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Zafrir, Barak, Amir Aker, and Walid Saliba. "Extreme lipoprotein(a) in clinical practice: A cross sectional study." International Journal of Cardiology Cardiovascular Risk and Prevention 16 (March 2023): 200173. http://dx.doi.org/10.1016/j.ijcrp.2023.200173.
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Wortzel, Hal S., Joseph A. Simonetti, Christopher E. Knoepke, Joseph R. Simpson, Leah Brar, Patricia Westmoreland, and Bridget B. Matarazzo. "Extreme Risk Protection Orders: Legislative Intent and Clinician Guidance." Journal of Psychiatric Practice 29, no. 6 (November 2023): 480–88. http://dx.doi.org/10.1097/pra.0000000000000749.
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In this second column of a 2-part series exploring extreme risk protections orders, we utilize recent events in Colorado, including legislative efforts to expand the list of eligible petitioners to include clinicians, as an opportunity to explore questions and challenges faced by mental health and medical professionals serving in this capacity. Clinicians are in need of more clear guidance, given an emerging role that comes without clear evidence or practice standards to inform individualized clinical decision-making, and which potentially pits public safety interests against patient care needs, especially those pertaining to therapeutic relationships. In the interim, clinicians will best serve their patients by continuing to practice in a fashion that is analogous to decision-making around other interventions with serious implications for patient autonomy such as involuntary hospitalization. Ongoing collaboration with legislators is needed to arrive at laws that are informed by the limitations inherent in clinical risk assessment and that can be translated into clinical practices that simultaneously support patient needs and community safety.
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Villarino, L., G. Alcaraz, M. De Miguel, A. Pelavski, A. Lacasta, and M. Roca. "Transfusional practice in the extreme old: peri-operative needs and clinical outcomes." European Journal of Anaesthesiology 31 (June 2014): 263. http://dx.doi.org/10.1097/00003643-201406001-00760.
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Seto, Tiffany, Navendu D. Samant, Nina Shah, Aida Shirazi, A. Dimitrios Colevas, and Jed Abraham Katzel. "Treatment patterns for patients with metastatic or recurrent head and neck cancer in a large integrated health-care system." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e18015-e18015. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e18015.
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e18015 Background: Since publication of the landmark KEYNOTE-048 Trial, pembrolizumab alone or with platinum-based chemotherapy and 5-fluorouracil (5FU) was established as a standard of care for the frontline treatment of patients with recurrent or metastatic head and neck squamous cell cancer (HNSCC), replacing the EXTREME regimen of Cetuximab with platinum and 5FU. In clinical practice, some clinicians modify the KEYNOTE-048 regimen by substituting a taxane for 5FU (i.e., Paclitaxel + Carboplatin + Pembrolizumab, PCT). Within the Kaiser Permanente Northern California (KPNCAL) network, we identified a cohort of 123 patients who received palliative first-line therapy for metastatic HNSCC to identify practice patterns in a real-world setting within a large health care delivery system. Methods: This is a data-only cohort study of all adult KPNCAL members diagnosed with metastatic HNSCC treated with palliative combination chemotherapy and/or immunotherapy between January 1, 2018 and July 31, 2020. Results: Among a cohort of 123 patients, 28 patients received the EXTREME regimen (platinum + 5FU + cetuximab), 10 received modified EXTREME (platinum + taxane + cetuximab), 14 received platinum + 5FU + pembrolizumab, 9 received platinum + taxane + pembrolizumab and 62 received single agent immunotherapy. From 2018 through mid-2020, there was an apparent shift away from cetuximab based regimens and a concurrent rise in immunotherapy-based regimens. By mid-2020, the majority of patients received an immunotherapy-based regimen (28 patients), while only 5 patients received a cetuximab based regimen (Table). Conclusions: Data from our cohort reported clinical practice patterns within a large multispecialty integrated health-care system in Northern California. Our findings highlight the marked variability in practice patterns within a single health care system for first-line metastatic therapy. While we identified trends away from cetuximab based therapy and toward immunotherapy-based therapy in clinical practice there remained wide practice variations among clinical oncologist treating patients with newly diagnosed metastatic HNSCC. This further emphasizes the need for prospective clinical trials to identify the optimal regimen or to confirm clinical equipoise between regimens among patients with metastatic or recurrent head and neck cancer. [Table: see text]
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Yalamati, P., B. J. Jones, and P. J. Twomey. "Appropriateness of the National Academy of Clinical Biochemistry recommendation of repeating HbA1c analysis for extreme results in clinical practice." Annals of Clinical Biochemistry 46, no. 2 (January 22, 2009): 165–66. http://dx.doi.org/10.1258/acb.2008.008153.
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Wenzel, T., H. Graf von Reventlow, and M. Kletecka-Pulker. "Challenges in the early assessment and protection of refugee survivors of torture and extreme violence." Nervenheilkunde 36, no. 08 (August 2017): 599–607. http://dx.doi.org/10.1055/s-0039-3401519.
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ZusammenfassungDie medizinische und psychiatrische Betreuung von Flüchtlingen ist zu einer globalen Herausforderung geworden. Spezielle Behandlung, Unterstützung und Schutz sind aufgrund der Gewalterfahrungen und den daraus resultierenden psychischen Folgen bei vielen Betroffenengruppen erforderlich. Folterüberlebende sind dabei aufgrund der oft schweren psychologischen Traumatisierung als besondere Gruppe zu berücksichtigen. Ihnen steht nach internationalen ethischen und Menschenrechtsstandards besonderer Schutz zu. Hierbei ist es nötig, Betroffene früh wäh-rend des Aufnahmeprozesses zu identifizieren, und diesen besonderen Schutz sowie weitere spezielle Hilfe zu gewähren. Dies erfordert einen interdisziplinären Ansatz unter Berücksichtigung besonderer rechtlicher und menschenrechtlicher Rahmenbedingungen. Bei der Begutachtung sind bezüglich Überlebenden von Folter besondere Aspekte zu berücksichtigen, die im „Istanbul Protokolls“ der Vereinten Nationen festgelegt sind.
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Matei, Valentin. "Ethical implications of placebo using in clinical practice." Romanian Journal of Psychiatry and Psychotherapy 19, no. 1 (March 31, 2017): 1–6. http://dx.doi.org/10.37897/rjpp.2017.1.1.
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Many authors consider that placebo history is in fact the history of medicine and this is probably true to a large extent. The placebo effect is still extremely used in clinical activity, between 41% and 99% of clinicians worldwide using this intervention. One definition of placebo is: “A medicine or procedure prescribed for the psychological benefit to the patient rather than for any physiological effect”. If we consider both placebo interventions and administration of placebo substances, it is impossible to separate patient-physician interaction (including the environment where the physician performs his/her activities or where the interaction takes place) from placebo effect. There are two extreme poles as regards placebo use in clinical practice: first pole – anything useful for patient's health is good, therefore, as long as we do good to the patient, we can use any placebo variant and, the second one – the patient must know everything about his/her treatment and placebo use is absolutely counter indicated/forbidden without patient's absolute/explicit agreement, but even in this case using placebo effect is rather non-ethic and useless. It is so difficult to separate the very complex interaction between physician-patient from placebo effect as currently defined. Therefore, we can simply renounce, up to the moment when we will have a complete and coherent definition of this effect, to use the concept of “placebo in clinic practice” because for the moment this concept doesn't bring much clarity to the field. It is the authors believe that pushing the principle of patient's autonomy into overdrive risks to pervert the fundamental aspect of medicine - trust and also to push this relationship into a kind of commercial relationship, it is true, one of a somehow special type.
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Dragic, Sasa, Danica Momcicevic, Biljana Zlojutro, Milka Jandric, Tijana Kovacevic, Vlado Djajic, Ognjen Gajic, and Pedja Kovacevic. "Successful Outcomes of Critically Ill Patients with Extreme Metabolic Acidosis Treated with Structured Approach: Case Series." Clinical Medicine Insights: Case Reports 14 (January 2021): 117954762110251. http://dx.doi.org/10.1177/11795476211025138.
