2020

Inpatient Virtual Vision Clinic Improves Access to Vision Rehabilitation Before and During the COVID-19 Pandemic.

Arch Rehabil Res Clin Transl 2021 Mar 19;3(1):100100. Epub 2020 Dec 19.

Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.

Objective: To describe and evaluate a secure video call system combined with a suite of iPad vision testing apps to improve access to vision rehabilitation assessment for inpatients.

Design: Retrospective.

Setting: Two acute care inpatient rehabilitation hospitals and 1 long-term acute care (LTAC) hospital. Read More

View Article and Full-Text PDF

Autologous Fat Grafting Promotes Macrophage Infiltration to Increase Secretion of Growth Factors and Revascularization, Thereby Treating Diabetic Rat Skin Defect.

Diabetes Metab Syndr Obes 2020 9;13:4897-4908. Epub 2020 Dec 9.

Department of Orthopaedic Trauma and Microsurgery, Wuhan University Zhongnan Hospital, Wuhan, Hubei 430071, People's Republic of China.

Background: Diabetic skin defect is difficult to manage in surgical clinics, and there is still lack of effective treatments for diabetic skin defects. Currently, autologous fat grafting (AFG) is promising in the field of reconstructive surgery, while macrophage infiltration in autologous adipose tissue is considered vital for tissue regeneration. But AFG is rarely applied to the treatment of diabetic skin defects, and whether macrophage infiltration assists AFG to promote wound healing is still unknown. Read More

View Article and Full-Text PDF
December 2020

Expertise-Related Differences in Cyclic Motion Patterns in Drummers: A Kinematic Analysis.

Front Psychol 2020 10;11:538958. Epub 2020 Nov 10.

Institute of Musicians' Medicine, University of Music Carl Maria von Weber Dresden, Dresden, Germany.

Background: At present only little information is available concerning the acquisition of skilled movements in musicians. Although optimally a longitudinal study of changing movement patterns during the process of increasing expertise is required, long-term follow up over several years is difficult to manage. Therefore, in the present cross-sectional study a comparative kinematic analysis of skilled movements in drummers with different levels of expertise was carried out. Read More

View Article and Full-Text PDF
November 2020

Traumatic spinopelvic dissociation managed with bilateral triangular osteosynthesis: Functional and radiological outcomes, health related quality of life and complication rates.

Injury 2021 Jan 8;52(1):95-101. Epub 2020 Oct 8.

Department of Orthopaedics and Traumatology,Manisa Celal Bayar University School of Medicine, Manisa, 45030, TURKEY.

Background: Spinopelvic dissociation (SPD) is difficult to manage and is associated with high mortality and morbidity, including concomitant orthopaedic polytrauma, spine injuries, pelvic ring disruptions, neurological, soft-tissue, and vascular injuries. The purpose of this study is to evaluate the functional and radiological outcomes; health related quality of life and complication rates of patients with traumatic spinopelvic dissociation underwent bilateral triangular osteosynthesis (TOS).

Methods: The study was approved by the medical school's institutional review board (IRB). Read More

View Article and Full-Text PDF
January 2021

Management of Patients With Chronic Pain in Ambulatory Surgery Centers.

Cureus 2020 Sep 12;12(9):e10408. Epub 2020 Sep 12.

Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA.

In the setting of increasingly streamlined surgical techniques and perioperative care, the United States healthcare system is seeing a steady rise in the number of procedures being carried out at ambulatory surgery centers. Concurrently, awareness and diagnosis of both chronic pain conditions and substance use disorders have also improved in recent years. As a result of these two shifts, the demographic characteristics of patients undergoing procedures at ambulatory surgery centers are actively evolving. Read More

View Article and Full-Text PDF
September 2020

The "Preparation for Shared Decision-Making" Tool for Women With Advanced Breast Cancer: Qualitative Validation Study.

J Particip Med 2019 Dec 20;11(4):e16511. Epub 2019 Dec 20.

Avalere Health, Center for Healthcare Transformation, Washington, DC, United States.

