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Evidence generating medicine

Meredith Vanstone, Sandra Monteiro, Eamon Colvin, Geoff Norman, Jonathan Sherbino, Matthew Sibbald, Kelly Dore, Amanda Peters
Background Diagnostic intuition is a rapid, non-analytic, unconscious mode of reasoning. A small body of evidence points to the ubiquity of intuition, and its usefulness in generating diagnostic hypotheses and ascertaining severity of illness. Little is known about how experienced physicians understand this phenomenon, and how they work with it in clinical practice. Methods Descriptions of how experienced physicians perceive their use of diagnostic intuition in clinical practice were elicited through interviews conducted with 30 physicians in emergency, internal and family medicine...
March 16, 2019: Diagnosis
Sarah Logan, Thiago Arzua, Scott G Canfield, Emily R Seminary, Samantha L Sison, Allison D Ebert, Xiaowen Bai
Neurological disorders have emerged as a predominant healthcare concern in recent years due to their severe consequences on quality of life and prevalence throughout the world. Understanding the underlying mechanisms of these diseases and the interactions between different brain cell types is essential for the development of new therapeutics. Induced pluripotent stem cells (iPSCs) are invaluable tools for neurological disease modeling, as they have unlimited self-renewal and differentiation capacity. Mounting evidence shows: (i) various brain cells can be generated from iPSCs in two-dimensional (2D) monolayer cultures; and (ii) further advances in 3D culture systems have led to the differentiation of iPSCs into organoids with multiple brain cell types and specific brain regions...
March 14, 2019: Comprehensive Physiology
Gayathri Viswanathan, Vipin Mohan Dan, Neelima Radhakrishnan, Akhila Sasikumar Nair, Aroma Prasanna Rajendran Nair, Sabulal Baby
ETHNOPHARMACOLOGICAL RELEVANCE: Centella asiatica (CA) is a medicinal herb traditionally used as a brain tonic in Ayurvedic medicine. Various ethnomedical leads revealed the effective use of CA in the treatment of symptoms associated to oxidative stress and inflammation. AIM OF THE STUDY: The aim of this study was to evaluate the therapeutic ability of CA methanol extract (CAM) in protecting mouse brain and astrocytes from oxidative stress and inflammation induced by Paracetamol, and thus to substantiate the allied traditional/ethnomedical claims of CA...
March 11, 2019: Journal of Ethnopharmacology
A O'Connor, P Cantillon, M Parker, A McCurtin
OBJECTIVES: Physiotherapy lacks the significant body of evidence that underpins performance-based assessments in disciplines such as medicine and nursing. In particular, very few studies have examined stakeholder perspectives of the process. This study set out to explore the perceptions of clinicians who undertake student assessment in the workplace in order to inform further development of performance-based assessment in physiotherapy. DESIGN: A qualitative, descriptive design was employed where focus group interviews were utilised for data collection...
November 16, 2018: Physiotherapy
Bin Xu, John Chiwei Lan, Qingjiang Sun, Chungchuan Hsueh, Bor-Yann Chen
Background: Microbial fuel cells (MFCs) are effective biofuel devices that use indigenous microbes to directly convert chemical energy from organics oxidation into bioelectric energy. To maximize energy-converting efficiency for bioelectricity generation in MFCs, redox mediators (RMs) (e.g., extracts obtained from plant resource- Camellia green tea) have been explored for optimal stimulation upon electron transfer (ET) capabilities. Anthocyanins are natural antioxidants widely used in food science and medicinal industry...
2019: Biotechnology for Biofuels
Renato V Samala, Laura J Hoeksema, Colleen Y Colbert
BACKGROUND: With the rapid growth in the number of fellowship programs in Hospice and Palliative Medicine (HPM), many are in the process of developing ways to demonstrate that fellows are attaining educational milestones. Reflection and self-assessment are key components of 2 Accreditation Council for Graduate Medical Education (ACGME) competencies, practice-based learning and improvement, and systems-based practice, which have both been historically challenging to learn and assess. OBJECTIVE: This article describes results of a content analysis of narrative data collected from HPM fellows' self-assessments as they performed hospice home visits independently in a new clinical rotation...
March 13, 2019: American Journal of Hospice & Palliative Care
Flavio Finger, Sebastian Funk, Kate White, M Ruby Siddiqui, W John Edmunds, Adam J Kucharski
BACKGROUND: Between August and December 2017, more than 625,000 Rohingya from Myanmar fled into Bangladesh, settling in informal makeshift camps in Cox's Bazar district and joining 212,000 Rohingya already present. In early November, a diphtheria outbreak hit the camps, with 440 reported cases during the first month. A rise in cases during early December led to a collaboration between teams from Médecins sans Frontières-who were running a provisional diphtheria treatment centre-and the London School of Hygiene and Tropical Medicine with the goal to use transmission dynamic models to forecast the potential scale of the outbreak and the resulting resource needs...
