154,767 results match your criteria standard care

Intermediate vs Standard-dose Prophylactic Anticoagulation in Patients with COVID-19 Admitted to ICU: Ninety-day Results from the INSPIRATION Trial.

Thromb Haemost 2021 Apr 17. Epub 2021 Apr 17.

Rajaie Cardiovascular Medical and Research Center, Tehran, Iran (the Islamic Republic of).

Background: Thrombotic complications are considered among the main extrapulmonary manifestations of COVID-19. The optimal type and duration of prophylactic antithrombotic therapy in these patients remain unknown.

Methods: This manuscript reports the final (90-day) results of the Intermediate versus Standard-dose Prophylactic anticoagulation In cRitically-ill pATIents with COVID-19: An opeN label randomized controlled trial (INSPIRATION) study. Read More

View Article and Full-Text PDF

Phyllodes tumors of the breast: Adjuvant radiation therapy revisited.

Breast 2021 Apr 7;58:1-5. Epub 2021 Apr 7.

Radiation Oncology Department, National Cancer Institute, Cairo University, Egypt.

Background: Phyllodes tumors (PT) are rare entity and surgical resection is the cornerstone of treatment. No standard of care exists regarding adjuvant treatment especially radiation therapy (RT).

Patients And Methods: We analyzed all patients with non-metastatic, resected phyllodes tumors who presented to our institution from January 2005 through December 2019. Read More

View Article and Full-Text PDF

Upper airway stimulation: Fewer complications, ED presentations, readmissions, and increased surgical success.

Am J Otolaryngol 2021 Apr 7;42(5):103035. Epub 2021 Apr 7.

Thomas Jefferson University Hospital, Department of Otolaryngology - Head and Neck Surgery, 925 Chestnut St, Philadelphia, PA 19107, United States of America.

Objectives: Evaluate the rate of complications, readmissions, emergency department presentations, and surgical success rates amongst three standard surgical treatment options for obstructive sleep apnea: upper airway stimulation, transoral robotic surgery, and expansion sphincter pharyngoplasty.

Study Design: Retrospective cohort.

Setting: Tertiary care center. Read More

View Article and Full-Text PDF

Should twin-mode white-light and virtual chromoendoscopy of pre-defined mucosal stations be considered a standard of care for transnasal panendoscopy?

Clin Otolaryngol 2021 Apr 17. Epub 2021 Apr 17.

Robert White Professor of Laryngology and Clinical Informatics, University of Southampton, UK.

Expeditious diagnosis and confident exclusion of cancer as the cause of patient symptoms is central to achieving the long-term NHS Plan's objective of diagnosing 75% of cancers at an early stage in order to save 55,000 lives a year. For foregut cancers, the principal diagnostic methodology is symptom-directed visualisation of the relevant subset of at-risk mucosal stations between the lips and the second part of the duodenum. In selected cases, mucosal visualisation is supplemented by additional tests like radiological evaluation of swallowing, cross-sectional imaging, and ultrasound scanning. Read More

View Article and Full-Text PDF

Achievement of goal anti-Xa activity with weight-based enoxaparin dosing for venous thromboembolism prophylaxis in trauma patients.

Pharmacotherapy 2021 Apr 17. Epub 2021 Apr 17.

Augusta University Medical Center, Augusta, Georgia.

Background: Trauma patients are at an increased risk of developing venous thromboembolism (VTE), and enoxaparin is considered the standard of care for VTE prophylaxis in this population. Although there is literature to suggest higher doses of enoxaparin are more effective in achieving goal anti-Xa levels, there is limited information regarding the use of weight-based dosing across all weights in the trauma population.

Objective: The purpose of this study was to evaluate the utility of routine anti-Xa peak monitoring for trauma patients initiated on weight-based enoxaparin for VTE prophylaxis and identify patient populations where monitoring is necessary. Read More

View Article and Full-Text PDF

Sex Differences in Glioblastoma Immunotherapy Response.

Neuromolecular Med 2021 Apr 17. Epub 2021 Apr 17.

Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, USA.

Glioblastoma (GBM), the most common primary malignant brain tumor, remains difficult to treat and shares phenotypes, including an aberrant immune response, with other neurological disorders. Understanding the cellular and molecular mechanisms underlying this pathological immune response remains a priority, particularly as standard of care for advanced cancers evolves to include immunotherapies, which have yet to show strong clinical efficacy in GBM. Epidemiological evidence supports a sex difference in GBM, with increased prevalence in males, and recent studies identified differences between males and females ranging from genetic aberrations to cellular programs. Read More

View Article and Full-Text PDF

Enhanced Transitions of Care for Medically Complex Refugees.

