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1دورية أكاديمية
المؤلفون: David Martin Shaw, Bernice S. Elger
المصدر: Swiss Medical Weekly, Vol 143, Iss 1920 (2013)
مصطلحات موضوعية: clinical trials, education, medical ethics, medical law, relevance, research ethics, Medicine
الوصف: A new Swiss law requires that any research involving humans must aim to answer “a relevant research question”. This paper explains the relevance of the relevance criterion in research, analyses the Swiss and British guidelines on relevance, and proposes a framework for researchers and research ethics committee (REC) members that enables a clearer conception of the role of relevance in research. We conclude that research must be either scientifically or societally beneficial in order to qualify as relevant, and RECs therefore cannot avoid reviewing the scientific aspects of proposed studies. Normally only scientifically relevant studies can be of benefit to society, but research of low scientific relevance can nonetheless be relevant to society if it forms part of the education of new doctors and scientists.
وصف الملف: electronic resource
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المؤلفون: Mary Ellen Gray, David Martin, Fareed N. Ali, Jonathan S. Silver, Matthew F Yuyun, G. Muqtada Chaudhry
المصدر: JACC Case Reports
JACC: Case Reports, Vol 2, Iss 5, Pp 796-801 (2020)مصطلحات موضوعية: 0301 basic medicine, medicine.medical_specialty, CRT, cardiac resynchronization therapy, medicine.medical_treatment, health care facilities, manpower, and services, education, Cardiomyopathy, Case Report, macromolecular substances, 030105 genetics & heredity, LVEF - Left ventricular ejection fraction, 03 medical and health sciences, 0302 clinical medicine, implantable cardioverter-defibrillator, Clinical Case, Internal medicine, Primary prevention, LVEF, left ventricular ejection fraction, VT, ventricular tachycardia, Diseases of the circulatory (Cardiovascular) system, Medicine, elective replacement indicator, health care economics and organizations, VF - Ventricular fibrillation, EOL, end of life, business.industry, AV, atrioventricular, ventricular arrhythmias, Implantable cardioverter-defibrillator, medicine.disease, ICD, implantable cardioverter-defibrillator, LAD, left anterior descending coronary artery, ERI, elective replacement indicator, Nonischemic cardiomyopathy, NSVT, nonsustained ventricular tachycardia, RC666-701, Cardiology, VF, ventricular fibrillation, VT - Ventricular tachycardia, Cardiology and Cardiovascular Medicine, business, cardiomyopathy, 030217 neurology & neurosurgery
الوصف: We present the case of a 57-year-old man with a primary prevention internal cardioverter-defibrillator for severe nonischemic cardiomyopathy. At the time of elective replacement indicator, systolic function had fully recovered, and his generator was not changed. Nearly 5 years post–elective replacement indicator he received appropriate internal cardioverter-defibrillator therapies during a myocardial infarction. (Level of Difficulty: Intermediate.)
Graphical abstract
We present the case of a 57-year-old man with a primary prevention internal cardioverter-defibrillator for severe nonischemic cardiomyopathy… -
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المؤلفون: Christina D. Chambers, Claire W. Rothschild, Juliane S. Reynolds, Chayim Herzig-Marx, Predrag Klasnja, Jeffrey S. Brown, David Martin, Sascha Dublin, Zachary Wyner
المصدر: Pharmacoepidemiology and drug safetyREFERENCES. 31(1)
مصطلحات موضوعية: medicine.medical_specialty, Epidemiology, Population, Pilot Projects, Pregnancy, Surveys and Questionnaires, medicine, Humans, Pharmacology (medical), Generalizability theory, Medical prescription, education, Depression (differential diagnoses), education.field_of_study, business.industry, Delivery of Health Care, Integrated, Panic, medicine.disease, Mobile Applications, Clinical research, Family medicine, Anxiety, Female, Pregnant Women, medicine.symptom, business
الوصف: Purpose Mobile applications ("apps") may be efficient tools for improving the quality of clinical research among pregnant women, but evidence is sparse. We assess the feasibility and generalizability of a mobile app for capturing supplemental data during pregnancy. Methods In 2017, we conducted a pilot study of the FDA MyStudies mobile app within a pregnant population identified through Kaiser Permanente Washington (KPWA), an integrated healthcare delivery system. We ascertained health conditions, medications, and substance use through app-based questionnaires. In a post-hoc analysis, we utilized electronic health records (EHR) to summarize sociodemographic and health characteristics of pilot participants and, for comparison, a pregnant population identified using similar methods. Results Six percent (64/1070) of contacted women enrolled in the pilot study. Nearly half (23/53) reported taking medication for headaches and one-fourth for constipation (13/53) and nausea (12/53) each. Few instances (2/92) of over-the-counter medication use were identified in electronic dispensing records. One-quarter to one-third of participants with depression and anxiety/panic, respectively, reported recently discontinuing medications for these conditions. Eighty-eight percent of pilot participants reported White race (95%CI: 81-95%), versus 67% of the comparison population (N = 2065). More pilot participants filled ≥1 prescription for antianxiety medication (22% [95%CI: 13-35%]) and antidepressants (19% [95%CI 10-31%]) pre-pregnancy than the comparison population (10 and 9%, respectively). Conclusions Mobile apps may be a feasible tool for capturing health data not routinely available in EHR. Pregnant women willing to use a mobile app for research may differ from the general pregnant population, but confirmation is needed.