Background: The range of decisions and considerations that women with advanced breast cancer (ABC) face can be overwhelming and difficult to manage. Research shows that most patients prefer a shared decision-making (SDM) approach as it provides them with the opportunity to be actively involved in their treatment decisions. The current engagement of these patients in their clinical decisions is suboptimal. Read More

View Article and Full-Text PDF
December 2019

Risk prediction and risk factor analysis of urban logistics to public security based on PSO-GRNN algorithm.

PLoS One 2020 5;15(10):e0238443. Epub 2020 Oct 5.

School of Traffic and Transportation, Beijing Jiaotong University, Beijing, China.

For the complicated operation process, many risk factors, and long cycle of urban logistics, it is difficult to manage the security of urban logistics and it enhances the risk. Therefore, to study a set of effective management mode for the safe operation of urban logistics and improve the risk prediction mechanism, is the primary research item of urban logistics security management. This paper summarizes the risk factors to public security in the process of urban logistics, including pick up, warehouse storage, transport, and the end distribution. Read More

View Article and Full-Text PDF
November 2020

The Microfluidic Trainer: Design, Fabrication and Validation of a Tool for Testing and Improving Manual Skills.

Micromachines (Basel) 2020 Sep 19;11(9). Epub 2020 Sep 19.

BST Biomedical Science and Technologies Lab, IRCCS Istituto Ortopedico Rizzoli, 40126 Bologna, Italy.

Microfluidic principles have been widely applied for more than 30 years to solve biological and micro-electromechanical problems. Despite the numerous advantages, microfluidic devices are difficult to manage as their handling comes with several technical challenges. We developed a new portable tool, the microfluidic trainer (MT), that assesses the operator handling skills and that may be used for maintaining or improving the ability to inject fluid in the inlet of microfluidic devices for in vitro cell culture applications. Read More

View Article and Full-Text PDF
September 2020

Top Ten Tips Palliative Care Clinicians Should Know About Interventional Pain and Procedures.

J Palliat Med 2020 10 27;23(10):1386-1391. Epub 2020 Aug 27.

Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado, USA.

Pain is a common symptom for patients with advanced illness. Palliative care (PC) clinicians are experts in pharmacologic and nonpharmacologic treatment of pain and other symptoms for these patients. True multimodal pain control should include consideration of interventional procedures and pumps to improve difficult-to-manage pain. Read More

View Article and Full-Text PDF
October 2020

Clinical Management in Systemic Type Pseudohypoaldosteronism Due to Variant and Literature Review.

J Clin Res Pediatr Endocrinol 2020 Aug 25. Epub 2020 Aug 25.

University of Health Sciences Turkey, Dr. Sami Ulus Maternity, Child Health and Diseases Training and Research Hospital, Pediatric Endocrinology Clinic.

Systemic pseudohypoaldosteronism is a rare salt wasting syndrome that is caused by inactivating variants in genes encoding epithelial sodium channel subunites. Hyponatremia, hyperkalemia, metabolic acidosis, increased aldosteron and renin levels are expected findings of this disease. It is difficult to manage this disease due to high dose oral replacement therapy. Read More

View Article and Full-Text PDF

Clinical insights into Charcot foot.

Authors:
Brian M Schmidt

Best Pract Res Clin Rheumatol 2020 06 5;34(3):101563. Epub 2020 Jul 5.

Michigan Medicine, Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, Domino's Farms (Lobby C, Suite 1300) 24 Frank Lloyd Wright Drive Ann Arbor, Michigan 48106, USA. Electronic address:

Charcot neuropathic arthropathy (CN) is a devastating condition resulting in non-reducible foot deformity that places patients with distal peripheral neuropathy at risk for the development of chronic neuropathic foot ulcers, major lower extremity amputation, and even death. The condition is often misdiagnosed early in its presentation because of a lack of knowledge among members of the medical community. Consequently, initial therapies for the condition are fewer and patients who present in more advanced stages of the condition are more difficult to manage. Read More

View Article and Full-Text PDF

Clinical evaluation of the Mannheim Prognostic Index in post-operative peritonitis: a prospective cohort study.