J Immigr Minor Health 2021 Apr 17. Epub 2021 Apr 17.

Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Washington, Box 359780, Seattle, WA, 98104, USA.

Background: Between 2015 and 2019, 261,091 refugees were resettled through the U.S. Refugee Admissions Program. Read More

View Article and Full-Text PDF

The effects of adding quinolones to beta-lactam antibiotics for sepsis.

Acta Anaesthesiol Scand 2021 Apr 16. Epub 2021 Apr 16.

Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.

Background: Sepsis is common, deadly, and a major challenge to treat. Quinolones added to beta-lactam antibiotics are currently recommended as a second-line empiric regimen in sepsis, but the evidence regarding their benefits and harms is unclear.

Objective: To assess the benefits and harms of adding quinolones to standard care for sepsis. Read More

View Article and Full-Text PDF

Safety and Efficacy of Ivermectin and Doxycycline Monotherapy and in Combination in the Treatment of COVID-19: A Scoping Review.

Drug Saf 2021 Apr 16. Epub 2021 Apr 16.

Department of Pediatrics, University of Kentucky, Lexington, KY, USA.

Introduction And Objective: Ivermectin (IVM) and doxycycline (DOXY) have demonstrated in-vitro activity against SARS-CoV-2, and have a reasonable safety profile. The objective of this systematic review was to explore the evidence in the literature on the safety and efficacy of their use as monotherapy and combination therapy in COVID-19 management.

Methods: After prospectively registering the study protocol with the Open Science Framework, we searched PubMed, Google Scholar, clinicaltrials. Read More

View Article and Full-Text PDF

Genetic Mosaicism as a Cause of Inborn Errors of Immunity.

J Clin Immunol 2021 Apr 16. Epub 2021 Apr 16.

Department of Pediatrics, Division of Rheumatology/Immunology, Washington University in St. Louis, 660 S. Euclid Ave. Box 8208, St. Louis, MO, 63110, USA.

Inborn errors of immunity (IEIs) are a heterogeneous group of disorders due to genetic defects in the immune response that have a broad clinical spectrum. Diagnosis of the precise genetic cause of IEI has led to improved care and treatment of patients; however, genetic diagnosis using standard approaches is only successful in ~40% of patients and is particularly challenging in "sporadic" cases without a family history. Standard genetic testing for IEI evaluates for germline changes in genes encoding proteins important for the immune response. Read More

View Article and Full-Text PDF

Computational modelling of perivascular-niche dynamics for the optimization of treatment schedules for glioblastoma.

Nat Biomed Eng 2021 Apr 16;5(4):346-359. Epub 2021 Apr 16.

Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA.

Glioblastoma stem-like cells dynamically transition between a chemoradiation-resistant state and a chemoradiation-sensitive state. However, physical barriers in the tumour microenvironment restrict the delivery of chemotherapy to tumour compartments that are distant from blood vessels. Here, we show that a massively parallel computational model of the spatiotemporal dynamics of the perivascular niche that incorporates glioblastoma stem-like cells and differentiated tumour cells as well as relevant tissue-level phenomena can be used to optimize the administration schedules of concurrent radiation and temozolomide-the standard-of-care treatment for glioblastoma. Read More

View Article and Full-Text PDF

Update in imaging of cancer therapy-related cardiac toxicity in adults.

Open Heart 2021 Apr;8(1)

Pediatric Cardiology, Wilhelmina Children's Hospital University Medical Centre, Utrecht, The Netherlands

Over the past decades, prognosis of patients with cancer has strongly improved and the number of cancer survivors is rapidly growing. Despite this success, cancer treatment is associated with development of serious cardiovascular diseases including left ventricular (LV) systolic dysfunction, heart failure, valvular disease, myocardial infarction, arrhythmias or pericardial diseases. Serial non-invasive cardiac imaging is an important tool to detect early signs of cardiotoxicity, to allow for timely intervention and provide optimal circumstances for long-term prognosis. Read More

View Article and Full-Text PDF

Amoxicillin oral provocation challenge in a primary care clinic: a descriptive analysis.

CMAJ Open 2021 Apr-Jun;9(2):E394-E399. Epub 2021 Apr 16.

Department of Family Medicine (Gateman), McMaster University, Kitchener, Ont.; Department of Family Medicine (Gateman), Western University, Kitchener, Ont.; North Perth Family Health Team (Rumble), Listowel, Ont.; Departments of Pediatrics and Child Health, and Food and Human Nutritional Sciences (Protudjer), University of Manitoba; George & Fay Yee Centre for Healthcare Innovation (Protudjer); The Children's Hospital Research Institute of Manitoba (Protudjer), Winnipeg, Man.; Department of Medicine (Kim), Western University; Department of Medicine (Kim), McMaster University, Kitchener, Ont.

