| | Society of Interventional Radiology Multidisciplinary Position Statement on Percutaneous Ablation of Non-small Cell Lung Cancer and Metastatic Disease to the Lungs | Society of Interventional Radiology Multidisciplinary Position Statement on Percutaneous Ablation of Non-small Cell Lung Cancer and Metastatic Disease to the Lungs
Society of Interventional Radiology Multidisciplinary Position Statement on Percutaneous Ablation of Non-small Cell Lung Cancer and Metastatic Disease to the Lungs
Overview The purpose of this study is to state the Society of Interventional Radiology's position on the use of image-guided thermal ablation for the treatment of early-stage non-small cell lung cancer, recurrent lung cancer, and metastatic disease to the lung. A multidisciplinary writing group, with expertise in treating lung cancer, conducted a comprehensive literature search to identify studies on the topic of interest. Recommendations were drafted and graded according to the updated SIR evidence grading system. A modified Delphi technique was used to achieve consensus agreement on the recommendation statements. A total of 63 studies, including existing systematic reviews and meta-analysis, retrospective cohort studies, and single-arm trials were identified. The expert writing group developed and agreed on 7 recommendations on the use of image-guided thermal ablation in the lung. It was concluded that SIR considers image-guided thermal ablation to be an acceptable treatment option for patients with inoperable Stage I NSCLC, those with recurrent NSCLC, as well as patients with metastatic lung disease. Authors Scott J. Genshaft, MD, Robert D. Suh, MD, Fereidoun Abtin, MD, Mark O. Baerlocher, MD, Albert J. Chang, MD, Sean R. Dariushnia, MD, A. Michael Devane, MD, Salomao Faintuch, MD, MS, Elizabeth A. Himes, BS, Aaron Lisberg, MD, Siddharth Padia, MD, Sheena Patel, MPH, Alda L. Tam, MD, MBA, and Jane Yanagawa, MD Journal J Vasc Interv Radiol
| 3 | | R420.00 |  |
| | COVID-19 in Pediatrics | COVID-19 in Pediatrics
Overview In 2019, a novel coronavirus emerged called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19). Initially identified in Wuhan, China, COVID-19 spread internationally and became a global pandemic. Most pediatric COVID-19 cases were milder than in adults, but in the early Spring of 2020, a new inflammatory syndrome emerged in children who had evidence of prior SARS CoV-2 infection, called Multisystem Inflammatory Syndrome in Children (MIS-C). As of March 2021, there were approximately 2,592,619 cases of COVID-19 in people under 18 in the United States and 300 deaths. Of all American cases, 2.1% were in children aged 0 to 4 years old, and another 10.2% were in those aged 5 to 17. Prevalence varies by age, with estimates ranging from 17% for children under 2 years old to 25% of children ages 6 to 10 years old, and 23% in 10 to 14 years old. The severity of the disease is generally lower for children, with only 1% to 5% of pediatric cases qualifying as severe versus to 10% to 20% in adults. This finding is thought to reflect the lower levels of angiotensin-converting enzyme 2 expression in alveolar cells, which is the mechanism by which SARS-CoV-2 enters cells. Being older than 12 years and having a high initial C-reactive protein (CRP) are risk factors for admission to a pediatric intensive care unit, and high CRP, leukocytosis, and thrombocytopenia are risk factors for organ dysfunction. Viral load and young age, specifically children under 1 year of age, are other risk factors for more severe disease. This study describes the features, diagnosis, and treatment of pediatric COVID-19 and MIS-C based on the data available at the time of publication.
Authors Case SM, Son MB
Journal Rheumatic Disease Clinics of North America | 3 | | R435.00 | |
| | HIV and Aids | HIV and Aids
Overview
HIV disease is caused by infection with HIV-1 or HIV-2, which are retroviruses in the Retroviridae family, Lentivirus genus. Human immunodeficiency virus (HIV) is a blood-borne virus typically transmitted via sexual intercourse, shared intravenous drug paraphernalia, and mother-to-child transmission (MTCT), which can occur during the birth process or during breastfeeding. The patient with HIV may present with signs and symptoms of any of the stages of HIV infection. No physical findings are specific to HIV infection; the physical findings are those of the presenting infection or illness. Examples of manifestations include acute seroconversion manifests as a flulike illness, consisting of fever, malaise, generalized rash, generalized lymphadenopathy is common and may be a presenting symptom. This course covers the screening, diagnosis, medication and management of Aids.
Author: Sharespike | 3 | | R425.00 | |
| | Asthma Exacerbation Part 2 | Asthma Exacerbation Part 2
Asthma Exacerbation Part 2
Overview
Asthma is a common chronic disease worldwide and affects approximately 26 million persons in the United States. It is the most common chronic disease in childhood, affecting an estimated 7 million children, and it is a common cause of hospitalization for children in the United States.
The pathophysiology of asthma is complex and involves airway inflammation, intermittent airflow obstruction, and bronchial hyperresponsiveness. The mechanism of inflammation in asthma may be acute, subacute, or chronic, and the presence of airway edema and mucus secretion also contributes to airflow obstruction and bronchial reactivity. Varying degrees of mononuclear cell and eosinophil infiltration, mucus hypersecretion, desquamation of the epithelium, smooth muscle hyperplasia, and airway remodelling are present. Physical findings vary with the severity of the asthma and with the absence or presence of an acute episode and its severity. Pharmacologic management includes the use of relief and control agents.
Author Sharespike | 3 | | R465.00 | |
| | Asthma Exacerbation Part 1 | Asthma Exacerbation Part 1
Asthma Exacerbation Part 1
Overview
Asthma is a common chronic disease worldwide and affects approximately 26 million persons in the United States. It is the most common chronic disease in childhood, affecting an estimated 7 million children, and it is a common cause of hospitalization for children in the United States.
The pathophysiology of asthma is complex and involves airway inflammation, intermittent airflow obstruction, and bronchial hyperresponsiveness. The mechanism of inflammation in asthma may be acute, subacute, or chronic, and the presence of airway edema and mucus secretion also contributes to airflow obstruction and bronchial reactivity. Varying degrees of mononuclear cell and eosinophil infiltration, mucus hypersecretion, desquamation of the epithelium, smooth muscle hyperplasia, and airway remodelling are present. Physical findings vary with the severity of the asthma and with the absence or presence of an acute episode and its severity. Pharmacologic management includes the use of relief and control agents. Author Sharespike | 3 | | R465.00 | |
| | Respiratory Distress Syndrome | Respiratory Distress Syndrome
Respiratory Distress Syndrome
Overview
Respiratory distress syndrome, also known as hyaline membrane disease, occurs almost exclusively in premature infants. The incidence and severity of respiratory distress syndrome are related inversely to the gestational age of the new-born infant.
Shortness of breath is a common complaint encountered by the EMS provider. We often hear it as part of a litany of other S/S or as a primary chief complaint. In either case SOB is never to be taken lightly and its causes should always be thoroughly investigated. My desire with this article is to give you some tips on how to streamline your treatment and formulate your thoughts as to how to proceed. In all cases the EMS team is responsible to respond to the needs of the patient. Hypoxia, regardless of the source needs to be vigorously addressed. The lungs need to be opened or cleared as determined by the physical exam. The cause of the SOB needs to be determined and addressed. Education and counselling of parents, caregivers, and families of premature infants must be undertaken as part of discharge planning. These individuals should be advised of the potential problems infants with respiratory distress syndrome may encounter during and after their nursery stay.