Updates Surg 2020 Dec 23;72(4):1159-1166. Epub 2020 Jun 23.

Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Strada delle Scotte 4, Siena, 53100, Italy.

Postoperative peritonitis (PoP), despite their relatively low incidence, are associated with high mortality. Such poor outcomes are also related to the high proportion of aged patients, whose intra-abdominal infections are difficult to manage. The study included 84 consecutive patients with PoP. Read More

View Article and Full-Text PDF
December 2020

Genetics of Clubroot and Fusarium Wilt Disease Resistance in Brassica Vegetables: The Application of Marker Assisted Breeding for Disease Resistance.

Plants (Basel) 2020 Jun 9;9(6). Epub 2020 Jun 9.

Graduate School of Agricultural Science, Kobe University, Rokkodai, Nada-ku, Kobe 657-8501, Japan.

The genus Brassica contains important vegetable crops, which serve as a source of oil seed, condiments, and forages. However, their production is hampered by various diseases such as clubroot and Fusarium wilt, especially in Brassica vegetables. Soil-borne diseases are difficult to manage by traditional methods. Read More

View Article and Full-Text PDF

Outcomes of Dog Bite Avulsion Injury Reconstruction With Urinary Bladder Matrix.

Otolaryngol Head Neck Surg 2020 Dec 9;163(6):1166-1168. Epub 2020 Jun 9.

Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.

Dog bite avulsion injuries of the head and neck are difficult to manage in pediatric patients. This study assesses the outcomes of using porcine urinary bladder extracellular matrix (UBM) for reconstruction of these complete avulsion injuries. Five male pediatric patients underwent reconstruction using UBM. Read More

View Article and Full-Text PDF
December 2020

Ventricular Tachycardia in Structural Heart Disease.

J Innov Card Rhythm Manag 2019 Aug 15;10(8):3762-3773. Epub 2019 Aug 15.

Cardiac Electrophysiology Department, Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA.

Patients with structural heart disease (SHD) are at risk of ventricular tachycardia (VT), which can be difficult to manage clinically. Many treatment options are currently available, but no single approach can be applied with 100% perfect results; often, a combination of therapies is required to achieve good control of ventricular arrhythmias. Coronary artery disease with previous myocardial infarction (MI) is the most common form of SHD presenting with VT, with scar-mediated reentry being the predominant mechanism. Read More

View Article and Full-Text PDF

Aggressive Prophylactic Treatments for Postoperative Nausea and Vomiting Improve Outcomes in Pediatric Adenotonsillectomy Procedure.

J Pediatr Pharmacol Ther 2020 ;25(4):303-308

Objective: Postoperative nausea and vomiting (PONV) is an extremely common side effect of general anesthesia that is difficult to manage. We tested a hypothesis that an aggressive prophylactic intervention with additional antiemetic drugs will reduce the incidence of PONV in a high-risk pediatric population undergoing adenotonsillectomy.

Methods: In this retrospective study, pediatric patients undergoing adenotonsillectomy were screened for their risk factors for PONV. Read More

View Article and Full-Text PDF
January 2020

Small Cell Lung Cancer: Advances in Diagnosis and Management.

Semin Respir Crit Care Med 2020 06 25;41(3):435-446. Epub 2020 May 25.

Division of Medical Oncology, Georgetown University, Washington, District of Columbia, Washington, DC.

Small cell lung cancer (SCLC) is an aggressive subtype of lung cancer characterized by rapid growth and early spread. It is a highly lethal disease that typically is diagnosed at a late stage. Surgery plays a very small role in this cancer, and management typically involves chemotherapy, delivered with thoracic radiation in early-stage disease. Read More

View Article and Full-Text PDF

Synergistic and antagonistic drug interactions in the treatment of systemic fungal infections.

Elife 2020 05 5;9. Epub 2020 May 5.

Division of Microbiology and Immunology, Pathology Department, University of Utah School of Medicine, Salt Lake City, United States.

Invasive fungal infections cause 1.6 million deaths annually, primarily in immunocompromised individuals. Mortality rates are as high as 90% due to limited treatments. Read More

View Article and Full-Text PDF