March 12, 2019: BMC Medicine
Chunyuan Zhang, Xu Wu, Yanfang Xian, Lin Zhu, Ge Lin, Zhi-Xiu Lin
Isorhynchophylline (IRN) and rhynchophylline (RN), a pair of stereoisomers, are tetracyclic oxindole alkaloids isolated from Uncaria rhynchophylla , a commonly used Chinese medicinal herb. These two compounds have drawn extensive attention due to their potent neuroprotective effects with promising therapeutic potential for the treatment of Alzheimer's disease (AD). However, IRN and RN can interconvert into each other in vivo after oral administration. The present study aimed to elucidate the pharmacokinetic profiles and disposition kinetics of the administered and generated stereoisomers in the brain and cerebrospinal fluid (CSF) after oral administration of equal dose of IRN or RN to rats...
2019: Evidence-based Complementary and Alternative Medicine: ECAM
Hyun-Young Lee, Hae-June Lee, Gyoo-Cheon Kim, Jeong-Hae Choi, Jin-Woo Hong
Despite a long history, the clinical efficacy of cupping therapy is still under debate. This is likely due to the lack of direct evidence for the biological actions of cupping, since the short exposure of cells to vacuum condition rarely has affects cellular activity. In this study, the medicinal properties of a recent medical technology, non-thermal plasma, were added to classical cupping and designated as 'plasma cupping' (PC). In our results, the plasma-generating efficacy was increased under a cupping-like semi-vacuum condition (410 Torr) rather than normal atmospheric pressure (760 Torr)...
March 7, 2019: Scientific Reports
Tomoya Miyoshi, Ken Hiratsuka, Edgar Garcia Saiz, Ryuji Morizane
The kidney is one of the most complex organs composed of multiple cell types, functioning to maintain homeostasis via the filtering of metabolic wastes, balancing of blood electrolytes, and adjustment of blood pressure. Recent advances in 3D culture technologies in vitro enabled the generation of 'organoids' which mimic the structure and function of in vivo organs. Organoid technology has allowed for new insights into human organ development and human pathophysiology, with great potential for translational research...
March 6, 2019: Developmental Dynamics: An Official Publication of the American Association of Anatomists
Nikoletta K Pianou, Petros Z Stavrou, Evangelia Vlontzou, Phivi Rondogianni, Demetrios N Exarhos, Ioannis E Datseris
Prostate cancer (PCa) is the most common solid cancer affecting men worldwide. Serum prostate-specific antigen (PSA) is at present the most commonly used biomarker for PCa screening, as well as a reliable marker of disease recurrence after initial treatment. Bone metastases (BM) are present in advanced stages of the disease. Imaging of BM is important not only for localization and characterization, but also to evaluate their size and number, as well as to follow-up the disease during and after therapy. Bone metastases formation is triggered by cancer initiating cells in the bone marrow and is facilitated by the release of several growth factors...
March 5, 2019: Hellenic Journal of Nuclear Medicine
Kerttu Huttunen, Elsa Erixon, Ulrika Löfkvist, Elina Mäki-Torkko
BACKGROUND: Decision-making on treatment and (re)habilitation needs to be based on clinical expertise and scientific evidence. Research evidence for the impact of permanent unilateral hearing impairment (UHI) on children's development has been mixed and, in some of the reports, based on fairly small, heterogeneous samples. Additionally, treatment provided has been highly variable, ranging from no action taken or watchful waiting up to single-sided cochlear implantation. Published information about the effects of treatment has also been heterogeneous...
February 19, 2019: International Journal of Pediatric Otorhinolaryngology
Christophe Dadure, Nada Sabourdin, Francis Veyckemans, Florence Babre, Nathalie Bourdaud, Souhayl Dahmani, Mathilde De Queiroz, Jean-Michel Devys, Marie-Claude Dubois, Delphine Kern, Anne Laffargue, Marc Laffon, Corinne Lejus-Bourdeau, Karine Nouette-Gaulain, Gilles Orliaguet, Etienne Gayat, Lionel Velly, Nadège Salvi, Chrystelle Sola
OBJECTIVE: To provide French guidelines about "Airway management during paediatric anaesthesia". DESIGN: A consensus committee of 17 experts from the French Society of Anaesthesia and Intensive Care Medicine (Société Française d'Anesthésie-Réanimation, SFAR) and the Association of French speaking paediatric anaesthesiologists and intensivists (Association Des Anesthésistes Réanimateurs Pédiatriques d'Expression Francophone, ADARPEF) was convened...