Author
Sharespike
| 3 | | R425.00 | |
| | Dyspnea: Pathophysiology and a clinical approach - EMT | Dyspnea: Pathophysiology and a clinical approach - EMT
Dyspnea: Pathophysiology and a clinical approach - EMT
Overview
Dyspnea is defined as a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity and may either be acute or chronic. This is a common and often distressing symptom reported by patients, and accounts for nearly half of hospital admissions. The distinct sensations often reported by patients include effort/work of breathing, chest tightness, and air hunger (a feeling of not enough air on inspiration). Dyspnea should be assessed by the intensity of these sensations, the degree of distress involved, and its burden or impact on instrumental activities. Dyspnea is a common and often distressing symptom and a frequent reason for general practitioner and clinic visits. Dyspnea is symptom, and its experience is subjective and varies greatly among individuals exposed to the same stimuli or with similar pathologies. This differential experience of Dyspnea among individuals emanates from interactions among multiple physiological, psychological, social, and environmental factors that induce secondary physiological and behavioural responses. The management of Dyspnea will depend on the underlying cause.
Author
Sharespike | 3 | | R420.00 | |
| | Emphysema, Chronic obstructive pulmonary disease (COPD), Asthma | Emphysema, Chronic obstructive pulmonary disease (COPD), Asthma
Emphysema, Chronic obstructive pulmonary disease (COPD), Asthma
Overview Emphysema and chronic bronchitis are airflow-limited states contained within the disease state known as chronic obstructive pulmonary disease (COPD). Just as asthma is no longer grouped with COPD, the current definition of COPD put forth by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) also no longer distinguishes between emphysema and chronic bronchitis.
Emphysema is pathologically defined as an abnormal permanent enlargement of air spaces distal to the terminal bronchioles, accompanied by the destruction of alveolar walls and without obvious fibrosis. This process leads to reduced gas exchange, changes in airway dynamics that impair expiratory airflow, and progressive air trapping. Clinically, the term emphysema is used interchangeably with chronic obstructive pulmonary disease, or COPD.
The theory surrounding this definition has been around since the 1950s, with a key concept of irreversibility and/or permanent acinar damage. However, new data posit that increased collagen deposition leads to active fibrosis, which inevitably is associated with breakdown of the lung’s elastic framework.
Discussions on how obstructive diseases share similar phenotypes have been emerging and evolving within the literature. This course provides a particularly good outline.
Author Sharespike
| 3 | | R435.00 | |
| | Clinical Practice Guidelines: Cerebrovascular Accident (Stroke) and General Care in Emergencies | Clinical Practice Guidelines: Cerebrovascular Accident (Stroke) and General Care in Emergencies
Clinical Practice Guidelines: Cerebrovascular Accident (Stroke) and General Care in Emergencies
Overview
There is growing evidence that good early stroke management can reduce damage to the brain and minimise the effects of stroke. Because of this early recognition of stroke, the subsequent response of individuals to having a stroke, and the timing and method by which people are transferred to hospital are important to ensure optimal outcomes. In this hyperacute phase of care, the ambulance service provides a central, coordinating role (Australian Government Health and Medical Research Council, 2007). Appropriate diagnosis of stroke and immediate referral to a stroke team is vital given advances in hyperacute treatments (Australian Government Health and Medical Research Council, 2007).
As in all scene responses, EMS personnel must assess and manage the patient’s airway, breathing, and circulation. Most patients with acute ischemic stroke do not require emergency airway management or acute interventions for respiratory and circulatory support (Jauch et al., 2013).
Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa
| 3 | | R410.00 | |
| | Clinical Practice Guidelines: Airway Part 2 | Clinical Practice Guidelines: Airway Part 2
Clinical Practice Guidelines: Airway Part 2
Overview
Oxygen is one of the most common medications administered during the care of patients who present with medical emergencies. At present, oxygen appears to be administered for three main indications in the emergency setting, of which only one is evidence-based (British Thoracic Society Emergency Oxygen Guideline Group, 2008). Firstly, oxygen is given to correct hypoxaemia as there is good evidence that severe hypoxaemia is harmful. Secondly, oxygen is administered to ill patients prophylactically to prevent hypoxaemia. Recent evidence suggests that this practice may place patients at increased risk of the development of hypoxaemia, reactive oxygen species, and absorption atelectasis amongst other adverse effects. Thirdly, a very high proportion of medical oxygen is administered because most clinicians believe that oxygen can alleviate breathlessness; however, there is no evidence that oxygen relieves breathlessness in non-hypoxemic patients (British Thoracic Society Emergency Oxygen Guideline Group, 2008).
Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa
| 3 | | R410.00 | |
| | Clinical Practice Guidelines: Adult Resuscitation Part 3 | Clinical Practice Guidelines: Adult Resuscitation Part 3
Clinical Practice Guidelines: Adult Resuscitation Part 3
Overview
The correct and timely identification of cardiac arrest is critical to ensuring (1) the appropriate dispatch of a high-priority response, (2) the provision of telephone CPR instructions, and (3) the activation of community first responders carrying automated external defibrillators (AED) (Travers et al., 2015). Rapid defibrillation is a powerful predictor of successful resuscitation following ventricular fibrillation (VF) sudden cardiac arrest (SCA). (Berg et al., 2010a) Advanced life support (ALS) is still considered a vital link in the chain of survival for patients with out-of-hospital cardiac arrest. Despite this the quality of evidence for many ALS interventions remains poor (Callaway et al., 2015) as do the outcomes of patients, particularly those suffering unwitnessed out-of-hospital cardiac arrest were CPR and defibrillation is delayed. As part of the development of these guidelines, the core guideline panel opted to adopt the AHA resuscitation guidelines for advanced cardiac life support. It should therefore be noted that for recommendations not reviewed by the AHA in the 2015 edition, the 2010 recommendation are considered valid.
Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa
| 3 | | R410.00 | |
| | Clinical Practice Guidelines: Adult Resuscitation Part 2 | Clinical Practice Guidelines: Adult Resuscitation Part 2
Clinical Practice Guidelines: Adult Resuscitation Part 2
Overview
The correct and timely identification of cardiac arrest is critical to ensuring (1) the appropriate dispatch of a high-priority response, (2) the provision of telephone CPR instructions, and (3) the activation of community first responders carrying automated external defibrillators (AED) (Travers et al., 2015). Rapid defibrillation is a powerful predictor of successful resuscitation following ventricular fibrillation (VF) sudden cardiac arrest (SCA). (Berg et al., 2010a) Advanced life support (ALS) is still considered a vital link in the chain of survival for patients with out-of-hospital cardiac arrest. Despite this the quality of evidence for many ALS interventions remains poor (Callaway et al., 2015) as do the outcomes of patients, particularly those suffering unwitnessed out-of-hospital cardiac arrest were CPR and defibrillation is delayed. As part of the development of these guidelines, the core guideline panel opted to adopt the AHA resuscitation guidelines for advanced cardiac life support. It should therefore be noted that for recommendations not reviewed by the AHA in the 2015 edition, the 2010 recommendation are considered valid.
Acknowledgement
Journal: Clinical Practice Guidelines (July 2018)
| 3 | | R410.00 | |
| | Clinical Practice Guidelines: Adult Resuscitation Part 1 | Clinical Practice Guidelines: Adult Resuscitation Part 1
Clinical Practice Guidelines: Adult Resuscitation Part 1
Overview
The correct and timely identification of cardiac arrest is critical to ensuring (1) the appropriate dispatch of a high-priority response, (2) the provision of telephone CPR instructions, and (3) the activation of community first responders carrying automated external defibrillators (AED) (Travers et al., 2015). Rapid defibrillation is a powerful predictor of successful resuscitation following ventricular fibrillation (VF) sudden cardiac arrest (SCA). (Berg et al., 2010a) Advanced life support (ALS) is still considered a vital link in the chain of survival for patients with out-of-hospital cardiac arrest. Despite this the quality of evidence for many ALS interventions remains poor (Callaway et al., 2015) as do the outcomes of patients, particularly those suffering unwitnessed out-of-hospital cardiac arrest were CPR and defibrillation is delayed. As part of the development of these guidelines, the core guideline panel opted to adopt the AHA resuscitation guidelines for advanced cardiac life support. It should therefore be noted that for recommendations not reviewed by the AHA in the 2015 edition, the 2010 recommendation are considered valid.
Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa
| 3 | | R410.00 | |
| | Clinical Practice Guidelines: Airway Part 1 | Clinical Practice Guidelines: Airway Part 1
Clinical Practice Guidelines: Airway Part 1
Overview
Oxygen is one of the most common medications administered during the care of patients who present with medical emergencies. At present, oxygen appears to be administered for three main indications in the emergency setting, of which only one is evidence-based (British Thoracic Society Emergency Oxygen Guideline Group, 2008). Firstly, oxygen is given to correct hypoxaemia as there is good evidence that severe hypoxaemia is harmful. Secondly, oxygen is administered to ill patients prophylactically to prevent hypoxaemia. Recent evidence suggests that this practice may place patients at increased risk of the development of hypoxaemia, reactive oxygen species, and absorption atelectasis amongst other adverse effects. Thirdly, a very high proportion of medical oxygen is administered because most clinicians believe that oxygen can alleviate breathlessness; however, there is no evidence that oxygen relieves breathlessness in non-hypoxemic patients (British Thoracic Society Emergency Oxygen Guideline Group, 2008).
Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa | 3 | | R410.00 | |
| | Tuberculosis Part 2 | Tuberculosis Part 2
Overview
Tuberculosis (TB) (see the image below), a multisystemic disease with myriad presentations and manifestations, is the most common cause of infectious disease–related mortality worldwide. Although TB rates are decreasing in the United States, the disease is becoming more common in many parts of the world. In addition, the prevalence of drug-resistant TB is increasing worldwide. Classic clinical features associated with active pulmonary TB in elderly individuals with TB may not display typical signs and symptoms. The absence of any significant physical findings does not exclude active TB. Classic symptoms are often absent in high-risk patients, particularly those who are immunocompromised or elderly. It is important to isolate patients with possible TB in a private room with negative pressure.
Acknowledgements Authors:
Thomas E Herchline,Thomas E Herchline, Judith K Amorosa, Judith K Amorosa. | 3 | | R420.00 | |
| | Tuberculosis Part 1 | Tuberculosis Part 1
Overview Tuberculosis (TB) (see the image below), a multisystemic disease with myriad presentations and manifestations, is the most common cause of infectious disease–related mortality worldwide. Although TB rates are decreasing in the United States, the disease is becoming more common in many parts of the world. In addition, the prevalence of drug-resistant TB is increasing worldwide. Classic clinical features associated with active pulmonary TB in elderly individuals with TB may not display typical signs and symptoms. The absence of any significant physical findings does not exclude active TB. Classic symptoms are often absent in high-risk patients, particularly those who are immunocompromised or elderly. It is important to isolate patients with possible TB in a private room with negative pressure.
Acknowledgements Authors: Thomas E Herchline and Judith K Amorosa | 3 | | R420.00 | |
| | Clinical Practice Guidelines: Respiratory | Clinical Practice Guidelines: Respiratory
Clinical Practice Guidelines: Respiratory
Overview
Asthma is a common condition which produces a significant workload for general practice, hospital outpatient clinics and inpatient admissions. Much of this morbidity relates to poor management (British Thoracic Society, 2014). Chronic obstructive pulmonary disease (COPD) is a group of disorders characterised by airway inflammation and airflow limitation that is not fully reversible. COPD should be distinguished from asthma because it is a progressive, disabling disease with increasingly serious complications and exacerbations. The symptoms, signs and physiology of these conditions can overlap with asthma and differentiation can be difficult, particularly in middle-aged smokers presenting with breathlessness and cough. This difficulty is compounded by the fact that most COPD patients exhibit some degree of reversibility with bronchodilators. Patients with severe chronic asthma, chronic bronchiolitis, bronchiectasis and cystic fibrosis may also present with a similar clinical pattern and partially reversible airflow limitation (The Thoracic Society of Australia and New Zealand, 2002). Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa | 3 | | R410.00 | |
| | Viral Pneumonia Part 3 | Viral Pneumonia Part 3
Overview The reported incidence of viral pneumonia (see the image below) has increased during the past decade. In part, this apparent increase simply reflects improved diagnostic techniques, but an actual increase appears to have also occurred. Depending on the virulence of the organism, as well as the age and comorbidities of the patient, viral pneumonia can vary from a mild, self-limited illness to a life-threatening disease. This course is divided into 3 parts covering the aspects of Pneumonia leading into the much dreaded COVID 19 The influenza viruses are the most common viral cause of pneumonia. Primary influenza pneumonia manifests with persistent symptoms of cough, sore throat, headache, myalgia, and malaise for more than three to five days. Respiratory syncytial virus (RSV) is the most frequent cause of lower respiratory tract infection in infants and children and the second most common viral cause of pneumonia in adults.
Parainfluenza virus (PIV) is second in importance only to RSV as a cause of lower respiratory tract disease in children and pneumonia and bronchiolitis in infants younger than 6 months. PIV pneumonia and bronchiolitis are caused primarily by the PIV-3 strain. The signs and symptoms include fever, cough, coryza, dyspnea with rales, and wheezing.
Acknowledgements Authors:
Zab Mosenifar and Richard Brawerman | 3 | | R420.00 | |
| | Viral Pneumonia Part 2 | Viral Pneumonia Part 2
Overview The reported incidence of viral pneumonia (see the image below) has increased during the past decade. In part, this apparent increase simply reflects improved diagnostic techniques, but an actual increase appears to have also occurred. Depending on the virulence of the organism, as well as the age and comorbidities of the patient, viral pneumonia can vary from a mild, self-limited illness to a life-threatening disease. This course is divided into 3 parts covering the aspects of Pneumonia leading into the much dreaded COVID 19. The influenza viruses are the most common viral cause of pneumonia. Primary influenza pneumonia manifests with persistent symptoms of cough, sore throat, headache, myalgia, and malaise for more than three to five days. Respiratory syncytial virus (RSV) is the most frequent cause of lower respiratory tract infection in infants and children and the second most common viral cause of pneumonia in adults.
Parainfluenza virus (PIV) is second in importance only to RSV as a cause of lower respiratory tract disease in children and pneumonia and bronchiolitis in infants younger than 6 months. PIV pneumonia and bronchiolitis are caused primarily by the PIV-3 strain. The signs and symptoms include fever, cough, coryza, dyspnea with rales, and wheezing.
Acknowledgements Authors:
Zab Mosenifar and Richard BrawermanThe University of Pretoria | 3 | | R420.00 | |
| | Viral Pneumonia Part 1 | Viral Pneumonia Part 1
Overview The reported incidence of viral pneumonia (see the image below) has increased during the past decade. In part, this apparent increase simply reflects improved diagnostic techniques, but an actual increase appears to have also occurred. Depending on the virulence of the organism, as well as the age and comorbidities of the patient, viral pneumonia can vary from a mild, self-limited illness to a life-threatening disease.
This course is divided into 3 parts covering the aspects of Pneumonia leading into the much dreaded COVID 19. The influenza viruses are the most common viral cause of pneumonia. Primary influenza pneumonia manifests with persistent symptoms of cough, sore throat, headache, myalgia, and malaise for more than three to five days. Respiratory syncytial virus (RSV) is the most frequent cause of lower respiratory tract infection in infants and children and the second most common viral cause of pneumonia in adults.
