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Clinical protocols

X Yang, Y X Chen, J W Zeng, M G He
Over the past decade, breakthrough has been made on myopia progression control with a lot of evidence from clinical trials, but the effective clinical application of many of them remained immature. Though refraction clinics have been set up in many specialized hospitals offering spectacles to correct refractive error, there was few protocol or standard of treatment for reducing myopia progression. This commentary reviews the latest and essential publications and presents critical advice on applying the research findings to clinical practice...
February 11, 2019: [Zhonghua Yan Ke za Zhi] Chinese Journal of Ophthalmology
Glenn Hernández, Gustavo A Ospina-Tascón, Lucas Petri Damiani, Elisa Estenssoro, Arnaldo Dubin, Javier Hurtado, Gilberto Friedman, Ricardo Castro, Leyla Alegría, Jean-Louis Teboul, Maurizio Cecconi, Giorgio Ferri, Manuel Jibaja, Ronald Pairumani, Paula Fernández, Diego Barahona, Vladimir Granda-Luna, Alexandre Biasi Cavalcanti, Jan Bakker
Importance: Abnormal peripheral perfusion after septic shock resuscitation has been associated with organ dysfunction and mortality. The potential role of the clinical assessment of peripheral perfusion as a target during resuscitation in early septic shock has not been established. Objective: To determine if a peripheral perfusion-targeted resuscitation during early septic shock in adults is more effective than a lactate level-targeted resuscitation for reducing mortality...
February 17, 2019: JAMA: the Journal of the American Medical Association
Adam Reuben, Andrew Appelboam, Andy Barton, Patricia Jane Vickery, Richard Body, Malcolm Hilton, Jason Coppell, Paul Ewings
INTRODUCTION: Patients presenting to emergency departments (EDs) with epistaxis uncontrolled by subsequent simple first aid measures or application of topical vasoconstrictors will typically undergo anterior nasal packing. Packing is effective, but can be extremely painful and unpleasant and patients usually need hospital admission. Tranexamic acid (TXA) is a cheap, safe, readily available antifibrinolytic agent known to be beneficial in a variety of clinical settings where uncontrolled bleeding may be a problem...
February 15, 2019: BMJ Open
David Wiljer, Rebecca Charow, Helen Costin, Lydia Sequeira, Melanie Anderson, Gillian Strudwick, Tim Tripp, Allison Crawford
INTRODUCTION: The notion of compassion and compassionate care is playing an increasingly important role in health professional education and in the delivery of high-quality healthcare. Digital contexts, however, are not considered in the conceptualisation of compassionate care, nor is there guidance on how compassionate care is to be exercised while using digital health technologies. The widespread diffusion of digital health technologies provides new contexts for compassionate care, with both opportunities for new forms and instantiations of compassion as well as new challenges...
February 15, 2019: BMJ Open
Oriana Ciani, Maria Cucciniello, Francesco Petracca, Giovanni Apolone, Giampaolo Merlini, Silvia Novello, Paolo Pedrazzoli, Nicoletta Zilembo, Chiara Broglia, Enrica Capelletto, Marina Garassino, Elena Nicod, Rosanna Tarricone
INTRODUCTION: Mobile health technologies may enhance patient empowerment and data integration along the whole care continuum. However, these interventions pose relatively new regulatory, organisational and technological challenges that limit appropriate evaluation. Lung Cancer App (LuCApp) is a mobile application developed by researchers and clinicians to promote real-time monitoring and management of patients' symptoms. This protocol illustrates a clinical trial designed to evaluate the usability, effectiveness and cost-effectiveness of LuCApp versus standard of care...
February 15, 2019: BMJ Open
Amber E Young, Anna Davies, Sophie Bland, Sara Brookes, Jane M Blazeby
INTRODUCTION: Systematic reviews collate trial data to provide evidence to support clinical decision-making. For effective synthesis, there must be consistency in outcome reporting. There is no agreed set of outcomes for reporting the effect of burn care interventions. Issues with outcome reporting have been identified, although not systematically investigated. This study gathers empirical evidence on any variation in outcome reporting and assesses the need for a core outcome set for burn care research...
February 15, 2019: BMJ Open
Per Andrén, Kristina Aspvall, Lorena Fernández de la Cruz, Paulina Wiktor, Sofia Romano, Erik Andersson, Tara Murphy, Kayoko Isomura, Eva Serlachius, David Mataix-Cols
OBJECTIVE: Behaviour therapy (BT) for Tourette's disorder (TD) and persistent (chronic) motor or vocal tic disorder (PTD) is rarely available. We evaluated the feasibility of adapting two existing BT protocols for TD/PTD (habit reversal training (HRT) and exposure and response prevention (ERP)) into a therapist-guided and parent-guided online self-help format. DESIGN: A pilot, single-blind, parallel group randomised controlled trial. SETTING: A specialist outpatient clinic in Sweden...