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Introduction: Hydrogen ion concentration which is expressed as pH value is in human blood maintained in narrow physiological range (7.36-7.44 in arterial blood). This range is crucial for normal functioning of most biochemical reactions. Extreme acidosis with pH < 6.8 is incompatible with life, unless pathophysiologic process is rapidly reversed. Timely, standardized, and structured approach to assessment and management of extreme critical illness is essential to maximize the chances of patient’s survival. Cases: We present a series of 3 critically ill patients admitted to Medical intensive care unit (MICU) diagnosed with extreme metabolic acidosis (pH ⩽ 6.8). Each patient was treated using Checklist for Early Recognition and Treatment of Acute Illness and INjury (CERTAIN) which is a standard decision support tool in our MICU. Causes of extreme metabolic acidosis included hemorrhagic shock, sepsis, and acute renal failure and diabetic ketoacidosis. Rapid assessment, prompt resuscitation (IV fluids, vasopressors, mechanical ventilation, and renal replacement), and application of specific causal treatment led to positive outcomes in all 3 patients. Discussion: Medical physiology textbooks set the lower limit of pH value at which life is possible to 6.8. However, examples from clinical practice show that if adequate resuscitation measures are taken early in the acute phase of the disease, the biochemical cascade of reactions that are considered irreversible (at pH ⩽ 6.8) may be reversed after all. Conclusion: Critical care approach to extreme metabolic acidosis is a prime example of applied clinical physiology where basic science and clinical practice connect. With these case series we show that timely and structured approach to critical illness shifts the boundaries of reversibility for some of the most severe physiologic derangements.
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Gómez-Aparicio, Maria Antonia, Jeannette Valero, Begoña Caballero, Rafael García, Ovidio Hernando-Requejo, Ángel Montero, Alfonso Gómez-Iturriaga, et al. "Extreme Hypofractionation with SBRT in Localized Prostate Cancer." Current Oncology 28, no. 4 (August 3, 2021): 2933–49. http://dx.doi.org/10.3390/curroncol28040257.
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Prostate cancer is the most commonly diagnosed cancer among men around the world. Radiotherapy is a standard of care treatment option for men with localized prostate cancer. Over the years, radiation delivery modalities have contributed to increased precision of treatment, employing radiobiological insights to shorten the overall treatment time, improving the control of the disease without increasing toxicities. Stereotactic body radiation therapy (SBRT) represents an extreme form of hypofractionated radiotherapy in which treatment is usually delivered in 1–5 fractions. This review assesses the main efficacy and toxicity data of SBRT in non-metastatic prostate cancer and discusses the potential to implement this scheme in routine clinical practice.
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Williams, David J., Robert J. Thomas, Paul C. Hourd, Amit Chandra, Elizabeth Ratcliffe, Yang Liu, Erin A. Rayment, and J. Richard Archer. "Precision manufacturing for clinical-quality regenerative medicines." Philosophical Transactions of the Royal Society A: Mathematical, Physical and Engineering Sciences 370, no. 1973 (August 28, 2012): 3924–49. http://dx.doi.org/10.1098/rsta.2011.0049.
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Innovations in engineering applied to healthcare make a significant difference to people's lives. Market growth is guaranteed by demographics. Regulation and requirements for good manufacturing practice—extreme levels of repeatability and reliability—demand high-precision process and measurement solutions. Emerging technologies using living biological materials add complexity. This paper presents some results of work demonstrating the precision automated manufacture of living materials, particularly the expansion of populations of human stem cells for therapeutic use as regenerative medicines. The paper also describes quality engineering techniques for precision process design and improvement, and identifies the requirements for manufacturing technology and measurement systems evolution for such therapies.
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Venkataramu, Vyjayanthi N., and Debanjan Banerjee. "Gender Dysphoria in Psychiatric Practice: Understanding the Clinical Ambiguity and Management." Journal of Psychosexual Health 3, no. 2 (April 2021): 124–32. http://dx.doi.org/10.1177/26318318211017049.
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There have been several myths and misconceptions about the dichotomous understanding of sex and gender. While sex is biologically determined, gender and gender identity depend on childhood experiences, upbringing, social expectations, beliefs, family environment, and peer interactions and is socially constructed. Gender dysphoria (GD) is the extreme distress experienced by an individual because of a mismatch between their gender identity and the sex assigned at birth. GD has been an ambiguous category in psychiatry, initially termed as “gender identity disorder” till Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ( DSM-5) considered removal of the term “disorder” to reduce the stigma associated. The critical element in GD is “clinically significant distress” that differentiates it from gender nonconformity. Individuals with GD identify themselves as transgender and frequently are victims of coercive social norms, discrimination, and stigma. This leads to delay in expression of distress, psychiatric mismanagement, and high comorbidity of depression, anxiety, post-traumatic stress, self-harm, and suicidality. Though management involves a holistic multidisciplinary approach including psychotherapy, social support, and gender-reassignment treatments (medical/surgical), there has been considerable debate and ambiguity related to the same. With this background, the article critics the understanding of GD, focuses on the WPATH SOC-7 treatment guidelines, and highlights the role of mental health professionals for better care.
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Schroeteler, F. "Physiotherapeutische Interventionen bei Parkinson." Nervenheilkunde 27, no. 12 (2008): 1083–89. http://dx.doi.org/10.1055/s-0038-1627346.
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ZusammenfassungPhysiotherapie steigert die motorische Leistungsfähigkeit bei Parkinson bezüglich Gangparameter, Haltung und Gleichgewicht. Eine Reduktion von Stürzen durch physiotherapeutisches Training bei Parkinsonsyndromen kann bislang weder eindeutig wider- noch belegt werden. Physiotherapie reduziert signifikant eine Vielzahl der motorischen Defizite, die zu Stürzen führen. Studien zur Effektivität von physiotherapeutischen Therapieansätzen liegen nur für das idiopathische Parkinsonsyndrom vor, klinische Erfahrungen zeigen, dass auch die übrigen Parkinsonsyndrome davon profitieren. Extreme Rumpffehlstellungen bei Parkinson wie Kamptokormie oder Anterocollis erhöhen die Sturzgefahr zusätzlich zur Grunderkrankung. Diese markanten Störungen können empirisch durch physiotherapeutische Interventionen positiv beeinflusst werden: Muskuläres Krafttraining der betroffenen Muskulatur, Steigerung der Gleichgewichtsleistungen und vor allem der Einsatz geeigneter mobiler Hilfsmittel sind entscheidend.
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Martinek, Radek, Martina Ladrova, Michaela Sidikova, Rene Jaros, Khosrow Behbehani, Radana Kahankova, and Aleksandra Kawala-Sterniuk. "Advanced Bioelectrical Signal Processing Methods: Past, Present and Future Approach—Part I: Cardiac Signals." Sensors 21, no. 15 (July 30, 2021): 5186. http://dx.doi.org/10.3390/s21155186.
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Advanced signal processing methods are one of the fastest developing scientific and technical areas of biomedical engineering with increasing usage in current clinical practice. This paper presents an extensive literature review of the methods for the digital signal processing of cardiac bioelectrical signals that are commonly applied in today’s clinical practice. This work covers the definition of bioelectrical signals. It also covers to the extreme extent of classical and advanced approaches to the alleviation of noise contamination such as digital adaptive and non-adaptive filtering, signal decomposition methods based on blind source separation and wavelet transform.
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Bulatowa, M. "Organic personality disorder in forensic psychiatric juvenile practice." European Psychiatry 26, S2 (March 2011): 767. http://dx.doi.org/10.1016/s0924-9338(11)72472-5.
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TopicalityDiagnostic category “ganic Personality Disorder”OPD) is widely used in forensic psychiatric practice for juveniles. Clinical pattern of psychopathological disturbances, masked in the OPD structure, is polymorphous; its shaping is influenced by polyetiological factors, organism compensatory facilities, pathoplastic mechanism of pubertal period.ObjectiveTo single out structural syndromic, etiological pathogenetic and clinical dynamic components of a juvenile OPD.MethodsClinical psychopathological with psychological, neurological and paraclinical data; clinical statistic.Object80 male juvenile delinquents diagnosed OPD (in accordance with ICD-10: F07.00; F07.08; F07.09). Among law infringements prevailed personal crimes notable for extreme gravity.ResultsWhile correlating clinical manifestations and statistical data processing, there were singled out 3 groups designated as Organic Disorders Models.Model 1 - cerebral asthenic syndrome with vegetative dysfunction;Model 2 - syndrome of organic cognitive and organic emotional volitional immaturity; Model 3 - encephalopathical (oligophrenia-like) syndrome.Etiological factors analysis proved exogenous influence prevalence in Model 3 juveniles.Clinical dynamics study demonstrated: most patients suffered from mental manifestations of organic disorder in the way of volitional regulation derangement and cognitive dysfunctions during preschool period.The above-mentioned diagnostic models are taken into account by experts during conducting forensic psychiatric evaluations.ConclusionsThe results may be used in forensic psychiatric practice to work out criteria of OPD expert evaluation, and in general psychiatry under the framework of early prevention of criminal activity. Timely adjustment of early manifestations of behavioural and cognitive disorders contributes to full compensation of organic disorder and mental disturbances arresting.