Parainfluenza virus (PIV) is second in importance only to RSV as a cause of lower respiratory tract disease in children and pneumonia and bronchiolitis in infants younger than 6 months. PIV pneumonia and bronchiolitis are caused primarily by the PIV-3 strain. The signs and symptoms include fever, cough, coryza, dyspnea with rales, and wheezing.
Acknowledgements
Authors:
Zab Mosenifar and Richard Brawerman | 3 | | R420.00 | |
| | Malaria | Malaria
Overview Malaria is a potentially life-threatening disease caused by infection with Plasmodium protozoa transmitted by an infective female Anopheles mosquito. Patients with malaria typically become symptomatic a few weeks after infection, though the symptomatology and incubation period may vary, depending on host factors and the causative species. Most patients with malaria have no specific physical findings, but splenomegaly may be present. In patients with suspected malaria, obtaining a history of recent or remote travel to an endemic area is critical. Asking explicitly if they travelled to a tropical area at any time in their life may enhance recall. Maintain a high index of suspicion for malaria in any patient exhibiting any malarial symptoms and having a history of travel to endemic areas.
It is also important to determine the patient's immune status, age, and pregnancy status; allergies or other medical conditions that he or she may have; and medications that he or she may be using.
Acknowledgements Authors:
Thomas E Herchline, Thomas E Herchline, Ryan Q Simon
| 3 | | R420.00 | |
| | Acute Management of Stroke | Acute Management of Stroke
Acute Management of Stroke
Overview:
The goal for the acute management of patients with stroke is to stabilize the patient and to complete initial evaluation and assessment, including imaging and laboratory studies, within 60 minutes of patient arrival. Critical decisions focus on the need for intubation, blood pressure control, and determination of risk/benefit for thrombolytic intervention.
In patients with transient ischemic attacks (TIAs), failure to recognize the potential for near- term stroke, failure to perform a timely assessment for stroke risk factors, and failure to initiate primary and secondary stroke prevention exposes the patient to undue risk of stroke and exposes clinicians to potential litigation. TIAs confer a 10% risk of stroke within 30 days, and one half of the strokes occurring after a TIA, occurred within 48 hours.
Newer stroke trials have explored the benefit of using neuroimaging to select patients who are most likely to benefit from thrombolytic therapy and the potential benefits of extending the window for thrombolytic therapy beyond the guideline of 3 hours with t-PA and newer agents. CT angiography may demonstrate the location of vascular occlusion. CT perfusion studies can produce perfusion images and together with CT angiography are becoming more available and utilized in the acute evaluation of stroke patients. Advanced neuroimaging with diffusion and perfusion imaging may then serve an important role in identifying potentially salvageable tissue at risk and guiding clinical decision-making regarding therapy.
Acknowledgements:
Authors:
Edward C Jauch | 3 | | R440.00 | |
| | Oral corticosteroids for asthma exacerbations might be associated with adrenal suppression: Are physicians aware of that? | Oral corticosteroids for asthma exacerbations might be associated with adrenal suppression: Are physicians aware of that?
Oral corticosteroids for asthma exacerbations might be associated with adrenal suppression: Are physicians aware of that?
Overview
Oral corticosteroids (OCS) are a mainstay of treatment for asthma exacerbations, and short-term OCS courses were generally considered to be safe. Our study aimed at investigating the integrity of the HPA axis in children with persistent asthma or recurrent wheezing at the beginning of an inhaled corticosteroids (ICS) trial. Morning basal cortisol was assessed just before the beginning of ICS, and 30, 60, and 90 days later, using Immulite® Siemens Medical Solutions Diagnostic chemiluminescent enzyme immunoassay (Los Angeles, USA; 2006).
In all, 140 children (0.3-15 years old) with persistent asthma or recurrent wheezing have been evaluated and 40% of them reported short-term OCS courses for up to 30 days before evaluation. Out of these, 12.5% had biochemical adrenal suppression but showed adrenal recovery during a three-month ICS trial treatment. In conclusion, short-term systemic courses of corticosteroids at conventional doses can put children at risk of HPA axis dysfunction. ICS treatment does not impair adrenal recovery from occurring. Health practitioners should be aware of the risk of a blunted cortisol response upon
Acknowledgement
Authors Cristina B. Barra, Maria Jussara F. Fontes, Marco Túlio G. Cintra, Renata C. Cruz, Janaína A. G. Rocha, Maíla Cristina C. Guimarães and Ivani Novato Silva
Journal Revista Da Associação Médica Brasileira
| 3 | | R420.00 | |
| | MRI for Detecting Root Avulsions in Traumatic Adult Brachial Plexus Injuries: A Systematic Review and Meta-Analysis of Diagnostic Accuracy | MRI for Detecting Root Avulsions in Traumatic Adult Brachial Plexus Injuries: A Systematic Review and Meta-Analysis of Diagnostic Accuracy
MRI for Detecting Root Avulsions in Traumatic Adult Brachial Plexus Injuries: A Systematic Review and Meta-Analysis of Diagnostic Accuracy
Overview Background Traumatic brachial plexus injuries affect 1% of patients involved in major trauma. MRI is the best test for traumatic brachial plexus injuries, although its ability to differentiate root avulsions (which require urgent reconstructive surgery) from other types of nerve injury remains unknown. The purpose of this study is to evaluate the accuracy of MRI for diagnosing root avulsions in adults with traumatic brachial plexus injuries.
For this systematic review, MEDLINE and Embase were searched from inception to August 20, 2018. Studies of adults with traumatic nonpenetrating unilateral brachial plexus injuries were included. The target condition was root avulsion. The index test was preoperative MRI, and the reference standard was surgical exploration. A bivariate meta-analysis was used to estimate summary sensitivities and specificities of MRI for avulsion. Results Eleven studies of 275 adults performed between 1992 and 2016 were included. Most participants had been injured in motorcycle collisions (84%).
On the basis of limited data, MRI offers modest diagnostic accuracy for traumatic brachial plexus root avulsion(s), and early surgical exploration should remain as the preferred method of diagnosis.
Authors: Ryckie G. Wade , Yemisi Takwoingi, Justin C. R. Wormald, John P. Ridgway, Steven Tanner, James J. Rankine, Grainne Bourke
Journal Radiology
| 3 | | R430.00 | |
| | Prenatal vitamin D supplementation reduces risk of asthma/recurrent wheeze in early childhood: A combined analysis of two randomized controlled trials | Prenatal vitamin D supplementation reduces risk of asthma/recurrent wheeze in early childhood: A combined analysis of two randomized controlled trials
Prenatal vitamin D supplementation reduces risk of asthma/recurrent wheeze in early childhood: A combined analysis of two randomized controlled trials
Overview
We recently published two independent randomized controlled trials of vitamin D supplementation during pregnancy, both indicating a >20% reduced risk of asthma/recurrent wheeze in the offspring by 3 years of age. However, neither reached statistical significance. VDAART (N = 806) and COPSAC2010. (N = 581) randomized pregnant women to daily high-dose vitamin D3 (4,000 IU/d and 2,400 IU/d, respectively) or placebo. All women also received a prenatal vitamin containing 400 IU/d vitamin D3. The primary outcome was asthma/recurrent wheeze from 0-3yrs.
We conducted random effects combined analyses of the treatment effect, individual patient data (IPD) meta-analyses, and analyses stratified by 25(OH)D level at study entry. This combined analysis shows that vitamin D supplementation during pregnancy results in a significant reduced risk of asthma/recurrent wheeze in the offspring, especially among women with 25(OH)D level 30 ng/ml at randomization, where the risk was almost halved. Future studies should examine the possibility of raising 25(OH)D levels to at least 30 ng/ml early in pregnancy or using higher doses than used in our studies
Acknowledgements
Authors Helene M. Wolsk, Bo L. Chawes, Augusto A. Litonjua, Bruce W. Hollis, Johannes Waage, Jakob Stokholm, Klaus Bønnelykke, Hans Bisgaard and Scott T. Weiss.