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المؤلفون: Francis Okongo, Donald Maxwell Parkin, David Martin Ogwang, Biying Liu
المصدر: International Journal of Cancer. 144:2985-2991
مصطلحات موضوعية: Male, Cancer Research, Adolescent, Population, 03 medical and health sciences, 0302 clinical medicine, Breast cancer, Neoplasms, medicine, Humans, Uganda, Registries, Child, education, Cervical cancer, education.field_of_study, business.industry, Incidence, Incidence (epidemiology), Infant, Newborn, Infant, Cancer, medicine.disease, Cancer registry, Non-Hodgkin's lymphoma, Oncology, Child, Preschool, 030220 oncology & carcinogenesis, Female, Skin cancer, business, Demography
الوصف: Gulu Cancer Registry was established in 2014 to assess the incidence and survival of cancer in 4 districts of the Acholi Sub-region of northern Uganda. Here we report the results of the first 4 years of registration (2013-2016) in this largely rural population of 771,514. In total there were 1627 cases of cancers registered; 644 among men (corresponding to an ASR of 106.7 per 100,000 population) and 983 cancer cases among women (ASR 118.5 per 100,000). The most common cancers were cancers of the cervix and non-Hodgkin Lymphoma in females, and non-Hodgkin Lymphoma, Kaposi Sarcoma, prostate and liver cancers in men. Incidence rates of Burkitt lymphoma in children were high in comparison to elsewhere in Africa, whilst the incidence of breast cancer in women was rather low. The figures suggest a rather different pattern from that observed in the metropolitan population of Kampala, where there has been a cancer registry since 1951. This helps to provide a more complete picture of the national cancer profile, permitting more targeted interventions in prevention, early detection and treatment services.
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المؤلفون: Jonathan Davies, Christoph Teufel, Jazz Croft, Paul Madley-Dowd, David Martin, Jon Heron, Daniela Strelchuk, Stanley Zammit
المصدر: PLoS ONE, Vol 16, Iss 2, p e0246948 (2021)
Croft, J, Martin, D, Madley-Dowd, P, Strelchuk, D, Davies, J, Heron, J, Teufel, C & Zammit, S 2021, ' Childhood trauma and cognitive biases associated with psychosis : A systematic review and meta-analysis ', PLoS ONE, vol. 16, no. 2, e0246948 . https://doi.org/10.1371/journal.pone.0246948
PLoS ONEمصطلحات موضوعية: Child abuse, Epidemiology, Social Sciences, Criminology, Pediatrics, Database and Informatics Methods, 0302 clinical medicine, Mathematical and Statistical Techniques, Cognition, Sociology, Risk Factors, Medicine and Health Sciences, Psychology, Public and Occupational Health, Child Abuse, Database Searching, Child, Problem Solving, media_common, Multidisciplinary, Schools, Statistics, Traumatic Injury Risk Factors, Metaanalysis, Research Assessment, Cognitive bias, Locus of control, Meta-analysis, Physical Sciences, Research Reporting Guidelines, Medicine, Crime, Clinical psychology, Research Article, Psychosis, media_common.quotation_subject, Science, Research and Analysis Methods, Education, 03 medical and health sciences, Bias, Perception, Mental Health and Psychiatry, medicine, Humans, Statistical Methods, Association (psychology), Cognitive Psychology, Psychoses, Biology and Life Sciences, medicine.disease, 030227 psychiatry, Psychotic Disorders, Medical Risk Factors, Cognitive Science, Attribution, 030217 neurology & neurosurgery, Mathematics, Neuroscience
الوصف: Childhood trauma is associated with an increased risk of psychosis, but the mechanisms that mediate this relationship are unknown. Exposure to trauma has been hypothesised to lead to cognitive biases that might have causal effects on psychotic symptoms. The literature on whether childhood trauma is associated with psychosis-related cognitive biases has not been comprehensively reviewed. A systematic review and meta-analysis or narrative synthesis of studies examining the association between childhood trauma and the following biases: external locus of control (LOC), external attribution, probabilistic reasoning, source monitoring, top-down processing, and bias against disconfirmatory evidence. Studies were assessed for quality, and sources of heterogeneity were explored. We included 25 studies from 3,465 studies identified. Individuals exposed to childhood trauma reported a more external LOC (14 studies: SMD Median = 0.40, Interquartile range 0.07 