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Ramirez, F. Daniel, Benjamin Hibbert, Trevor Simard, Ronnen Maze, Ali Pourdjabbar, Aun-Yeong Chong, Michel Le May, et al. "Clinical outcomes among patients with extreme obesity undergoing elective coronary revascularization: Evaluation of major complications in contemporary practice." International Journal of Cardiology 186 (May 2015): 266–72. http://dx.doi.org/10.1016/j.ijcard.2015.03.247.
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Horváth, Boldizsar, Judit Skrapits, and József Bódis. "Obstetrical Management of an Extremely Overweight Pregnant Woman (184 kg bw) with Special Attention on Thromboprophylaxis." Case Reports in Obstetrics and Gynecology 2013 (2013): 1–4. http://dx.doi.org/10.1155/2013/689549.
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The 27-year-old pregnant woman has been overweight since her childhood. Endocrinological assessments did not confirm hormonal disease. Her pregnancy was without complication. A signs of intrauterine distress were observed and elective caesarean section was performed under heparin protection because of anatomy unsuitable for delivery per vias naturals. The mother’s bodyweight was 184 kg. By monitoring the change in fX activity LMWH treatment (Enoxaparin) initiated with a dose of 120 mg twice daily and then the dose was gradually elevated to 200 mg twice daily thereby achieving the lower range of the desired therapeutic effect. Apart from mild disorder of wound healing, the recovery was free of complication. The patient suffered from thrombophilia (extremely overweight, pregnant, thrombophlebitis under the knee, surgery, and postoperative immobilization). In case of quite extreme bodyweight there is no dosage recommendation or clinical practice for LMWH. Because of the extreme overweight and the therapeutic dose titration test of heparin, monitoring of fX activity by measurement of inhibition, dosage of heparin other than the recommended (abdominal wall instead of upper arm SC), and the very fluctuating heparin dosage which is well correlating with clinical practice, it is reasonably expected that this case will take interest.
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TEREGULOV, A. YU, A. A. KIRSHIN, A. R. KIRSHINA, M. R. VALEEV, and E. T. TEREGULOVA. "Clinical case of successful endovascular treatment of the false aneurysm of truncus coeliacus with the formation of an arteriovenous fistula after pancreatoduodenal resection." Practical medicine 21, no. 3(Application) (2023): 67–70. http://dx.doi.org/10.32000/2072-1757-2023-3-67-70.
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False postoperative visceral aneurysms are extremely rare in the clinical practice. Often false aneurysms are a diagnostic finding, and after discharge from the hospital, the patient is exposed to an extreme risk of rupture and death. We present our own observation of successful verification and endovascular correction of pseudoaneurysm of truncus coeliacus after surgical treatment of cancer of the distal part of the common bile duct.
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Pires, Rute, Ana Sousa Ferreira, Marco Paulino, João Gama Marques, Joana Henriques-Calado, and Bruno Gonçalves. "The Self-Administered Version of the Structured Interview for Disorders of Extreme Stress (SIDES-SR) in a Clinical and Non-Clinical Portuguese Sample." Behavioral Sciences 12, no. 12 (November 22, 2022): 468. http://dx.doi.org/10.3390/bs12120468.
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Disorders of Extreme Stress Not Otherwise Specified (DESNOS) refers to a constellation of symptoms deriving from chronic interpersonal trauma, inflicted by caregivers or in the context of intimate relationships. The Structured Interview for Disorders of Extreme Stress—Self-Report (SIDES-SR) was designed for the assessment of DESNOS. This study aimed to validate the Portuguese version of the SIDES-SR in the community (N = 814; Mage = 40.09, SD = 14.25, 39.2% male, 60.8% female) and clinical (N = 310; Mage = 42.49, SD = 12.47, 57.7% male, 42.3% female) samples. It had three objectives: (1) to validate the SIDES-SR rationally derived domains in the community sample; (2) to characterise the reliability of the SIDES-SR scales in both samples; and (3) to explore mean differences in the SIDES-SR results in both samples. The Portuguese SIDES-SR confirmed the six clinical domains of DESNOS and demonstrated acceptable internal consistency levels, similar to those obtained in prior research. Highly significant differences and large and very large effect sizes between the community and clinical samples were found for all the SIDES-SR domains. DESNOS symptomatology was shown to be more frequent in females and the clinical sample reported a higher frequency of traumatic events in life, specifically interpersonal trauma. The results support the relevance of the SIDES-SR for clinical practice in the assessment of the DESNOS diagnosis.
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Barker, Colin M. "Clinical Practice Update: Who Should Be Referred for Transcatheter Aortic Valve Replacement in 2017?" US Cardiology Review 11, no. 2 (2017): 67. http://dx.doi.org/10.15420/usc.2017:22:1.
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Transcatheter aortic valve replacement (TAVR) was initially envisioned as a less invasive option for patients with severe symptomatic aortic stenosis (AS) either not candidates or very high-risk candidates for surgical aortic valve replacement (SAVR). Based on data from the original Placement of Aortic Transcatheter Valves (PARTNER) trial and CoreValve® US Pivotal trials, TAVR is now approved and accepted in the treatment for severe symptomatic AS in extreme-, high-, and intermediate-risk patients. Thus far, the randomized controlled trial data for TAVR have been non-inferior or even superior to both medical therapy and SAVR. Given all the data, the logical next step is to study low-risk patient groups. Anecdotal and non-randomized data have been conflicting when comparing TAVR with SAVR in low-risk patients. Two low-risk randomized trials have started in the US, and ultimately, these trials will determine the feasibility of TAVR as an acceptable alternative to SAVR in low-risk patients with severe AS. Thus, in 2017, any patient with AS should be referred to a multidisciplinary valve team to be evaluated for TAVR, SAVR, or nothing, depending on risk and availability of ongoing clinical trials.
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Amsel, Tuvya T., and Avital Ginton. "Evidence Based Practice Integration into Polygraph Practice: A suggested paradigm." European Polygraph 15, no. 1 (April 1, 2021): 9–28. http://dx.doi.org/10.2478/ep-2021-0001.
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Abstract The philosophy of evidence-based practice advocates professionals to rely on scientific evidence. Although the idea seems obvious, misuse of the philosophy raised controversy, which created confusion and misunderstanding of the concept. Yet, since it was introduced in the nineties to the medical community and despite the controversy, it gained more and more disciples and was embraced by nonmedical practitioners, including the polygraph profession. In the last decades, the polygraph community has gradually abandoned the intuitive-based polygraph practice that relies on less scientifically rooted subjective procedures and advanced toward evidence-based polygraph practice. This paper describes the evidence-based practice in general and details the practical aspects of evidence-based polygraph practice in particular, along with discussing the limitations of the current scientific research. It questions the current bone-tone trend to implement an extreme Evidence-Based approach into the polygraph practice, suggesting the practitioner to avoid a rigid “one size fit all” standardized protocols which are advocated as a must on the way to earn scientific recognition, whereas, in fact, it is the unfortunate outcome of lack of differential research data. As in the medical field, in-where the Evidence-Based practice managed to incorporate the clinical experience of experts with the hard research evidence and has not disregarded their valuable knowledge and experience, the present article calls for adopting this integrative approach in the polygraph field too and adjust the protocols to the specific circumstances of the case and the examinee in a “tailor-made” mode, which is based on existing data and flexible thinking wherever there is no data to rely on, as was suggested under the concept of “Adaptive-Polygraphy” (Ginton, 2013).
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Erstad, Brian L., and David E. Nix. "Assessment of Kidney Function in Patients With Extreme Obesity: A Narrative Review." Annals of Pharmacotherapy 55, no. 1 (June 21, 2020): 80–88. http://dx.doi.org/10.1177/1060028020935580.