Journal PLoS One
| 3 | | R465.00 | |
| | Role of viral and bacterial pathogens in causing pneumonia among Western Australian children | Role of viral and bacterial pathogens in causing pneumonia among Western Australian children
Role of viral and bacterial pathogens in causing pneumonia among Western Australian children
Overview
Pneumonia is the leading cause of childhood morbidity and mortality globally. Introduction of the conjugate Haemophilus influenzae B and multivalent pneumococcal vaccines in developed countries including Australia has significantly reduced the overall burden of bacterial pneumonia.
Many respiratory pathogens that are known to cause pneumonia are also identified in asymptomatic children, so the true contribution of these pathogens to childhood community-acquired pneumonia (CAP) remains unclear. We aim to determine the contribution of bacteria and viruses to childhood CAP to inform further development of effective diagnosis, treatment and preventive strategies.
Nasopharyngeal swabs are collected from both cases and controls to detect the presence of viruses and bacteria by PCR; pathogen load will be assessed by quantitative PCR. The prevalence of pathogens detected in cases and controls will be compared, the OR of detection and population attributable fraction to CAP for each pathogen will be determined; relationships between pathogen load and disease status and severity will be explored.
Acknowledgement
Authors Natalie Mejbah Uddin Bhuiyan, Thomas L Snelling, Rachel West, Jurissa Lang, Tasmina Rahman, Meredith L Borland, Ruth Thornton, Lea-Ann Kirkham, Chisha Sikazwe, Andrew C Martin, Peter C Richmond, David W Smith, Adam Jaffe, Christopher C Blyth.
Journal BMJ Open Publisher Cross Mark | 3 | | R430.00 | |
| | Trends in Pediatric Complicated Pneumonia in an Ontario Local Health Integration Network | Trends in Pediatric Complicated Pneumonia in an Ontario Local Health Integration Network
Trends in Pediatric Complicated Pneumonia in an Ontario Local Health Integration Network
Trends in Pediatric Complicated Pneumonia in an Ontario Local Health Integration Network
Overview
Following the introduction of 7-valent pneumo-coccal vaccine (PCV7), while overall rates of invasive pneumococcal disease and pneumo-coccal pneumonia in children declined, rates of empyema increased. We examined changes in the incidence of hospitalization for pediatric complicated pneumonia (PCOMP) in Eastern Ontario, Canada, particularly since the introduction of the 13-valent vaccine (PCV13). A retrospective chart review was carried out evaluating previously healthy children admitted with PCOMP, which included empyema, para-pneumonic effusion, necrotizing pneumonia, and lung abscess between 2002 and 2015.
The number of admissions per year rose most sharply between 2009 and 2012, corresponding to the period following introduction of PCV7 and then the occurrence of pandemic influenza A (H1N1). In children who likely received PCV13, the incidence of PCOMP returned to approximately pre-PCV7 levels. In contrast, rates of PCOMP in older children (who would not have received PCV13) remained elevated during the post-PCV13 time period. While rates of PCOMP, particularly in older children, remain elevated following the introduction of PCV13, this might be expected to resolve with more widespread vaccine coverage with PCV13 and herd immunity.
Acknowledgement
Author
Tahereh Haji , Adam Byrne and Tom KovesiD
Journal
Children (Basel)
Publisher Basel, Switzerland 2018
URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5867495/pdf/children-05-00036.pdf
| 3 | | R450.00 | |
| | Advances in Pharmacotherapy of Tuberculosis | Advances in Pharmacotherapy of Tuberculosis
Advances in Pharmacotherapy of Tuberculosis
Advances in Pharmacotherapy of TuberculosisOverview
Tuberculosis remains a growing threat of infectious diseases of twenty-first century. An attempt to find new anti-tuberculosis agents was made especially to treat multidrug resistant and extensively drug-resistant tuberculosis. One of the most promising drugs is bedaquiline - a new drug approved by Food and Drug Administration (FDA) and by the European Union countries. This compound is intended to treat multi drug-resistant pulmonary tuberculosis in adult patients in combination regimens in case of impossibility of using other drugs. Alarming epidemiological indicators suggesting increased amount of incidents of tuberculosis tended to search for new compounds with potential anti-tuberculosis activity.
This paper is also focused on some interesting molecules in treating multidrug-resistant tuberculosis which are currently tested in clinical studies: delamanid, AZD5847, pretomanid , sutezolid and SQ109 - and some prospective molecules at the level of preclinical studies. Disturbing statistics of frequency of newly recognized tuberculosis or multi-drug resistant tuberculosis was a step to counteract this disease and give some perspectives in clinical trials. The hope in new anti-tuberculosis agents, still tested in clinical studies and the creation of new regimens.
Acknowledgement
Authors Michal Pstragowski, Malgorzata Zbrzezna and Magdalena Bujalska-ZadroØny
Journal Acta Poloniae Pharmaceutica
Publisher Pharmacodynamics, Medical University of Warsaw URL: http://ptfarm.pl/pub/File/Acta_Poloniae/2017/1/003.pdf
| 3 | | R460.00 | |
| | Atezolizumab: feasible second-line therapy for patients with non-small cell lung cancer? A review of efficacy, safety and place in therapy | Atezolizumab: feasible second-line therapy for patients with non-small cell lung cancer? A review of efficacy, safety and place in therapy
Atezolizumab: feasible second-line therapy for patients with non-small cell lung cancer? A review of efficacy, safety and place in therapy
Atezolizumab: feasible second-line therapy for patients with non-small cell lung cancer? A review of efficacy, safety and place in therapy Overview
Advanced non-small cell lung cancer (NSCLC) prognosis is still poor and has recently been reformed by the development of immune checkpoint inhibitors and the approval of anti PD-1 (programmed cell-death 1) treatments such as nivolumab and pembrolizumab in second line. More recently, Atezolizumab (MDPL 3280A), a programmed cell-death-ligand 1 (PD-L1) inhibitor, was also studied in this setting.
Here, we report a review of the literature assessing the efficacy, safety, and place of Atezolizumab in the second-line treatment of advanced NSCLC. We are still far from fully understanding cancer immunity and the mechanisms leading to the success or not of immunotherapy agents. For this reason, we should investigate to a greater level the factors of failure, such as EGFR-mutant tumours.
We performed a literature search of PubMed, American Society of Clinical Oncology, European Society of Medical Oncology and World Conference on Lung Cancer meetings. Atezolizumab showed a good tolerance profile and efficacy in comparison with docetaxel for second-line treatment of advanced NSCLC. Potential predictive biomarkers also have to be assessed.
Acknowledgement
Author Fanny Jean, Pascale Tomasini and Fabrice Berlesi
Journal Therapeutic Advances in Medical Oncology 2017, Vol. 9(12) 769-779 Special Collection/review Immunotherapy for Lung Cancer: Progress, Opportunities and Challenges journals. sagepub.com/home/tam
| 3 | | R445.00 | |
| | Dysfunction of NaV1.4, a skeletal muscle voltage-gated sodium channel, in sudden infant death syndrome (case-control study) | Dysfunction of NaV1.4, a skeletal muscle voltage-gated sodium channel, in sudden infant death syndrome (case-control study)
Dysfunction of NaV1.4, a skeletal muscle voltage-gated sodium channel, in sudden infant death syndrome (case-control study)
Dysfunction of NaV1.4, a skeletal muscle voltage-gated sodium channel, in sudden infant death syndrome (case-control study)
Overview
Sudden infant death syndrome (SIDS) is the leading cause of post-neonatal infant death in high-income countries. Central respiratory system dysfunction seems to contribute to these deaths.