February 23, 2019: Anaesthesia, Critical Care & Pain Medicine
Richard Komakech, Motlalepula Gilbert Matsabisa, Youngmin Kang
Wounds remain one of the major causes of death worldwide. Over the years medicinal plants and natural compounds have played an integral role in wound treatment. Aspilia africana (Pers.) C. D. Adams which is classified among substances with low toxicity has been used for generations in African traditional medicine to treat wounds, including stopping bleeding even from severed arteries. This review examined the potential of the extracts and phytochemicals from A. africana , a common herbaceous flowering plant which is native to Africa in wound healing...
2019: Evidence-based Complementary and Alternative Medicine: ECAM
Peter C Rockers, Richard O Laing, Paul G Ashigbie, Monica A Onyango, Carol K Mukiira, Veronika J Wirtz
BACKGROUND: Novartis Access is a Novartis programme that offers a portfolio of non-communicable disease medicines at a wholesale price of US$1 per treatment per month in low-income and middle-income countries. We evaluated the effect of Novartis Access in Kenya, the first country to receive the programme. METHODS: We did a cluster-randomised controlled trial in eight counties in Kenya. Counties (clusters) were randomly assigned to the intervention or the control group with a covariate-constrained randomisation procedure that maximised balance on a set of demographic and health variables...
February 21, 2019: Lancet Global Health
Nan Russell Yancey
Although nurses across generations have called for nursing practice to be informed by the best evidence available in the moment, evidence-based practice has gained prominence across healthcare since release of the 2001 Institute of Medicine's report Crossing the Quality Chasm. Recent nursing literature is replete with calls for evidence-based practice to be the foundation for nursing practice and incorporated in nursing education across levels. However, it is essential to clarify what is evidence-based practice in nursing in order to address concerns for what should be the evidence for nursing practice and teaching-learning in nursing...
January 2019: Nursing Science Quarterly
Saranya P Wyles, Richard E Hayden, Fredric B Meyer, Andre Terzic
Regenerative sciences are poised to transform clinical practice. The quest for regenerative solutions has, however, exposed a major gap in current healthcare education. A call for evidence-based adoption has underscored the necessity to establish rigorous regenerative medicine educational programs early in training. Here, we present a patient-centric regenerative medicine curriculum embedded into medical school core learning. Launched as a dedicated portal of new knowledge, learner proficiency was instilled by means of a discovery-translation-application blueprint...
2019: NPJ Regenerative Medicine
Gang Wang, Yu-Zhu Wang, Yang Yu, Jun-Jie Wang
ETHNOPHARMACOLOGICAL RELEVANCE: Studies have shown that the etiology and pathogenesis of colorectal cancer are closely related to the tumor microenvironment, and the cancer tissue is still in the state of "energy deficit" and has to promote energy generation through high glycolysis. Rhus chinensis Mill is a Chinese herbal medicine used to treat various types of solid tumors in China. Colorectal cancer (CRC) is a heterogeneous disease group caused by abnormal changes in glucose metabolism resulted in lactic acid production, which remodels acidosis...
February 14, 2019: Journal of Ethnopharmacology
Alberto J Espay, Joaquin A Vizcarra, Luca Marsili, Anthony E Lang, David K Simon, Aristide Merola, Keith A Josephs, Alfonso Fasano, Francesca Morgante, Rodolfo Savica, J Timothy Greenamyre, Franca Cambi, Tritia R Yamasaki, Caroline M Tanner, Ziv Gan-Or, Irene Litvan, Ignacio F Mata, Cyrus P Zabetian, Patrik Brundin, Hubert H Fernandez, David G Standaert, Marcelo A Kauffman, Michael A Schwarzschild, S Pablo Sardi, Todd Sherer, George Perry, James B Leverenz
The gold standard for a definitive diagnosis of Parkinson disease (PD) is the pathologic finding of aggregated α-synuclein into Lewy bodies and for Alzheimer disease (AD) aggregated amyloid into plaques and hyperphosphorylated tau into tangles. Implicit in this clinicopathologic-based nosology is the assumption that pathologic protein aggregation at autopsy reflects pathogenesis at disease onset. While these aggregates may in exceptional cases be on a causal pathway in humans (e.g., aggregated α-synuclein in SNCA gene multiplication or aggregated β-amyloid in APP mutations), their near universality at postmortem in sporadic PD and AD suggests they may alternatively represent common outcomes from upstream mechanisms or compensatory responses to cellular stress in order to delay cell death...
February 12, 2019: Neurology
Federico Pennestrì, Giuseppe Banfi
The global increase of health demands pushes administrators and policy makers to provide good quality health care at sustainable costs. Many approaches have been developed, among which value-based health care (VBHC) is one of the most promising: value is given by outcomes achieved per dollar spent. Best value is given by shared benefits between all the stakeholders involved in the process: patients, providers, suppliers, payers and citizens. However, VBHC implementation is a current challenge for hospitals and healthcare providers, that may find it difficult to adapt their organization into a patient-centered clinical pathway based on both classical outcomes and innovative patient-evaluation...
February 9, 2019: Clinical Chemistry and Laboratory Medicine: CCLM
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