to 0.52), consistent with a narrative synthesis of 11 other studies of LOC. There was substantial heterogeneity in the meta-analysis (I2 = 93%) not explained by study characteristics examined. Narrative syntheses for other biases showed weaker, or no evidence of association with trauma. The quality of included studies was generally low. Our review provides some evidence of an association between childhood trauma and a more external LOC, but not with the other biases examined. The low quality and paucity of studies for most of the cognitive biases examined highlights the need for more rigorous studies to determine which biases occur after trauma, and whether they mediate an effect of childhood trauma on psychosis.
وصف الملف: application/pdf
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المؤلفون: Kevin Haynes, Thomas Harkins, Nancy D. Lin, Crystal Garcia, Vinit P. Nair, Sean D. Pokorney, Noelle M. Cocoros, David Martin, Sana M. Al-Khatib, Christopher B. Granger, Lauren E. Parlett, Hussein R. Al-Khalidi, Jennifer C. Goldsack, Cheryl N. McMahill-Walraven, Richard Platt, Debbe McCall, Hana Lipowicz
المصدر: Am Heart J
مصطلحات موضوعية: Male, medicine.medical_specialty, Anemia, Population, Administration, Oral, Pharmacy, Comorbidity, 030204 cardiovascular system & hematology, Health Services Misuse, Risk Assessment, Article, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Risk Factors, Internal medicine, Atrial Fibrillation, Medicine, Humans, 030212 general & internal medicine, education, Stroke, Aged, Aged, 80 and over, education.field_of_study, Health Services Needs and Demand, Insurance, Health, business.industry, Anticoagulants, Atrial fibrillation, medicine.disease, Quality Improvement, United States, Cohort, Female, Diagnosis code, Cardiology and Cardiovascular Medicine, business
الوصف: BACKGROUND: Although oral anticoagulants (OACs) have been shown to substantially reduce the risk of stroke and other thromboembolic events in patients with atrial fibrillation (AF), these medications are significantly underutilized in clinical practice. However, many studies showing underuse of OACs predated the advent of the non-vitamin K antagonist oral anticoagulants. We conducted this study to examine use of OACs in a large commercially insured population, which was enrolled in a randomized trial to address underuse of OACs. METHODS: Administrative health care claims data from 5 research partners who participate in the FDA-Catalyst, a program of the Sentinel Initiative, were queried in September 2017 to identify patients ≥30 years old with ≥365 days of medical/pharmacy coverage, ≥2 diagnosis codes for AF, a CHA(2)DS(2)-VASc score ≥2, absence of selected conditions for which OAC use is contraindicated, and no evidence of OAC use in the 365 days prior to the index AF diagnosis. The identified cohort has been targeted for enrollment in the IMPACT-AFib trial, a randomized clinical trial evaluating the effect of patient and provider education interventions on the use of OACs. RESULTS: A total of 241,044 AF patients met the cohort eligibility criteria prior to assessment of OAC treatment. In this cohort, 220,869 (92%) patients were ≥ 65 years old and 94,459 (39%) patients were ≥ 80 years old. Patients were randomized to early or delayed intervention. Among 120,522 patients randomized to the early intervention arm, 43,826 (36%) had no evidence of OAC use in the prior 12 months. Compared with patients with evidence of an OAC use in the prior 12 months, patients without OAC use were more likely to be 80 years of age or older, women, and residents of the Midwest region. Patients without OAC use were more likely to have a history of anemia (52% vs. 48%) and less likely to have diabetes (39% vs. 44%), a history of stroke or TIA (17% vs. 20%), and a history of heart failure (40% vs. 48%). The mean CHA(2)DS(2)-VASc score was 5 for both the OAC and no-OAC recipients; however, patients with no OAC use had a higher ATRIA score (39% vs. 35%). CONCLUSIONS: Data from a large privately insured population show that despite a high risk of stroke, over one third of patients with AF and no obvious contraindications to an OAC were not treated with an OAC in the prior 12 months. Thus, there is an unmet medical need for studies that develop evidence-based interventions that could lead to greater use of OACs in patients with AF who are at risk for stroke.