Excitation that drives contraction of skeletal respiratory muscles is controlled by the sodium channel NaV1.4, which is encoded by the gene SCN4A. Variants in NaV1.4 that directly alter skeletal muscle excitability can cause myotonia, periodic paralysis, congenital myopathy, and myasthenic syndrome.
Rare SCN4A variants that directly alter NaV1.4 function occur in infants who had died from SIDS. These variants are predicted to significantly alter muscle membrane excitability and compromise respiratory and laryngeal function. These findings indicate that dysfunction of muscle sodium channels is a potentially modifiable risk factor in a subset of infant sudden deaths.
Acknowledgement
Author Dogan Roope Männikkö, Leonie Wong, David J Tester, Michael G Thor, Richa Sud, Dimitri M Kullmann, Mary G Sweeney, Costin Leu, Sanjay M Sisodiya, David R FitzPatrick, Margaret J Evans, Iona J M Jeffrey, Jacob Tfelt-Hansen, Marta C Cohen, Peter J Fleming, Amie Jaye, Michael A Simpson, Michael J Ackerman, Michael G Hanna, Elijah R Behr, Emma Matthews
Journal
Vol 391 April 14, 2018
Publisher
Cross Mark https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5899997/pdf/main.pdf
| 3 | | R470.00 | |
| | Denture wearing during sleep doubles the risk of pneumonia in the very elderly. | Denture wearing during sleep doubles the risk of pneumonia in the very elderly.
Denture wearing during sleep doubles the risk of pneumonia in the very elderly.
Overview
Poor oral health and hygiene are increasingly recognized as major risk factors for pneumonia among the elderly. To identify modifiable oral health-related risk factors, we prospectively investigated associations between a constellation of oral health behaviours and incident pneumonia in the community-living very elderly. At baseline, 524 randomly selected seniors were examined for oral health status and oral hygiene behaviours as well as medical assessment, including blood chemistry analysis, and followed up annually until first hospitalization for or death from pneumonia. During a 3-year follow-up period, 48 events associated with pneumonia were identified. Among 453 denture wearers, 186 who wore their dentures during sleep were at higher risk for pneumonia than those who removed their dentures at night. In a multivariate Cox model, both perceived swallowing difficulties and overnight denture wearing were independently associated with an approximately 2.3-fold higher risk of the incidence of pneumonia, which was comparable with the HR attributable to cognitive impairment, history of stroke and respiratory disease. In addition, those who wore dentures during sleep were more likely to have tongue and denture plaque, gum inflammation, positive culture for Candida albicans, and higher levels of circulating interleukin-6 as compared with their counterparts. This study provided empirical evidence that denture wearing during sleep is associated not only with oral inflammatory and microbial burden but also with incident pneumonia, suggesting potential implications of oral hygiene programs for pneumonia prevention in the community.
Acknowledgement
Author:
Iinuma T, Arai Y, Abe Y, Takayama M, Fukumoto M, Fukui Y, Iwase T, Takebayashi T, Hirose N, Gionhaku N, Komiyama K
Journal:
Journal of Dental Research
Publisher:
International & American Associations for Dental Research
URL:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4541085/pdf/10.1177_0022034514552493.pdf
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MicrosoftInternetExplorer4 | 3 | | R450.00 | |
| | Oral care and nosocomial pneumonia: a systematic review. | Oral care and nosocomial pneumonia: a systematic review.
Oral care and nosocomial pneumonia: a systematic review.
Overview
To perform a systematic review of the literature on the control of oral biofilms and the incidence of nosocomial pneumonia, in addition to assessing and classifying studies as to the grade of recommendation and level of evidence.
The review was based on PubMed, LILACS, and Scopus databases, from January 1st, 2000 until December 31st, 2012. Studies evaluating oral hygiene care related to nosocomial infections in patients hospitalized in intensive care units were selected according to the inclusion criteria. Full published articles available in English, Spanish, or Portuguese, which approached chemical or mechanical oral hygiene techniques in preventing pneumonia, interventions performed, and their results were included.
Most articles included a study group with chlorhexidine users and a control group with placebo users for oral hygiene in the prevention of pneumonia.
All articles were classified as B in the level of evidence, and 12 articles were classified as 2B and two articles as 2C in grade of recommendation. It was observed that the control of oral biofilm reduces the incidence of nosocomial pneumonia, but the fact that most articles had an intermediate grade of recommendation makes clear the need to conduct randomized controlled trials with minimal bias to establish future guidelines for oral hygiene in intensive care units.
Acknowledgement
Author:
Vilela MC, Ferreira GZ, Santos PS, Rezende NP
Journal:
Einstein (Soa Paulo, Brazil)
Publisher:
Unknown
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4943826/pdf/1679-4508-eins-13-2-0290.pdf | 3 | | R390.00 | |
| | Imaging the heart in pulmonary hypertension: an update. | Imaging the heart in pulmonary hypertension: an update.
Imaging the heart in pulmonary hypertension: an update.
Overview
Non-invasive imaging of the heart plays an important role in the diagnosis and management of pulmonary hypertension (PH), and several well-established techniques are available for assessing performance of the right ventricle, the key determinant of patient survival. While right heart catheterisation is mandatory for establishing a diagnosis of PH, echocardiography is the most important screening tool for early detection of PH. Cardiac magnetic resonance imaging (CMRI) is also a reliable and practical tool that can be used as part of the diagnostic work-up. Echocardiography can measure a range of haemodynamic and anatomical variables (e.g. pericardial effusion and pulmonary artery pressure), whereas CMRI provides complementary information to echocardiography via high-resolution, three-dimensional imaging. Together with echocardiography and CMRI, techniques such as high-resolution computed tomography and positron emission tomography may also be valuable for screening, monitoring and follow-up assessments of patients with PH, but their clinical relevance has yet to be established.
Technological advances have produced new variants of echocardiography, CMRI and positron emission tomography, and these permit closer examination of myocardial architecture, motion and deformation. Integrating these new tools into clinical practice in the future may lead to more precise non-invasive determination of diagnosis, risk and prognosis for PH.
Acknowledgement
Author:
Grünig E, Peacock AJ
Journal:
European respiratory review: an official journal of the European Respiratory Society.
Publisher:
ERS publications
http://err.ersjournals.com/content/24/138/653.long
| 3 | | R370.00 | |
| | Medical Tourism. | Medical Tourism.
Overview
BACKGROUND: Medical tourism is a burgeoning industry in our region. It involves patients travelling outside of their home country for medical treatment.
OBJECTIVE:
This article provides an outline of the current research around medical tourism, especially its impact on Australians.
DISCUSSION:
Patients are increasingly seeking a variety of medical treatments abroad, particularly those involving cosmetic surgery and dental treatment, often in countries in South-East Asia. Adverse events may occur during medical treatment abroad, which raises medico-legal and insurance issues, as well as concerns regarding follow-up of patients. General practitioners need to be prepared to offer advice, including travel health advice, to patients seeking medical treatment abroad
Acknowledgement
Author:
Leggat P
Journal:
Australian family physician.
Publisher:
Focus Environmental
| 3 | | R360.00 | |
| | The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism. | The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism.
The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism.