February 15, 2019: BMJ Open
Jessica Steffany Miranda, Luciana Patricia Fernandes Abbade, Arthur Pollo Deonizio, Joelcio Francisco Abbade, Lawrence Mbuagbaw, Lehana Thabane
Pressure ulcers (PUs) have a high incidence, especially in hospital units. Randomised clinical trials (RCTs) of therapeutic interventions for PU should include a clear description of the outcomes and results to enhance transparency and replicability. OBJECTIVES: The primary objective of this study is to assess the completeness of the descriptions of the outcomes of therapeutic interventions in RCTs in adult patients with PU. The secondary objectives are to evaluate the types of reported primary outcomes, measurement methods or tools used to evaluate the outcomes and the results of reported outcomes...
February 15, 2019: BMJ Open
Martin Geoffrey Thomas, Carrie Bayliss, Simon Bond, Francis Dowling, James Galea, Vipul Jairath, Christopher Lamb, Christopher Probert, Elizabeth Timperley-Preece, Alastair Watson, Lynne Whitehead, John G Williams, Miles Parkes, Arthur Kaser, Tim Raine
INTRODUCTION: Acute severe ulcerative colitis (ASUC) is a severe manifestation of ulcerative colitis (UC) that warrants hospitalisation. Despite significant advances in therapeutic options for UC and in the medical management of steroid-refractory ASUC, the initial treatment paradigm has not changed since 1955 and is based on the use of intravenous corticosteroids. This treatment is successful in approximately 50% of patients but failure of this and subsequent medical therapy still occurs, with colectomy rates of up to 40% reported...
February 15, 2019: BMJ Open
Bill Lukin, Jaimi Greenslade, Alison Mary Kearney, Carol Douglas, Tegwen Howell, Michael Barras, Phillip Good
CONTEXT: A rapid method of methadone conversion known as the Perth Protocol is commonly used in Australian palliative care units. There has been no follow-up or validation of this method and no comparison between different methods of conversion. OBJECTIVES: The primary objective of this study was to test the hypothesis that the achieved doses of methadone are independent of the conversion method (rapid vs slower). The secondary objectives included examining the relationship between calculated target doses, actual achieved doses and duration of conversions...
February 16, 2019: BMJ Supportive & Palliative Care
Elisa M T Melloni, Sara Poletti, Benedetta Vai, Irene Bollettini, Cristina Colombo, Francesco Benedetti
BACKGROUND: Cognitive deficits are a core feature of bipolar disorder (BD), and persist during the euthymic phase. White matter (WM) microstructural abnormalities are widely considered a structural marker of BD. Features of illness chronicity, such as illness duration and number of mood episodes, have been associated with worsening of both clinical profile and brain structural alterations. This study examined the role of WM integrity as a possible mediator between illness duration and cognitive performances in a sample of BD patients...
February 8, 2019: Journal of Affective Disorders
Alexandra Haase, Wolfgang Glienke, Lena Engels, Gudrun Göhring, Ruth Esser, Lubomir Arseniev, Ulrich Martin
The utilization of human induced pluripotent stem cells (hiPSCs) for disease modeling and drug discovery is already reality, and several first-in-man-applications as cellular therapeutics have been initiated. Implementation of good manufacturing practice (GMP)-compliant protocols for the generation of hiPSC lines is crucial to increase the application safety as well as to fulfil the legal requirements for clinical trials approval. Here we describe the development of a GMP-compatible protocol for the reprogramming of CD34+ hematopoietic stem cells from peripheral blood (CD34+ PBHSC) into hiPSCs using Sendai virus-based reprogramming vectors...
February 11, 2019: Stem Cell Research
Giselle S Mosnaim, Sally M Weinstein, Oksana Pugach, Genesis Rosales, Angkana Roy, Surrey Walton, Molly A Martin
OBJECTIVE: To describe the methodology of a randomized controlled trial comparing the efficacy of integrated asthma community health workers (CHW) and a certified asthma educator (AE-C) to improve asthma outcomes in low-income minority children in Chicago. METHODS: Child/caregiver dyads were randomized to CHW home visits or education in the clinic from an AE-C. Intervention was delivered in the first year after enrollment. Data collection occured at baseline, 6-, 12-, 18, and 24-months...
February 14, 2019: Contemporary Clinical Trials
Amardeep Ghosh Dastidar, Anna Baritussio, Estefania De Garate, Zsofia Drobni, Giovanni Biglino, Priyanka Singhal, Elena G Milano, Gianni D Angelini, Stephen Dorman, Julian Strange, Thomas Johnson, Chiara Bucciarelli-Ducci
OBJECTIVES: This study sought to assess the prognostic impact of cardiovascular magnetic resonance (CMR) and conventional risk factors in patients with myocardial infarction with nonobstructed coronaries (MINOCA). BACKGROUND: Myocardial infarction with nonobstructed coronary arteries (MINOCA) represents a diagnostic dilemma, and the prognostic markers have not been clarified. METHODS: A total of 388 consecutive patients with MINOCA undergoing cardiac magnetic resonance (CMR) assessment were identified retrospectively from a registry database and prospectively followed for a primary clinical endpoint of all-cause mortality...