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Objectives: To discuss the evidence and caveats associated with estimated and measured creatinine clearance (eClCr and mClCr) and glomerular filtration rate (eGFR and mGFR) assessments of kidney function in patients with more extreme forms of obesity. Data Sources: PubMed (1976 to mid-May 2020) was used, with bibliographies of retrieved articles searched for additional articles. Study Selection and Data Extraction: Articles using gold standard mGFR to evaluate eClCr, mClCr, and eGFR assessments of kidney function in patients with more extreme forms of obesity were included. Data Synthesis: The overestimation of GFR by mClCr is well established, but mClCr is an alternative to mGFR assessments for determining medication dosing in patients with extremes of body size or muscle mass, or in patients receiving narrow therapeutic index medications when eGFR is likely to be inaccurate. The vast majority of studies comparing eGFR assessments with gold standard indicators of kidney function were attempts to validate eGFR equations for diagnosing and staging chronic kidney disease (CKD). Relevance to Patient Care and Clinical Practice: For dosing medications in patients with stable kidney function and extreme obesity, a deindexed 4-variable Modification of Diet in Renal Disease or CKD Epidemiology Collaboration equation is an alternative to Cockcroft-Gault. Consistent use of the same equation by provider and between providers within any given setting is of paramount importance. Conclusions: In patients with extreme obesity and stable kidney function, eClCr or eGFR using deindexed values provides estimates of function for dosing adjustments of medications with elimination by the kidneys, but more research is needed with respect to the best size descriptor to use with estimating equations.
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Breggin, Peter R. "Extreme Psychospiritual States Versus Organic Brain Disease: Bringing Together Science and the Human Factor." Journal of Humanistic Psychology 59, no. 5 (April 9, 2018): 686–96. http://dx.doi.org/10.1177/0022167818761975.
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Extreme states can be psychospiritual and “functional” in origin or they can be “organic” and driven by biological dysfunction. Contemporary psychiatry largely rejects this distinction, preferring to insist that everything “extreme” is biological in origin; but the distinction is important for understanding and helping people. Psychospiritual crises, including those labeled bipolar or schizophrenic, are “functional” and express meaning. As “bizarre” as the language or the symbols may seem, meanings that often reflect childhood abuse can be explored in a trusting, kind, and caring therapeutic relationship. The more that a real biological or organic dysfunction, such as traumatic head injury or neurotoxic exposure, is the root cause of the extreme state, the less sense its manifestations will make. Nonetheless, drug-induced extreme states, even when caused by hallucinogens or by psychiatric “medicines,” often leave sufficient brain function operational to reveal important meanings about the person’s experience, along with the otherwise senseless intoxication. With so many people prescribed psychiatric drugs, these neurotoxic chemicals are now the most common cause of extreme states in clinical practice, and withdrawal from these offending agents is critical to recovery (Breggin, 2013). However, even when the extreme state is driven by neurological dysfunction, a safe space and skilled therapists can help relieve the individual’s otherwise overwhelming feelings of anxiety or terror.
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Korneva, Viktoria A., Tatiana Y. Kuznetsova, Inga S. Scopets, and Natalia N. Vezikova. "Efficacy and safety of the use of alirocumab in real clinical practice." Terapevticheskii arkhiv 94, no. 12 (January 16, 2023): 1401–6. http://dx.doi.org/10.26442/00403660.2022.12.201991.
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Aim. To evaluate the results of two-year use of alirokumab in Karelia Republic.
Materials and methods. The observation group consisted of 27 patients (17 patients with familial hypercholesterolemia, 10 patients with the history of myocardial infarction), mean age 53.44.3 years, 70.3% men, follow-up duration from one year to 2.5 years, 18 (66.6%) patients received therapy for more than 2 years. 19 patients received alirocumab at a dose of 75 mg/ml once every 2 weeks, eight at a dose of 150 mg/ml once every 2 weeks. Before the start of therapy, the majority received maximally tolerated statin therapy, 10 patients received statin therapy in combination with ezetemibe, 3 patients received ezetemibe monotherapy due to statin intolerance. The target levels of LDL cholesterol were considered for very high risk patients less than 1.4 mmol/L, high risk less than 1.8 mmol/L, extreme risk less than 1 mmol/L.
Results. The reduction of LDL on therapy with alirocumab was 58%; target levels of LDL were achieved in 77.8%. The level of decrease in LDL cholesterol less than 50% was noted only in 7.4% of cases. Patients requiring a large dose of the drug were classified as very high risk, had higher cholesterol and LDL-C levels. The level of Lp(a) decrease on 29.7% by 612 months. No destabilization of coronary heart disease, new cases of stroke were registered.
Conclusion. The inclusion of alirocumab in the treatment regimen contributed to the stable course of atherosclerosis-associated diseases, the achievement of LDL cholesterol targets in 77.8% of patients, was not accompanied by side effects during 2.5 years therapy.
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Fegert, J. M. "Ethische und rechtliche Probleme bei Behandlungen schizophrener Patienten mit Neuroleptika im Kindes- und Jugendalter." Nervenheilkunde 22, no. 02 (2003): 75–79. http://dx.doi.org/10.1055/s-0038-1624379.
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ZusammenfassungBeauchamp und Childress formulierten 4 medizinethische Grundprinzipien: das Gebot der Nichtschädigung, der Besserung und Fürsorge, der Gerechtigkeit und der Autonomie. Ausgehend von diesen Grundprinzipien und vor dem Hintergrund der erheblichen Differenzen in Bezug auf gesicherte Erkenntnisse über Behandlungserfolge medikamentöser Interventionen bei schizophrenen Psychosen im Jugendalter verglichen zum Erwachsenenalter wird die Problematik der Heilversuche kritisch diskutiert. Die so genannte »Off-label-Verschreibung«, d. h. die Verschreibung von Substanzen, die in dieser Indikation z. B. für eine bestimmte Altersgruppe in Deutschland nicht zugelassen sind, wird dargestellt. Auch diskutiert der Beitrag rechtlich bedeutsame Fragestellungen, insbesondere im Zusammenhang mit der Aufklärung. Derzeit ist in Europa bei der Behandlung von schizophrenen Psychosen im Kindes- und Jugendalter die paradoxe Situation entstanden, dass der Heilversuch nicht die extreme Ausnahme, sondern der Regelfall in der Krankenbehandlung dieser Patienten ist. Mögliche Maßnahmen zur Verbesserung der Strukturqualität, der Behandlungsprozesse und der Dokumentation der Ergebnisse werden ebenso diskutiert wie eventuell notwendige Veränderungen von Seiten des Gesetzgebers.
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Salinda, Ma Theresa, Jocelyn Baluyot Hipona, Marivic Ilarde, and Alicia Tuazon. "A Concept Analysis on Culturally Congruent Care." Journal Of Nursing Practice 4, no. 2 (April 1, 2021): 167–76. http://dx.doi.org/10.30994/jnp.v4i2.132.
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Background: Culturally Congruent is providing quality care that promote cultural competency. This include extreme humility and extreme openness and acceptance of different culture in beliefs, values, and discipline.Purpose: This study aims to provide quality patient care despite the challenges in the healthcare plans like misinformation, mistrust and misinterpretation. The nurse should provide quality health care that suit to patient culture.Methods: The method use is a case analysis. The eight steps of this method are: 1) Selecting a concept; 2) Determining the aims or purposes of analysis; 3) Identifying all uses of the concept; 4) Determining the defining attributes of the concept; 5) Constructing a model case; 6) Constructing borderline, contrary, invented, and illegitimate cases; 7) Identifying antecedents and consequences; and 8) Defining empirical references.Results: The theory of culture care emphasizes in the uniqueness of nursing as a means to know and help the culture in the field of clinical practice. Culturally based care factors are recognized as major influence upon human expressions related to health and illness. The theory also serves as guide to nurses’ thinking, practice and in research development.Conclusion: Integrating cultural competence models will promote effectiveness in nursing practice.
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Al-Azizi, Karim, Mohanad Hamandi, and Michael Mack. "Clinical trials of transcatheter aortic valve replacement." Heart 105, Suppl 2 (March 2019): s6—s9. http://dx.doi.org/10.1136/heartjnl-2018-313511.
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Transcatheter aortic valve replacement(TAVR) has emerged as an effective treatment option in patients with severe aortic stenosis, in large part due to a robust evidence base generated by a series of randomised controlled trials (RCTs). During the past decade more than 15 000 patients have been randomised worldwide in nine clinical trials, mostly for regulatory approval in the USA, making it one of the most carefully scrutinised medical devices at the time of introduction into clinical practice. Initial trials were performed in inoperable or extreme risk patients compared to medical therapy and demonstrated superiority. Subsequent RCTs compared TAVR to surgical aortic valve replacement in high and intermediate surgical risk patients and TAVR was found to be non-inferior in all studies. RCTs of low surgical risk patients have completed enrolment and 1 year outcomes will be available in early 2019. The details of the trials, trial results, outcomes and remaining clinical questions are summarised in this article.