Background: Penicillin is the most frequently reported drug allergen; however, most of these allergies are not true allergies and do not justify the prescription of alternative, less effective and more expensive antibiotic drugs. We aimed to show that patients at low risk of amoxicillin allergy can safely and efficiently undergo oral provocation challenge (OPC) by their primary care physician.

Methods: In this descriptive analysis, we conducted a retrospective chart review of all primary care patients who had undergone OPC from November 2017 to October 2019 in the Amoxicillin Allergy Clinic at the North Perth Family Health Team, Listowel, Ontario. Read More

View Article and Full-Text PDF

Identifying heart failure in patients with chronic obstructive lung disease through the Canadian Primary Care Sentinel Surveillance Network in British Columbia: a case derivation study.

CMAJ Open 2021 Apr-Jun;9(2):E376-E383. Epub 2021 Apr 16.

School of Population and Public Health (Vijh), Centre for Health Services and Policy Research (Wong, Peterson, Ezzat, Gibb) and School of Nursing (Wong, Ezzat), University of British Columbia, Vancouver, BC; Primary Care Research Unit (Grandy) and Department of Family Medicine (Grandy), Dalhousie University, Halifax, NS; Division of Cardiology (Hawkins), University of British Columbia, Vancouver, BC.

Background: Heart failure (HF) poses a substantial global health burden, particularly in patients with chronic obstructive pulmonary disease (COPD). The objective of this study was to validate an electronic medical record-based definition of HF in patients with COPD in primary care practices in the province of British Columbia, Canada.

Methods: We conducted a cross-sectional retrospective chart review from Sept. Read More

View Article and Full-Text PDF

Type 2 Diabetes Subtype Responsive to ACCORD Intensive Glycemia Treatment.

Diabetes Care 2021 Apr 16. Epub 2021 Apr 16.

Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH

Objective: Current type 2 diabetes (T2D) management contraindicates intensive glycemia treatment in patients with high cardiovascular disease (CVD) risk and is partially motivated by evidence of harms in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Heterogeneity in response to intensive glycemia treatment has been observed, suggesting potential benefit for some individuals.

Research Design And Methods: ACCORD was a randomized controlled trial that investigated whether intensively treating glycemia in individuals with T2D would reduce CVD outcomes. Read More

View Article and Full-Text PDF

European Respiratory Society clinical practice guidelines for the diagnosis of asthma in children aged 5-16 years.

Eur Respir J 2021 Apr 16. Epub 2021 Apr 16.

Division of Respiratory Medicine, University Children's Hospital Zuerich and Childhood Research Center, Zuerich, Switzerland.

Diagnosing asthma in children represents an important clinical challenge. There is no single gold standard test to confirm the diagnosis. Consequently, both over-, and under-diagnosis of asthma are frequent in children. Read More

View Article and Full-Text PDF

Protocol for a mixed-method study to inform the feasibility of undertaking a large-scale multicentre study comparing the clinical and patient-reported outcomes of oncoplastic breast conservation as an alternative to mastectomy with or without immediate breast reconstruction in women unsuitable for standard breast-conserving surgery (the ANTHEM Feasibility Study).

BMJ Open 2021 Apr 16;11(4):e046622. Epub 2021 Apr 16.

Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK.

Introduction: Approximately 40% of the 55 000 women diagnosed with breast cancer each year in the UK undergo mastectomy because they are considered unsuitable for standard breast-conserving surgery (BCS) due to tumour size or multiple tumour foci. Mastectomy can significantly impact women's quality of life, and only one in four women currently undergo immediate breast reconstruction (IBR).Level 2 oncoplastic breast-conserving surgery (OPBCS) combines removing the cancer with a range of plastic surgical volume replacement (eg, local perforator flaps) and volume displacement techniques (eg, therapeutic mammaplasty) that can extend the role of BCS and may allow some women not suitable for standard BCS to avoid mastectomy. Read More

View Article and Full-Text PDF

Quarter of a century of contact lens prescribing trends in the United Kingdom (1996 - 2020).

Cont Lens Anterior Eye 2021 Apr 13:101446. Epub 2021 Apr 13.

School of Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, Queensland, Australia. Electronic address:

Purpose: To document contact lens prescribing trends in the United Kingdom over the past quarter of a century.

Methods: An annual survey of contact lens prescribing was conducted each year from 1996 to 2020, inclusive, by asking a random selection of optometrists and contact lens opticians to provide information relating to 10 consecutive contact lens fits between January and March.