Overview
Pulmonary embolism (PE) is a potentially life threatening condition requiring adequate diagnosis and treatment. Computed tomography pulmonary angiography (CTPA) is excellent for including and excluding PE, therefore CT is the first-choice diagnostic imaging technique in patients suspected of having acute PE. Due to its wide availability and low invasiveness, CTPA tends to be overused. Correct implementation of clinical decision rules in diagnostic workup for PE improves adequate use of CT. Also, CT adds prognostic value by evaluating right ventricular (RV) function. CT-assessed RV dysfunction and to lesser extent central emboli location predicts PE-related mortality in normotensive and hypotensive patients, while PE embolic obstruction index has limited prognostic value. Simple RV/left ventricular (LV) diameter ratio measures >1.0 already predict risk for adverse outcome, whereas ratios <1.0 can safely exclude adverse outcome.
Consequently, assessing the RV/LV diameter ratio may help identify patients who are potential candidates for treatment at home instead of treatment in the hospital. A minority of patients develop chronic thromboembolic pulmonary hypertension (CTEPH) following acute PE, which is a life-threatening condition that can be diagnosed by CT. In proximal CTEPH, involving the more central pulmonary arteries, thrombectomy usually results in good outcome in terms of both functional status and long-term survival rate. CT is becoming the imaging method of choice for diagnosing CTEPH as it can identify patients who may benefit from thrombectomy.
New CT developments such as distensibility measurements and dual-energy or subtraction techniques may further refine diagnosis and prognosis for improved patient care.
Acknowledgement
Author:
Dogan H, de Roos A, Geleijins J, Huisman MV, Kroft LJ
Journal:
Diagnostic and interventional radiology (Ankara, Turkey)
Publisher:
Turkish Society of Radiology
http://www.dirjournal.org/sayilar/77/buyuk/307-3161.pdf
| 3 | | R380.00 | |
| | Cardiopulmonary Physiotherapy: Pulmonary Rehabilitation for Management of Chronic Obstructive Pulmonary Disease. | Cardiopulmonary Physiotherapy: Pulmonary Rehabilitation for Management of Chronic Obstructive Pulmonary Disease.
Cardiopulmonary Physiotherapy: Pulmonary Rehabilitation for Management of Chronic Obstructive Pulmonary Disease.
Richard Casaburi, Ph.D., M.D., and Richard ZuWallack, M.D.
This online course discusses the successes and failures of a respiratory rehabilitation programme designed for an overweight, sedentary 61-year-old woman who has been diagnosed with chronic obstructive pulmonary disease.
| 3 | | R400.00 | |
| | Diagnosis and Management of Asthma in Children. | Diagnosis and Management of Asthma in Children.
Diagnosis and Management of Asthma in Children.
OVERVIEW
Asthma is a very common illness faced by children the world over. With that said, rather than escalating treatment in severe and problematic cases of childhood cancer, a more systematic approach is needed to find a solution to this problem. Elements of the systematic approach included a review of the diagnosis, adherence, the ability to take drugs correctly as well as the environment of the children in question.
The objective of this article was therefore to review other articles concerning the treatment and management of childhood asthma that should prompt a focused and urgent review of what trigger factors led to asthma attacks and whether the attacks were appropriately managed. Some of the articles that were reviewed during this research were obtained from PubMed and Cochrane database.
However, only articles related to the diagnosis and practical management of asthma were selected for this research. Also, small trials and case series were excluded if the findings had been subsumed into a meta-analysis or Cochrane review.
ACKNOWLEDGEMENT
AUTHORS: Andrew Bush, (paediatrics) and Louise Fleming (senior clinical lecturer)
JOURNAL: BMJ Journals
PUBLISHER: BMJ Open
URL: https://www.group.bmj.com
| 3 | | R400.00 | |
| | Minimally Invasive Methods for Staging in Lung Cancer: Systematic Review and Meta-Analysis. | Minimally Invasive Methods for Staging in Lung Cancer: Systematic Review and Meta-Analysis.
Minimally Invasive Methods for Staging in Lung Cancer: Systematic Review and Meta-Analysis.
OVERVIEW
Recently, the approach to patients with suspected non-small-cell lung cancer (NSCLC), has changed [1]. As a matter of fact, several diagnostic and staging methods have been developed to avoid the use of more invasive techniques.
Surgical methods, such as mediastinoscopy, video assisted thoracoscopy (VATS), mediastinal dissection, and lymph node resection, are the reference standard for lung cancer lymph node staging. Nonetheless, minimally invasive methods, including computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET), as well as bronchoscopic methods, are alternatives with low complication rates and these methods are often used as the first approach for confirming or excluding metastatic disease. The objective of this study was thus to provide a synthesis of the evidence on the diagnostic performance of EBUS + EUS in patients undergoing mediastinal staging. The method used in carrying out this study was a systematic review and meta-analysis aimed at evaluating the diagnostic yield of EBUS + EUS compared with surgical staging.
The study was concluded that EBUS + EUS is a highly accurate and safe procedure and the combined procedure should be considered in selected patients with lymphadenopathy noted at stations that are not traditionally accessible with conventional EBUS.
ACKNOWLEDGEMENT
AUTHOR: Gonzalo Labarca, Carlos Aravena, Francisco Ortega, Alex Arenas, AdnanMajid, Erik Folch, Hiren J.Mehta, Michael A. Jantz, and Sebastian Fernandez-Bussy
JOURNAL: Pulmonary Medicine
PUBLISHER: Hindawi Publishing Corporation
URL: https://www.hindawi.com
| 3 | | R420.00 | |
| | Patient characteristics associated with risk of first hospital admission and re-admission for acute exacerbation of chronic obstructive pulmonary disease (COPD) following primary care COPD diagnosis: a cohort study using linked electronic patient records. | Patient characteristics associated with risk of first hospital admission and re-admission for acute exacerbation of chronic obstructive pulmonary disease (COPD) following primary care COPD diagnosis: a cohort study using linked electronic patient records.
Patient characteristics associated with risk of first hospital admission and re-admission for acute exacerbation of chronic obstructive pulmonary disease (COPD) following primary care COPD diagnosis: a cohort study using linked electronic patient records.
OVERVIEW
Hospital admission for chronic obstructive pulmonary disease (COPD) is a significant burden on healthcare resources. The readmission rates are equally high. As a matter of fact, COPD is the second most common reason for emergency hospital admission in the UK.
The objective of this study was to investigate patient characteristics of an unselected primary care population associated with risk of first hospital admission and readmission for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The design of this study was a retrospective open cohort using pseudonymised electronic primary care data linked to secondary care data. The setting of this study was primary care in Lothian Scotland. Participants of this study were from 7002 patients from 72 general practices with a COPD diagnosis date between 2000 and 2008 recorded in their primary care record. The patients were however followed up until 2010, death or they left a participating practice.
Based on the results of this study, it was concluded that several patient characteristics were associated with first AECOPD admission in a primary care cohort of people with COPD but fewer were associated with readmission.
ACKNOWLEDGEMENT
AUTHOR: L C Hunter, R J Lee, Butcher, C J Weir, C M Fischbacher, D McAllister, S H Wild, N Hewitt, R M Hardie
JOURNAL: Respiratory Medicine
PUBLISHER: BMJ Open
URL: http://bmjopen.bmj.com
| 3 | | R355.00 | |
| | Point-of-care C reactive protein for the diagnosis of lower respiratory tract infection in NHS primary care. | Point-of-care C reactive protein for the diagnosis of lower respiratory tract infection in NHS primary care.
Point-of-care C reactive protein for the diagnosis of lower respiratory tract infection in NHS primary care.
OVERVIEW
Most often, majority of patients presenting to primary care with a suspected lower respiratory tract infection (LRTI) are prescribed antibiotics. That doesn’t however change the fact that most respiratory tract infections are viral and only marginal benefit is achieved from the prescription of antibiotics that in some cases does not outweigh the risk of harm.