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Accordino, Melissa K., Jason D. Wright, Sowmya Vasan, Alfred I. Neugut, Grace C. Hillyer, Jim C. Hu, and Dawn L. Hershman. "Use and Costs of Disease Monitoring in Women With Metastatic Breast Cancer." Journal of Clinical Oncology 34, no. 24 (August 20, 2016): 2820–26. http://dx.doi.org/10.1200/jco.2016.66.6313.
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Purpose The optimal frequency of monitoring patients with metastatic breast cancer (MBC) is unknown; however, data suggest that intensive monitoring does not improve outcomes. We performed a population-based analysis to evaluate patterns and predictors of extreme use of disease-monitoring tests (serum tumor markers [STMs] and radiographic imaging) among women with MBC. Methods The SEER-Medicare database was used to identify women with MBC diagnosed from 2002 to 2011 who underwent disease monitoring. Billing dates of STMs (carcinoembryonic antigen and/or cancer antigen 15-3/cancer antigen 27.29) and imaging tests (computed tomography and/or positron emission tomography) were recorded; if more than one STM or imaging test were completed on the same day, they were counted once. We defined extreme use as > 12 STM and/or more than four radiographic imaging tests in a 12-month period. Multivariable analysis was used to identify factors associated with extreme use. In extreme users, total health care costs and end-of-life health care utilization were compared with the rest of the study population. Results We identified 2,460 eligible patients. Of these, 924 (37.6%) were extreme users of disease-monitoring tests. Factors significantly associated with extreme use were hormone receptor–negative MBC (odds ratio [OR], 1.63; 95% CI, 1.27 to 2.08), history of a positron emission tomography scan (OR, 2.92; 95% CI, 2.40 to 3.55), and more frequent oncology office visits (OR, 3.14; 95% CI, 2.49 to 3.96). Medical costs per year were 59.2% higher in extreme users. Extreme users were more likely to use emergency department and hospice services at the end of life. Conclusion Despite an unknown clinical benefit, approximately one third of elderly women with MBC were extreme users of disease-monitoring tests. Higher use of disease-monitoring tests was associated with higher total health care costs. Efforts to understand the optimal frequency of monitoring are needed to inform clinical practice.
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Zhuravleva, M. V., B. A. Rodionov, M. A. Lysenko, S. V. Yakovlev, S. S. Andreev, N. N. Ilyukhina, and A. B. Prokofiev. "Study of Cases of Bacteremia with Gram-Negative Pathogens with Multiple and Extreme Antibiotic Resistance in Real Clinical Practice." Antibiotics and Chemotherapy 66, no. 3-4 (June 25, 2021): 27–34. http://dx.doi.org/10.37489/0235-2990-2021-66-3-4-27-34.
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Aim: To study cases of bacteremia caused by multidrug-resistant (MDR) and extremely-resistant (XDR) gram-negative bacteria in the departments of a multidisciplinary hospital.Material and Methods. Since 2017, a retrospective epidemiological study has been conducted to investigate cases of infections with bacteremia caused using gram-negative bacteria with multiple or extreme antibiotic resistance. The pathogens were identified using the MALDI-TOF MS method, the sensitivity to antibacterial drugs was determined using the automatic Phoenix system, the beta-lactamase genes were detected using real-time PCR on a GeneXpert analyzer.Results. In 2017, bacteremia caused by MDR and XDR pathogens was detected in 42 and 76 patients, in 2018 — in 57 and 81 patients, in 2019 — in 65 and 111 patients, respectively. During three years of observation, the most frequent XDR microorganisms were, in descending order, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa. In 2019, among 11 K.pneumoniae strains, class D carbapenemase (OXA-48) was detected in 5 cases (45.5%), 3 strains produced NDM metallo-carbapenemase, and 3 strains had a combination of NDM and OXA-48 enzymes. Infections caused by MDR and XDR pathogens were characterized by high mortality. Thus, the relative risk of death in patients with XDR infection was 1.33 times higher than in patients from the MDR group (95% CI 1.04-1.69, P<0.05) in 2019. The duration of hospital stay also increased: in the XDR group — up to 29.5 days, in the MDR group – up to 16.4 days, with an average length of hospitalization of 6.0 bed-days in 2019.Conclusions. K.pneumoniae and A.baumannii with extreme antibiotic resistance are the main causative agents of severe late nosocomial infections in immunosuppressed patients. Nosocomial infections with bacteremia caused by gram-negative bacteria with the XDR phenotype and resistant to carbapenems are characterized by a high mortality rate (from 72 to 80%), and increase the duration of hospitalization by more than 4 times.
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Ajmera, Ishan, T. Charlie Hodgman, and Chungui Lu. "An Integrative Systems Perspective on Plant Phosphate Research." Genes 10, no. 2 (February 13, 2019): 139. http://dx.doi.org/10.3390/genes10020139.
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The case for improving crop phosphorus-use-efficiency is widely recognized. Although much is known about the molecular and regulatory mechanisms, improvements have been hampered by the extreme complexity of phosphorus (P) dynamics, which involves soil chemistry; plant-soil interactions; uptake, transport, utilization and remobilization within plants; and agricultural practices. The urgency and direction of phosphate research is also dependent upon the finite sources of P, availability of stocks to farmers and reducing environmental hazards. This work introduces integrative systems approaches as a way to represent and understand this complexity, so that meaningful links can be established between genotype, environment, crop traits and yield. It aims to provide a large set of pointers to potential genes and research practice, with a view to encouraging members of the plant-phosphate research community to adopt such approaches so that, together, we can aid efforts in global food security.
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Chaudhuri, Gaurab Ranjan, Ruma Guha, Rajesh Hansda, and Soumendra Nath Bandyopadhyay. "A-V malformation of nose: A rare challenging case." Asian Journal of Medical Sciences 8, no. 1 (January 3, 2017): 94–97. http://dx.doi.org/10.3126/ajms.v8i1.13121.
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Congenital A-V malformations of head-neck region are extremely uncommon lesions encountered in clinical practice. They may lead to a wide array of clinical effects from cosmetic disfigurement and recurrent life threatening haemorrhage to cardiac failure. Treatment of these lesions pose a challenge to reconstructive surgeons due to their extreme vascularity, high incidence of recurrence and involvement of adjacent vascular channels. The case presented here is a congenital A-V malformation treated successfully by thorough surgical excision and reconstruction by a well vascularised flap.Asian Journal of Medical Sciences Vol.8(1) 2017 94-97
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WOOD, V. E., D. HUENE, and J. NGUYEN. "Treatment of the Upper Limb in Charcot–Marie–Tooth Disease." Journal of Hand Surgery 20, no. 4 (August 1995): 511–18. http://dx.doi.org/10.1016/s0266-7681(05)80166-4.
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Even though Charcot–Marie–Tooth (CMT) disease is seen frequently, relatively little has been written about the successful treatment of upper limb involvement using tendon transfers. It appears that there are several types of CMT disease and there is extreme variability in the clinical symptoms. The results of treatment were assessed by looking at four specific areas of hand function: decreased conduction velocity of the nerves, lack of opposition, weak pinch, and clawing of the fingers. A plan has been developed for tendon transfers that has worked well in clinical practice.
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Voskanyan, A. E., N. A. Semenova, A. L. Golovteev, A. A. Zhmurova-Kriventsova, O. N. Titova, A. A. Stepanova, O. R. Ismagilova, O. A. Shchagina, S. V. Dumova, and O. L. Chugunova. "Hereditary forms of prion disease in pediatric practice: bibliographic review and series of clinical cases." Pediatria. Journal named after G.N. Speransky 102, no. 6 (December 15, 2023): 27–35. http://dx.doi.org/10.24110/0031-403x-2023-102-6-27-35.
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As for now, there is very limited and surely insufficient scientific data published Worldwide on the manifestation of hereditary forms of prion disease in childhood. Authors provide brief overview of PRNP-associated prion diseases and the description of their own two clinical cases of this disease with manifestation in childhood. Both of the observed patients had many similar clinical manifestations at the onset of the disease at the age of 15 to 16 y/o, such as: predominance of neuropsychiatric symptoms at the onset, rapid progression of the disease, early development of dementia and the lethal outcome within 1 to 1.5 years. Genotype that had been identified by the results of a molecular genetic study was also similar in both patients: the repeatedly described mutation D178N in combination with the M129M polymorphism in the PRNP gene. Prion disease in all cases initially occurred under the guise of mental disorders, making it difficult to suspect a diagnosis at an early stage. Considering the extreme rarity of the manifestation of hereditary forms of prion disease in childhood, the Article is drawing attention to the current problematics connected with low alertness and delayed diagnosis of this pathology in pediatric practice.