Results: Over the 25 year survey period, 2,671 practitioners returned survey forms, reporting a total of 25,575 contact lens fits. Read More

View Article and Full-Text PDF

Smoothing the transition of adolescents with CF from pediatric to adult care: Pre-transfer needs.

Arch Pediatr 2021 Apr 13. Epub 2021 Apr 13.

Filière muco CFTR 165, Hospices Civils de Lyon, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; Unité Transversale en Éducation Thérapeutique du Patient, University Grenoble-Alpes ThEMAS TIMC-IMAG (UMR CNRS 5525), Communaute d'Universités et Établissements Université Grenoble Alpes, 38400 Saint-Martin-d'Hères, France; CRCM pédiatrique UTEP, filière muco CFTR, Communaute d'Universités et Établissements Université Grenoble Alpes, CHU Grenoble Alpes UTEP BP 217, 38043 Grenoble, France.

Introduction: In France, the cystic fibrosis (CF) care pathway is performed in 45 CF centers, the life expectancy of patients has steadily increased, but to date there are no national recommendations for the transition from pediatric to adult care. The transition to an adult CF center still raises questions about the relevance of its organizational arrangements. The "SAFETIM need" study aimed to identify the organizational needs both of patients and of parents before the transfer to an adult CF center. Read More

View Article and Full-Text PDF

Advanced glycation end products measured by skin autofluorescence are associated with melancholic depressive symptoms - Findings from Helsinki Birth Cohort Study.

J Psychosom Res 2021 Apr 10:110488. Epub 2021 Apr 10.

Folkhälsan Research Center, Helsinki, Finland; Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Background: Millions of people live with depression and its burden of disease. Depression has an increased comorbidity and mortality that has remained unexplained. Studies have reported connections between advanced glycation end products (AGEs) and various disease processes, including mental health. Read More

View Article and Full-Text PDF

An Integrated eDiagnosis Approach (IeDA) versus standard IMCI for assessing and managing childhood illness in Burkina Faso: a stepped-wedge cluster randomised trial.

BMC Health Serv Res 2021 Apr 16;21(1):354. Epub 2021 Apr 16.

Centre for Maternal Adolescent Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.

Background: The Integrated eDiagnosis Approach (IeDA), centred on an electronic Clinical Decision Support System (eCDSS) developed in line with national Integrated Management of Childhood Illness (IMCI) guidelines, was implemented in primary health facilities of two regions of Burkina Faso. An evaluation was performed using a stepped-wedge cluster randomised design with the aim of determining whether the IeDA intervention increased Health Care Workers' (HCW) adherence to the IMCI guidelines.

Methods: Ten randomly selected facilities per district were visited at each step by two trained nurses: One observed under-five consultations and the second conducted a repeat consultation. Read More

View Article and Full-Text PDF

Birth companionship in a government health system: a pilot study in Kigoma, Tanzania.

BMC Pregnancy Childbirth 2021 Apr 16;21(1):304. Epub 2021 Apr 16.

U.S. Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, USA.

Background: Having a companion of choice throughout childbirth is an important component of good quality and respectful maternity care for women and has become standard in many countries. However, there are only a few examples of birth companionship being implemented in government health systems in low-income countries. To learn if birth companionship was feasible, acceptable and led to improved quality of care in these settings, we implemented a pilot project using 9 intervention and 6 comparison sites (all government health facilities) in a rural region of Tanzania. Read More

View Article and Full-Text PDF

Long non-coding RNA pairs to assist in diagnosing sepsis.

BMC Genomics 2021 Apr 16;22(1):275. Epub 2021 Apr 16.

Shenzhen People's Hospital, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medicine College of Jinan University, Shenzhen, 518020, China.

Background: Sepsis is the major cause of death in Intensive Care Unit (ICU) globally. Molecular detection enables rapid diagnosis that allows early intervention to minimize the death rate. Recent studies showed that long non-coding RNAs (lncRNAs) regulate proinflammatory genes and are related to the dysfunction of organs in sepsis. Read More

View Article and Full-Text PDF

[Heidelberg Milestones Communication (HeiMeKOM) - Experiences, Best Practice Examples and Recommendations from the Final Symposium on January 30 and 31 in 2020].

Gesundheitswesen 2021 Apr 16. Epub 2021 Apr 16.

Abteilung Internistische Onkologie, Thoraxklinik am Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Mitglied des Deutschen Zentrums für Lungenforschung (DZL), Heidelberg, Deutschland.