February 11, 2019: JACC. Cardiovascular Imaging
R Isaacs, G Smith, L Gale-Andrews, M Wee, E van Teijlingen, D Bick, V Hundley
BACKGROUND: Paper-based charts remain the principal means of documenting the vital signs of hospitalised pregnant and postnatal women. However, poor chart design may contribute to both incorrect charting of data and clinical responses. We decided to identify design faults that might have an adverse clinical impact. METHODS: One hundred and twenty obstetric early warning charts and escalation protocols from consultant-led maternity units in the United Kingdom and the Channel Islands were analysed using an objective and systematic approach...
January 8, 2019: International Journal of Obstetric Anesthesia
Zhiqin Lin, Chengjun Wang, Zhenwen Gao, Xiangrong Li, Folin Lan, Tianqing Liu, Yongzhi Wang, Zhongli Jiang
OBJECTIVETrapped temporal horn (TTH) is a rare subtype of loculated hydrocephalus that is often managed surgically. The natural history of TTH is not well understood, and there are few data on the outcomes of conservative management of this condition. The aim of this study was to analyze the clinical features and outcomes of conservatively and surgically managed cases of TTH.METHODSThe authors retrospectively reviewed the clinical data for 19 consecutive cases of TTH that developed after microsurgical resection of lateral ventricular trigone meningioma between 2011 and 2015...
February 15, 2019: Journal of Neurosurgery
Jana Seuthe, Nicholas D'Cruz, Pieter Ginis, Burkhard Weisser, Daniela Berg, Günther Deuschl, Alice Nieuwboer, Christian Schlenstedt
BACKGROUND: Walking on a split-belt treadmill (SBT) can help to modulate an asymmetric gait, particularly for people with neurological conditions, such as Parkinson's disease (PD), where asymmetry plays a role due to the laterality of the disease. RESEARCH QUESTION: This systematic review critically evaluates the literature on SBT in PD. First, different SBT paradigms and methodological approaches were evaluated. Second, the review explored how people with PD adapt their gait to different SBT conditions compared to healthy controls (HC)...
February 7, 2019: Gait & Posture
Balasundari Ramesh, Kotturathu Mammen Cherian, Adegbenro Omotuyi John Fakoya
Poly-L-lactic acid (PLLA) is a biodegradable synthetic polyester synthesized by polymerization or polycondensation. PLLA hydrolytically degrades into lactic acid, a biocompatible metabolic by-product, making it suitable for clinical applications. PLLA scaffolds or nanofibers have been used in various regenerative medicine and drug delivery applications. These scaffolds impart biocompatible properties of high surface area, hydrophobicity, native extracellular properties, and mechanical strength for an organ system...
February 16, 2019: Methods in Molecular Biology
Deepak B Thimiri Govinda Raj, Niamat Ali Khan, Srisaran Venkatachalam, Dinh Toi Chu
Here, we elaborate our detailed protocol for synthesis, functionalization, and application of superparamagnetic nanoparticle (SPMNP) for plasma membrane and lysosome isolation. We used standard thermal decomposition-based synthesis of iron oxide (Fe3 O4 ) core SPMNP 1.0. Using ligand addition methodology, we surface functionalized SPMNP 1.0 with phospholipids and generated phospholipid-SPMNP 2.0. Further we used NH2 -phospholipid-SPMNP 2.0 to isolate plasma membrane. Using our SPMNP subcellular fractionation protocol, we are able to isolate high-pure-high-yield plasma membrane using NH2 -phospholipid-SPMNP 2...
February 16, 2019: Methods in Molecular Biology
Ian Joseph Cohen, Helen Toledano, Jerry Stein, Yehuda Kollender, Eyal Fenig, Osnat Konen, Zvi Bar-Sever, Josephine Issakov, Meora Feinmesser, Smadar Avigad, Shifra Ash
PURPOSE: We report the unexpected absence of early relapse (before 30 months) in 24 consecutive patients with isolated limb primary Ewing sarcoma treated with an intensified pilot protocol, SCMCIE94. METHODS: Clinical data for the study were collected retrospectively from the patient files. The protocol included 6 courses of chemotherapy, split radiation, and limb salvage surgery. This SCMCIE94 protocol had been used in almost all the patients described in an earlier report, in whom those with non-pelvic isolated tumors and low/absent CD56 expression in Ewing sarcoma tumor cells were all long-term survivors...
February 15, 2019: Cancer Chemotherapy and Pharmacology
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