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Heller, Gillian Z., Maurizio Manuguerra, and Roberta Chow. "How to analyze the Visual Analogue Scale: Myths, truths and clinical relevance." Scandinavian Journal of Pain 13, no. 1 (October 1, 2016): 67–75. http://dx.doi.org/10.1016/j.sjpain.2016.06.012.
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AbstractBackground and aimsThe Visual Analogue Scale (VAS) is a popular tool for the measurement of pain. A variety of statistical methods are employed for its analysis as an outcome measure, not all of them optimal or appropriate. An issue which has attracted much discussion in the literature is whether VAS is at a ratio or ordinal level of measurement. This decision has an influence on the appropriate method of analysis. The aim of this article is to provide an overview of current practice in the analysis of VAS scores, to propose a method of analysis which avoids the shortcomings of more traditional approaches, and to provide best practice recommendations for the analysis of VAS scores.MethodsWe report on the current usage of statistical methods, which fall broadly into two categories: those that assume a probability distribution for VAS, and those that do not. We give an overview of these methods, and propose continuous ordinal regression, an extension of current ordinal regression methodology, which is appropriate for VAS at an ordinal level of measurement. We demonstrate the analysis of a published data set using a variety of methods, and use simulation to compare the power of the various methods to detect treatment differences, in differing pain situations.ResultsWe demonstrate that continuous ordinal regression provides the most powerful statistical analysis under a variety of conditions.Conclusions and Implications We recommend that in the situation in which no covariates besides treatment group are included in the analysis, distribution-free methods (Wilcoxon, Mann–Whitney) be used, as their power is indistinguishable from that of the proposed method. In the situation in which there are covariates which affect VAS, the proposed method is optimal. However, in this case, if the VAS scores are not concentrated around either extreme of the scale, normal-distribution methods (t-test, linear regression) are almost as powerful, and are recommended as a pragmatic choice. In the case of small sample size and VAS skewed to either extreme of the scale, the proposed method has vastly superior power to other methods.
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Moquin, Ross R., and James M. Ecklund. "Socioeconomic issues of United States military neurosurgery." Neurosurgical Focus 12, no. 4 (April 2002): 1–6. http://dx.doi.org/10.3171/foc.2002.12.4.7.
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Although the practice of neurosurgery in the United States (US) Armed Forces is in many ways similar to the civilian practice of neurosurgery, there are many differences as well. The unique challenges, duties, and opportunities US military neurosurgeons are given, both in peacetime and in times of conflict, are discussed, as are pathways for entering into service. The advantages of military service for neurosurgeons include sponsored training, decreased direct exposure to tort actions, little involvement with third-party payers, significant opportunities for travel, and military-specific experiences. The most appealing aspect of military practice is serving fellow members of the US Armed Forces. Disadvantages include the extreme gap between the military and civilian pay scales, lack of support personnel, and in some areas low surgery-related case volume. The greatest concern faced by the military neurosurgical community is the failure to retain experienced neurosurgeons after their obligated service time has been completed, for which several possible solutions are described. It is hoped that future changes will make the practice of military neurosurgery attractive enough so that it will be seen as a career in itself and not an obligation to endure before starting practice in the “real world.”
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Leshchinsky, L. A., R. M. Valeeva, L. T. Pimenov, and P. I. Chaly. "Some ways to improve the effectiveness of emergency treatment of the most frequent extreme conditions in the practice of a general practitioner." Kazan medical journal 69, no. 2 (April 15, 1988): 81–84. http://dx.doi.org/10.17816/kazmj97156.
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We have the results of observations of 2500 patients with myocardial infarction treated in the clinical cardiology dispensary of the Udmurt ASSR in 1981-1986. The effectiveness of resuscitation measures in clinical death on the basis of myocardial infarction in recent years is almost at the same level (46.1%-57.4% in different years).
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Puspitadewi, Susi R. "PERAWATAN PROSTHODONTIK PADA KONDISI RIDGE YANG KURANG MENGUNTUNGKAN." B-Dent, Jurnal Kedokteran Gigi Universitas Baiturrahmah 2, no. 2 (November 10, 2018): 151–60. http://dx.doi.org/10.33854/jbdjbd.26.
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Extreme resorption of the maxillary and mandibular denture bearing areas results in sunken appearance of cheeks, unstable and non retentive denture with associated pain and discomfort. Prosthodontic rehabilitation of a patient with compromised edentulous ridges in a conventional manner is a difficult task. Modifications in the treatment procedures should be considered to fulfil the patient's functional and esthetic desires. This article reviews the various compromised situations commonly encountered in a routine clinical practice and the possible management of each of them.
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Nyante, Gifty, Caleb Andoh, and Ajediran Bello. "Patterns of ethical issues and decision-making challenges in clinical practice among Ghanaian physiotherapists." Ghana Medical Journal 54, no. 3 (September 30, 2020): 179–85. http://dx.doi.org/10.4314/gmj.v54i3.9.
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Objectives: To determine the patterns of ethical issues and decision-making challenges encountered by practicing physiotherapists in Ghana.Design: This is a cross-sectional study in which the stratified sampling technique was adopted to sample the participants.Setting: The study involved physiotherapists at the private healthcare setting and from different levels of public healthcare facilities.Participants: Eighty-two duly registered physiotherapists who were practising in Ghana participated in the study.Interventions: Participants completed a 30-item questionnaire related to ethical issues and challenges encountered in making ethical decisions. Data analysis was premised on the frequency of occurrence of ethical tensions and difficulty in decision making which were dichotomized as 'high' and 'low' issues, and 'extreme' and 'low' difficult decisions, respectively.Results: The age range of the participants was 21-49 years (mean 31.5 ± 1.4years). 18 (22%), 31 (37.8%) and 33 (40.2%) physiotherapists practice in the primary, secondary and tertiary healthcare settings respectively. 56 (68.3%) and 43 (52.4%) of the participants affirmed that 'establishing priorities for patient's treatment amidst limited time resources' was the most frequently encountered and the most extremely difficult ethical issue to make a decision on respectively. Whereas, limiting physical therapy services for personal or organizational gains sub-theme was the least occurred issue which was also the least difficult to make a decision on as indicated by the respective 16 (19.5%) and 18 (22.0%) physiotherapists.Conclusion: A wide range of primary and secondary ethical issues were reported by the sampled physiotherapists, which tend to pose difficulty during the decision-making process in practice.Keywords: Ethical issues; code of ethics; decision making; physiotherapy practice, ethical judgementFunding: The research work was self-funded by the authors.
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Orazov, M. R., V. E. Radzinsky, and E. D. Dolgov. "‘Algological bonds of endometriosis’. Features of clinical management of patients with typical and atypical symptoms of endometriosis." Medical alphabet, no. 19 (November 5, 2023): 16–22. http://dx.doi.org/10.33667/2078-5631-2023-19-16-22.
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Endometriosis remains one of the most mysterious and controversial diseases in modern gynecology. Contemporary statistical data demonstrate the extreme relevance of actively implementing effective therapeutic approaches into the clinician’s everyday practice. However, a significant challenge associated with endometriosis is the pain syndrome. The question of so-called atypical algological manifestations of endometriosis, which previously seemed unrelated to the pathogenesis of the primary disease, is increasingly raised. In this regard, the aim of this article was to propose a three-level pathogenetic concept capable of linking the primary manifestation of endometriosis (pelvic pain) with other often distant algological patterns, as well as to create an algorithm for managing these patients based on their pathogenetic staging.
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Ionov, M. V., I. V. Emelyanov, and A. O. Konradi. "Directly observed therapy to assess adherence in patient with apparent refractory hypertension. A case-report." Russian Journal for Personalized Medicine 2, no. 5 (November 28, 2022): 62–71. http://dx.doi.org/10.18705/2782-3806-2022-2-5-62-71.
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Refractory arterial hypertension (RefHTN) is an extreme phenotype of resistant hypertension (RHTN), is associated with utmost poor clinical sequelae. True RHTN occurs in 10-15 % of treated patients. Up to half of them meet the definition of RefHTN, but another ~50 % are eventually diagnosed with ‘pseudo’-RHTN. Partial or complete non-adherence are among its the main causes. To date, there is no ‘gold’ standard to assess adherence. Directly observed therapy (DOT) is a promising non-invasive method to assess patient compliance. The wellknown abroad, DOT is not widely used in Russian clinical practice. In this short report we demonstrate a case of DOT in a patient with apparent RefHTN.