The National Cancer Plan emphasises the importance of medical communication and calls for its integration into medical education and training. In this context, the Milestone Communication Approach meets the communicative challenges in dealing with lung cancer patients. Interprofessional tandems, consisting of doctors and nurses, conduct structured conversations at defined moments with patients and their relatives. Read More

View Article and Full-Text PDF

Thalamic Deep Brain Stimulation for Spasmodic Dysphonia: A Phase I Prospective Randomized Double-Blind Crossover Trial.

Neurosurgery 2021 Apr 16. Epub 2021 Apr 16.

Division of Otolaryngology, University of British Columbia, Vancouver, Canada.

Background: Adductor spasmodic dysphonia (SD) is a dystonia of the vocal folds causing difficulty with speech. The current standard of care is repeated botulinum toxin injections to weaken the adductor muscles. We sought to ameliorate the underlying neurological cause of SD with a novel therapy-deep brain stimulation (DBS). Read More

View Article and Full-Text PDF

The Efficacy of Liposomal Bupivacaine for Opioid and Pain Reduction: A Systematic Review of Randomized Clinical Trials.

J Surg Res 2021 Apr 13;264:510-533. Epub 2021 Apr 13.

Harvard Medical School, General and Endocrine Surgery, Massachusetts General Hospital, Boston, MA.

Background The opioid crisis has prompted surgeons to search for alternative postoperative methods of analgesia. Liposomal bupivacaine is a long-acting local anesthetic formulation used for pain, potentially reducing opioid use. Evaluation of liposomal bupivacaine as a viable alternative for pain management is needed. Read More

View Article and Full-Text PDF

Use of urinary hippuric acid and o-/p-/m-methyl hippuric acid to evaluate surgical smoke exposure in operating room healthcare personnel.

Ecotoxicol Environ Saf 2021 Apr 13;217:112231. Epub 2021 Apr 13.

Department of Respiratory Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan; Department of Obstetrics and Gynaecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Center for Environmental Sustainability and Human Health, Ming Chi University of Technology, Taishan, New Taipei, Taiwan. Electronic address:

Toluene and xylene are common components of surgical smoke, whereas hippuric acid (HA) and methylhippuric acid (MHA) are the products of toluene and xylene metabolism in humans, respectively. HA and MHA can be used as indicators to evaluate the exposure hazards of toluene and xylene. In this study, we used liquid chromatography tandem mass spectrometry (LC-MS/MS) to simultaneously analyze the HA, o-/m-/p-MHA, and creatinine contents in the urine of healthcare personnel. Read More

View Article and Full-Text PDF

Observational study on effectiveness and safety of multiple regimens of Triclabendazole in Human Fascioliasis after failure to standard of care regimens.: Multiple regimens of Triclabendazole for Fasciola.

J Glob Antimicrob Resist 2021 Apr 13. Epub 2021 Apr 13.

Laboratorio de Parasitología, Instituto de Medicina Tropical Alexander von Humboldt,Universidad Peruana Cayetano Heredia, Lima, Perú; Departments of Medicine (Division of Infectious Diseases), Microbiology and Molecular Immunology, Stony Brook University, Stony Brook, NY, USA.

Introduction: Triclabendazole (TCBZ) is the recommended anthelmintic against Fasciola hepatica at a dose of 10mg/kg of body weight administered as a single or double dose. However, treatment failures of TCBZ to standard-of-care doses have been reported in humans. The aim of this study is to describe the effectiveness and tolerability of alternative TCBZ regimens in those patients who failed the standard of care regimen for fascioliasis in Peru. Read More

View Article and Full-Text PDF

Neoadjuvant and adjuvant systemic therapy for newly diagnosed stage II- IV epithelial ovary, fallopian tube, or primary peritoneal carcinoma: A systematic review.

Crit Rev Oncol Hematol 2021 Apr 13:103324. Epub 2021 Apr 13.

Department of Obstetrics and Gynecology, Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada.

Background: To systematically review neoadjuvant and adjuvant therapy options for women with newly diagnosed stage II-IV ovarian cancer.

Methods: Phase III trials were searched using MEDLINE, EMBASE, and Cochrane Library. Maintenance therapies were excluded. Read More

View Article and Full-Text PDF

Sphingolipidomics of serum in extremely preterm infants: Association between low sphingosine-1-phosphate levels and severe retinopathy of prematurity.

Biochim Biophys Acta Mol Cell Biol Lipids 2021 Apr 13:158939. Epub 2021 Apr 13.

Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Background: Extremely preterm infants are at risk of developing retinopathy of prematurity (ROP) that can cause impaired vision or blindness. Changes in blood lipids have been associated with ROP. This study aimed to monitor longitudinal changes in the serum sphingolipidome of extremely preterm infants and investigate the relationship to severe ROP development. Read More

View Article and Full-Text PDF