The aim of this research was thus to determine the barriers and facilitators to adoption of POC CRP testing in National Health Service (NHS) primary care for the diagnosis of lower respiratory tract infection. This study was however done following a qualitative methodology based on grounded theory. This study was however undertaken in two stages. The first consisted of semi structured interviews with 8 clinicians from Europe and the UK who use the test in routine practice, and focused on their subjective experience in the challenges of implementing POC CRP testing. The second stage on the other hand was a multidisciplinary-facilitated workshop with NHS stakeholders to discuss barriers to adoption, impact of adoption and potential adoption scenarios.
The study concluded that Successful adoption models from the UK and abroad demonstrate a distinctive pattern and involve collaboration with central laboratory services.
ACKNOWLEDGEMENT
AUTHOR: Jeremy R Huddy, Melody Z Ni, James Barlow, Azeem Majeed, George B Hanna
JOURNAL: Journal of Clinical Pathology
PUBLISHER: BMJ Open
URL: http://bmjopen.bmj.com/ | 3 | | R355.00 | |
| | Potential Workload in Applying Clinical Practice Guidelines for Patients with chronic conditions and multimorbidity. | Potential Workload in Applying Clinical Practice Guidelines for Patients with chronic conditions and multimorbidity.
Potential Workload in Applying Clinical Practice Guidelines for Patients with chronic conditions and multimorbidity.
OVERVIEW
Multimorbidity, defined as the coexistence of chronic conditions, is becoming the norm in primary care settings. The objective of this study was to describe the potential workload for patients with multimorbidity when applying existing clinical practice guidelines.
The design for this study was a systematic analysis of clinical practice guidelines for chronic conditions and simulation modelling approach. Data was obtained from the National Guideline Clearinghouse index of US clinical practice guidelines. The most recent guidelines for adults with 1 of 6 prevalent chronic conditions in primary care (i.e. hypertension, diabetes, coronary heart disease (CHD), chronic obstructive pulmonary disease (COPD), osteoarthritis and depression) were identified. From the guidelines, all recommended health-related activities (HRAs) such as drug management, self-monitoring, visits to the doctor, laboratory tests and changes of lifestyle for a patient aged 45–64 years with moderate severity of conditions were extracted.
Results from this study indicated that depending on the concomitant chronic condition, patients with 3 chronic conditions complying with all the guidelines would have to take a minimum of 6 to a maximum of 13 medications per day, visit a health caregiver a minimum of 1.2 to a maximum of 5.9 times per month, etc.
ACKNOWLEDGEMENT
AUTHOR: Céline Buffel du Vaure, Philippe Ravaud, Gabriel Baron, Caroline Barnes, Serge Gilberg, Isabelle Boutron
JOURNAL: BMJ Global Health
PUBLISHER: BMJ Open
URL: http://bmjopen.bmj.com | 3 | | R375.00 | |
| | Practice Issues. | Practice Issues.
OVERVIEW
It is important to note that the responses to the various questions are the views independently expressed and are not necessarily opinions shared by cpdexpress.co.za. As matters involving Ethics and the law are subject to interpretation, the responses cannot, in any way, be regarded as binding or necessarily endorsed by the regulatory authorities.
There are ethical dilemmas regarding patients, colleagues and associates that one doesn’t even consider until they become issues in their practice. There are many questions to be asked regarding ethics, touting, canvassing, advertising, competition and many other issues that need to be addressed and this article addresses most of them. | 3 | | R450.00 | |
| | Primary care randomised controlled trial of a tailored interactive website for the self-management of respiratory infections (Internet Doctor). | Primary care randomised controlled trial of a tailored interactive website for the self-management of respiratory infections (Internet Doctor).
Primary care randomised controlled trial of a tailored interactive website for the self-management of respiratory infections (Internet Doctor).
OVERVIEW
Respiratory tract infection (RTI) is very common and most people suffer from it every year. Some people even suffer from it more than once with consulting primary care at least once each year, which represents a significant call on healthcare resources.
The objective of this stud was to assess an internet-delivered intervention providing advice to manage respiratory tract infections (RTIs). The design for this study was an open pragmatic parallel group randomized controlled trial meanwhile the setting was primary care in the United Kingdom. The participants of this study were adults (aged =18) registered with general practitioners, recruited by postal invitation. The intervention of this research however tailored advices about the diagnosis, natural history, symptom management (particularly paracetamol/ibuprofen use) and when to seek further help.
Out of the 3044 participants that were recruited for this study, 852 in the intervention group and 920 in the control group reported 1 or more RTIs, among whom there was a modest increase in NHS direct contacts in the intervention group (intervention 37/1574 (2.4%) versus control 20/1661 (1.2%); multivariate risk ratio (RR) 2.25 (95% CI 1.00 to 5.07, p=0.048)).
ACKNOWLEDGEMENT
AUTHORS: Paul Little, Beth Stuart, Panayiota Andreou, Lisa McDermott, Judith Joseph, Mark Mullee, Mike Moore, Sue Broomfield, Tammy Thomas, Lucy Yardley
JOURNAL: Respiratory Medicine
PUBLISHER: BMJ Open
URL: http://bmjopen.bmj.com | 3 | | R330.00 | |
| | Private Practice: The Do's And Don'ts. | Private Practice: The Do's And Don'ts.
Private Practice: The Do's And Don'ts.
OVERVIEW
You have studied extensively to become a healthcare professional in your field of study. You have learned and become adept at identifying a vast range of conditions. You can diagnose and effectively treat those conditions within the scope of the discipline.
Now you are faced with a plethora of dilemmas. What is fair value for your services? What appliances are appropriate and reasonable? What commercial and legal structures are appropriate for you? What influence may these commercial and legal structures have on your clinical recommendations? Who may have access to your record cards? What responsibility can you delegate to your staff? Who carries final responsibility for payment of your claims – member or medical aid? What constitutes anti-competitive behavior?
This is a very informative article that will help you to run your practice within the various guidelines. | 3 | | R400.00 | |
| | The Effect of Exercise on Respiratory Resistance in Athletes with and without Paradoxical Vocal Fold Motion Disorder. | The Effect of Exercise on Respiratory Resistance in Athletes with and without Paradoxical Vocal Fold Motion Disorder.
The Effect of Exercise on Respiratory Resistance in Athletes with and without Paradoxical Vocal Fold Motion Disorder.
OVERVIEW
In people with exercise-induced paradoxical vocal fold motion disorder (PVFMD), breathing is abnormally impeded at the level of the larynx during exercise. This situation can result to dyspnea and the reduced ability to continue strenuous activity.
The purpose of this study was thus to assess inspiratory (Ri) and expiratory (Re) resistances during resting tidal breathing (RTB), post-exercise breathing (PEB), and recovery breathing (RB) in athletes with and without paradoxical vocal fold motion disorder (PVFMD). In the course of this study, twenty-four teenage female athletes, (12 with and 12 without PVFMD), breathed into the Airflow Perturbation Device for baseline measures of respiratory resistance for two successive 1-min trials after treadmill running for up to 12 min. It is worth mentioning that the exercise duration and dyspnea ratings were collected and compared across groups.
Results of this study indicated that athletes with PVFMD had lower than control Ri and Re values during RTB that significantly increased at PEB and decreased during RB.
ACKNOWLEDGEMENT
AUTHORS: Sally J. K. Gallena, Nancy Pearl Solomon, Arthur T. Johnson, Jafar Vossoughi, and Wei Tian
JOURNAL: American Journal of Speech-Language Pathology
PUBLISHER: American Speech-Hearing Association (ASHA)
URL: http://www.asha.org | 3 | | R350.00 | |