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Starostina, E. G. "Acute metabolic decompensation in diabetes mellitus (lecture)." Problems of Endocrinology 44, no. 6 (December 1, 1998): 32–39. http://dx.doi.org/10.14341/probl11667.
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The treatment of acute metabolic decompensation in diabetes mellitus (DM), especially its extreme manifestations - diabetic com - still presents significant difficulties for many endocrinologists, resuscitators and other doctors, although in practice they often have to deal with this. In the scope of this lecture, we are not able to dwell in detail on the pathogenesis, biochemical and clinical features of acute diabetic decompensation of metabolism, therefore, it will mainly examine the most important principles of its treatment and the most frequently encountered diagnostic and tactical errors.
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Senchukova, S. R., Yu M. Krinitsyna, and D. A. Mikhailova. "Skin Manifestations of COVID-19 Infection in the Practice of Dermatologist." Russian Archives of Internal Medicine 12, no. 1 (February 1, 2022): 72–80. http://dx.doi.org/10.20514/2226-6704-2022-12-1-72-80.
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In early 2020, the World Health Organization announced the emergence of the disease-a new coronavirus infection (COVID-19). High contagiousness and asymptomatic transmission of the virus led to a rapid spread of infection and reached the scale of a pandemic. It was found that the SARSCoV-2 virus is pathogenic to the lower respiratory tract. At the same time, there are extrapulmonary manifestations, including skin rashes, which are characterized by an extreme variety. Some authors describe skin lesions as the first, and sometimes the only, symptom of a new coronavirus infection. Thus, skin manifestations should be carefully evaluated by dermatologists during the examination, especially during the ongoing pandemic.This article presents 6 clinical cases with various skin manifestations in the acute period of COVID-19 infection. The first patients to complain were dermatologists. Rashes on the skin are characterized by a variety and prevalence: polymorphic vasculitis, livedo-angiitis, urticary, spot-papular, papu lo-vesicular, papulo-squamous elements. All cases are united by the presence of the main symptoms of coronavirus infection characteristic of the acute period — hyperthermia, headache, fatigue, myalgia, partial or complete anosmia, ageusia.Thus, the exchange of clinical experience of skin manifestations in COVID-19 infection is extremely relevant during the ongoing pandemic. The analysis of the accumulated data will provide an understanding of the diagnostic significance and the ability to assess the prognosis when observing such patients.
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Ciurea, Andreea, Nicolae Voicu Rednic, Andrada Soancă, Iulia Cristina Micu, Alina Stanomir, Diana Oneț, Petra Șurlin, et al. "Current Perspectives on Periodontitis in Systemic Sclerosis: Associative Relationships, Pathogenic Links, and Best Practices." Diagnostics 13, no. 5 (February 22, 2023): 841. http://dx.doi.org/10.3390/diagnostics13050841.
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Systemic sclerosis is a chronic, autoimmune, multisystemic disease characterized by aberrant extracellular matrix protein deposition and extreme progressive microvasculopathy. These processes lead to damage within the skin, lungs, or gastrointestinal tract, but also to facial changes with physiognomic and functional alterations, and dental and periodontal lesions. Orofacial manifestations are common in SSc but are frequently overshadowed by systemic complications. In clinical practice, oral manifestations of SSc are suboptimally addressed, while their management is not included in the general treatment recommendations. Periodontitis is associated with autoimmune-mediated systemic diseases, including systemic sclerosis. In periodontitis, the microbial subgingival biofilm induces host-mediated inflammation with subsequent tissue damage, periodontal attachment, and bone loss. When these diseases coexist, patients experience additive damage, increasing malnutrition, and morbidity. The present review discusses the links between SSc and periodontitis, and provides a clinical guide for preventive and therapeutical approaches in the management of these patients.
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Zimbroff, Dan L., Michael H. Allen, John Battaglia, Leslie Citrome, Avrim Fishkind, Andrew Francis, Daniel L. Herr, et al. "Best Clinical Practice With Ziprasidone IM: Update After 2 Years of Experience." CNS Spectrums 10, S11 (2005): 1–15. http://dx.doi.org/10.1017/s1092852900025487.
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Acute agitation is a common psychiatric emergency often treated with intramuscular (IM) medication when rapid control is necessary or the patient refuses to take an oral agent. Conventional IM antipsychotics are associated with side effects, particularly movement disorders, that may alarm patients and render them unreceptive to taking these medications again. Ziprasidone (Geodon®) is the first second-generation, or atypical, antipsychotic to become available in an IM formulation. Ziprasidone IM was approved by the Food and Drug Administration in 2002 for the treatment of agitation in patients with schizophrenia. In October 2004, a roundtable panel of physicians with extensive experience in the management of acutely agitated patients met to review the first 2 years of experience with this agent. This monograph, a product of that meeting, discusses clinical experience to date with ziprasidone IM and offers recommendations on its use in various settings.In clinical trials, patients treated with ziprasidone IM demonstrated significant and rapid (within 15-30 minutes) reduction in agitation and improvement in psychotic symptoms, agitation, and hostility to an extent greater than or equal to that attained with haloperidol IM. Tolerability of ziprasidone IM was superior to that of haloperidol IM, with a lower burden of movement disorders. Clinical trials have also shown that ziprasidone IM can be administered with benzodiazepines without adverse consequences. Transition from IM to oral ziprasidone has been well tolerated, with maintenance of symptom control. The most common adverse events associated with ziprasidone IM were insomnia, headache, and dizziness in fixed-dose trials and insomnia and hypertension in flexible-dose trials. No consistent pattern of escalating incidence of adverse events with escalating ziprasidone doses has been observed. Changes in QTc interval associated with ziprasidone at peak serum concentrations are modest and comparable to those seen with haloperidol IM. Results of randomized clinical trials of ziprasidone IM have been corroborated in studies in real-world treatment settings involving patients with extreme agitation or a recent history of alcohol or substance abuse. In these circumstances, clinically significant improvement was seen within 30 minutes of ziprasidone IM administration, without regard to the suspected underlying etiology of agitation. Agents with a good safety/tolerability profile, such as ziprasidone IM, may be more cost effective long term than older agents, due to reduced incidence of acute adverse effects (eg, acute dystonia) that often require extended periods of observation. Additional trials of ziprasidone IM in agitated patients in a variety of clinical settings are warranted to generate comparative risk/benefit data with conventional agents and other second-generation antipsychotics.
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Soroka, A. K., V. N. Kotelnikov, V. E. Nazarov, B. I. Geltser, and V. A. Dergunov. "Organization of rendered surgical assistance in extreme conditions of autonomous navigation." Bulletin of the Russian Military Medical Academy 20, no. 2 (December 15, 2018): 254–58. http://dx.doi.org/10.17816/brmma12374.
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The problem related to the need to improve the effectiveness of providing emergency surgical care in extreme conditions of autonomous navigation is discussed. The principle of organization of medical support cannot be effectively implemented in the realities of the present time, due to the lack of sufficient naval bases. Modern medical technologies seem to be a strategic reserve that can solve the emerging problems before the medical service of the Navy. The most priority and promising technique with a high level of quality of urgent surgical care is the use of laparoscopic techniques by the personnel of the medical service directly at the ship’s medical station. Presented data on the results of the application of this technique indicate its prospects. In addition, in order to optimize the provision of emergency medical care to seamen in conditions of autonomous navigation, it is expedient to actively use telemedicine. The historical and systematic review of modern literature confirms the high potential of these methods provided that the surgeons’ competence and scientific and practical solution of technical aspects are sufficient. Important is the development of professional standards for specialized medical care in emergency conditions in the sea and active implementation in clinical practice.
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Allen, Jo, and Funmi Oshatogbe. "Sitting with uncertainty to create a rich nourishment for clinicians: Developing a systemic family therapy clinic for psychosis in community adult mental health team." Clinical Psychology Forum 1, no. 372 (February 14, 2024): 35–40. http://dx.doi.org/10.53841/bpscpf.2024.1.372.35.
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PHOTO CREDIT: Priscilla Du PreezSystemic practice can be a rich source of fuel for services, nourishing clinicians and families. To us, systemic thinking supports the creation of space, taking pause, being with and seeing the bigger picture. It is about multiplicity, of idea, of voices, of people and cultures coming together to make sense together. In a culture which is struggling under the weight of austerity, the pandemic and ongoing limitations of practice due to staff shortages and limited resources at a time of extreme demand, we need something to open ourselves and our clients to new possibilities and build trust and safety.This paper will describe systemic family therapy within a secondary care community mental health team. You will hear the voice of Jo, a consultant clinical psychologist and systemic psychotherapist and Funmi, an assistant psychologist in the team. We will discuss decision-making in this work and explore the experiences of the reflecting team, highlighting the value of a systemic approach in secondary adult mental health. The straightest route is not always the most effective or nourishing, sometimes it takes the windy path to get the richest source of progress.
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Gump, William. "Modern induced skull deformity in adults." Neurosurgical Focus 29, no. 6 (December 2010): E4. http://dx.doi.org/10.3171/2010.10.focus10203.
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The practice of induced skull deformity has long existed in numerous disparate cultures, but for the first time in history it can be applied to adults. While extremely limited in application, some ideas have persisted in the far fringes of modern Western culture with remarkable tenacity. Practitioners of extreme body modification undergo procedures, outside the sphere of traditional medical practice, to make striking, permanent, nontraditional esthetic tissue distortions with the goal of transgressing societal norms. The International Trepanation Advocacy Group represents another example of a fringe cultural movement, whose goal, rather than being purely aesthetic in nature, is to promote elective trepanation as a method for achieving a heightened level of consciousness. Both movements have relatively short and well-defined histories. Despite their tiny numbers of adherents, neurosurgeons may be called on to address relevant patient concerns preprocedurally, or complications postprocedurally, and would benefit from awareness of these peculiar subcultures.
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Tatarnikova, E. B., and O. I. Krivosheina. "A new approach to the treatment of dry eye syndrome against the background of chronic peripheral uveitis." Modern technologies in ophtalmology, no. 2 (June 15, 2021): 154–57. http://dx.doi.org/10.25276/2312-4911-2021-2-154-157.
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Aim. To study the clinical and functional effectiveness of a complex method of treatment of dry eye syndrome against the background of chronic peripheral uveitis, including local tear-replacement and anti-inflammatory therapy in combination with laser retinal coagulation on the extreme periphery of the fundus. Materials and methods. The study was performed among 98 patients who made up 2 follow-up groups: the main group (78 people) and the comparison group (20 people). All patients underwent OSDI questionnaires, visometry, pneumotonometry, biomicroscopy of the anterior segment of both eyes, binocular ophthalmoscopy with sclerocompression, and the Schirmer I test. In the main group, along with conservative treatment, laser coagulation of the extreme periphery of the retina was performed, in the comparison group - conservative treatment. The follow-up period was 3 months. Results and discussion. The use of a complex method of treatment of «dry eye» syndrome against the background of chronic peripheral uveitis significantly reduces the number of complaints according to the OSDI questionnaire, improves the condition of the eye surface (reducing the overhang of the conjunctival fold, the severity of «sluggish» hyperemia of the conjunctiva of the eyelids and transitional folds, reducing the amount of conjunctival discharge). The indicator of total tear production in the main group after 3 months. it increases by 1,5 times in comparison with the initial data, and in 100% of cases, stable relief of inflammation of the chorioretinal structures on the extreme periphery of the fundus is provided. Conclusion. A new effective method for the treatment of dry eye syndrome against the background of chronic peripheral uveitis, including local tear-replacement and anti-inflammatory therapy in combination with laser retinal coagulation on the extreme periphery of the fundus, has been developed and introduced into clinical practice. The use of this method provides stable clinical and functional results in the long-term period and can be recommended for the treatment of «dry eye» syndrome of mild to moderate severity against the background of chronic peripheral uveitis. Key words: dry eye syndrome, chronic peripheral uveitis, laser coagulation of the extreme periphery of the retina.
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Solomon, Oleg. "SEPSIS WITH ORAL ENTRY GATE IN IMMUNE DEPRESSED PATIENTS - A CHALLENGE TO CURRENT MEDICAL PRACTICE." Medicine and Materials 2, no. 1 (June 15, 2022): 3–8. http://dx.doi.org/10.36868/medmater.2022.02.01.003.
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"Sepsis occurs especially in people with a compromised immune system. Hosts become immunocompromised by chronic conditions, HIV, neoplasms, diabetes, as well as immunosuppressive and cytotoxic treatments. This first research direction aims at conducting an etiopathogenic study on a representative group of patients diagnosed with severe sepsis with oral gateway, following the prevalence and incidence of each clinical entity in the corroborative context of a range of factors influencing the final results, outlining with the real image of a complex pathology on the territory of Moldova is very accurate, aspects with a profound impact in the therapeutic approach both for severe sepsis and for the prophylactic methods of oral pathology. For the clinical study, a representative group of patients was studied: 94 patients hospitalized in the Galați Infectious Diseases Clinic between 2018 and 2019. Patients included in the study group, anchored in the territory of immunosuppression, have a general condition affected by: diabetes mellitus, chronic hepatitis, liver cirrhosis, alcoholism, neoplasms, chronic renal failure, anemia. Age is an important factor in the evolution of sepsis. This study also highlighted a phenomenon described in the literature, namely that there is an increased incidence of sepsis in patients of extreme age."
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Llopis Cuquerella, Marta, Maria del Carmen Ors Castaño, María Ballester Espinosa, Alejandra Magdaleno Cremades, Vicente Boix Aracil, María del Rocío Ramirez Belloch, Roberto Morales Giménez, et al. "Adjuvant treatment in extreme elderly patients with colorectal cancer." Journal of Clinical Oncology 35, no. 4_suppl (February 1, 2017): 784. http://dx.doi.org/10.1200/jco.2017.35.4_suppl.784.
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784 Background: Surgical and adjuvant treatment in extreme elderly ( > 80 years) patients with localized colorectal cancer is an unresolved issue. Owing to the lack of available neither clinical practice nor investigational data in this field we present our experience in this scenario. Methods: We retrospectively reviewed data regarding surgical and complementary treatment for colorectal cancer patients aged more than 80 consecutively attended by General Surgery Department in Vega Baja Hospital between 2008 and 2013. Results: A total number of 115 colorectal cancer patients were registered. 95 patients diagnosed of localized disease were selected for analysis. Colon vs rectal cancer ratio was 4:1. Median age was 83.6 years (80-94). Male sex was predominant (60 patients, 63.2%). Emergency surgery was performed in 15 patients (15.8%). Complementary treatment to surgery was advised, according to international guidelines, in 53 patients (55.8%). 10 patients (18.9%) with an advise of adjuvant treatment finally received it. More patients with rectal cancer received recommended treatment (41.7% rectal vs 12.2% colon cancer). Patients with stage III disease were more frequently finally treated according to guidelines (22.2 % stage III vs 11.8% stage II). More patients with stage II rectal cancer were advised and received treatment (recommendation: 66.7% rectal vs 36.1% colon cancer; administration: 25% rectal vs 7.7% colon cancer). Treatment was also more frequently administered to stage III rectal cancer (50% rectal vs 14.3% rectal cancer) (Table). Conclusions: Our experience in localized colorectal cancer in extreme elderly patients ( > 80 years) showed that, although advised according to guidelines, most of them did not receive adjuvant treatment to surgery. Complementary treatment administration was more common in rectal cancer patients and with more advanced disease. [Table: see text]
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Hanley, Natalia, Helen Simpson, and Juan M. Tauri. "Supporting justice-involved people with extreme complex needs in the Australian community: a third sector practice perspective." Journal of Intellectual Disabilities and Offending Behaviour 13, no. 1 (December 3, 2021): 45–55. http://dx.doi.org/10.1108/jidob-09-2021-0014.
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Purpose This qualitative research aims to explore staff perspectives on working effectively with people with intellectual disability who are in contact with the criminal justice system. Design/methodology/approach Taking a case study approach, staff working for a third sector community organisation were interviewed about the components of effective work with their customers. The staff supported people engaged in the Community Justice Program. Findings Staff consistently described relationship building as the most important part of their work. There were three components to relationship building: the process of relationship building, the elements of a high-quality staff–customer relationship and the staff skills needed to develop a good relationship. Originality/value This paper makes two contributions to the literature. First, it focuses our attention on a third sector organisation supporting people in contact with the justice system as opposed to a formal criminal justice agency. Second, the paper seeks to understand the processes and skills staff deploy to build a high-quality relationship with criminal justice-involved people with intellectual disability.