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المؤلفون: Hal David Martin, RobRoy L. Martin, Benjamin R. Kivlan
المصدر: International Journal of Sports Physical Therapy. 12:1163-1173
مصطلحات موضوعية: 030222 orthopedics, medicine.medical_specialty, education.field_of_study, medicine.diagnostic_test, business.industry, medicine.medical_treatment, Population, Neurectomy, Physical examination, Sequela, medicine.disease, Surgery, 03 medical and health sciences, Entrapment, 0302 clinical medicine, medicine.anatomical_structure, medicine, Clinical Commentary, Manual therapy, business, education, 030217 neurology & neurosurgery, Neurolysis, Pelvis
الوصف: The purpose of this clinical commentary is to review the anatomy, etiology, evaluation, and treatment techniques for nerve entrapments of the hip region. Nerve entrapment can occur around musculotendinous, osseous, and ligamentous structures because of the potential for increased strain and compression on the peripheral nerve at those sites. The sequela of localized trauma may also result in nerve entrapment if normal nerve gliding is prevented. Nerve entrapment can be difficult to diagnose because patient complaints may be similar to and coexist with other musculoskeletal conditions in the hip and pelvic region. However, a detailed description of symptom location and findings from a comprehensive physical examination can be used to determine if an entrapment has occurred, and if so where. The sciatic, pudendal, obturator, femoral, and lateral femoral cutaneous are nerves that can be entrapped and serve a source of hip pain in the athletic population. Manual therapy, stretching and strengthening exercises, aerobic conditioning, and cognitive-behavioral education are potential interventions. When conservative treatment is ineffective at relieving symptoms surgical treatment with neurolysis or neurectomy may be considered. Level of Evidence 5
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::35b96166763cbfe03869ce7e9fd33cbc
https://doi.org/10.26603/ijspt20171163 -
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المؤلفون: Mahdi Malekpour, Diane Leonard, Denise Torres, Susan Baro, James Dove, Nina Neuhaus, Mohsen Shabahang, Jeffrey Wild, Marie Hunsinger, Kenneth Widom, Joseph Blansfield, David Martin, Megan Rapp
المصدر: The American Journal of Surgery. 213:399-404
مصطلحات موضوعية: Adult, Diagnostic Imaging, Male, Patient Transfer, Rural Population, Emergency Medical Services, medicine.medical_specialty, Time Factors, education, Population, Traumatology, Cohort Studies, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Trauma Centers, medicine, Emergency medical services, Humans, 030212 general & internal medicine, Young adult, Referral and Consultation, Patient transfer, Aged, Retrospective Studies, Patient Care Team, education.field_of_study, business.industry, 030208 emergency & critical care medicine, Retrospective cohort study, General Medicine, Middle Aged, Pennsylvania, Emergency medicine, Wounds and Injuries, Female, Surgery, Rural Health Services, Rural area, business, Cohort study
الوصف: The majority of the US population live in urban areas, yet more than half of all trauma deaths occur in rural areas. The Rural Trauma Team Development Course (RTTDC) is developed to improve the outcomes of rural trauma and we aimed to study its effect on patient transfer.Trauma referrals 2 years before the RTTDC training were compared with referrals 2 years after the course.Of the 276 studied patients, 97 were referred before the RTTDC training and 179 patients were referred after the course. Transfer acceptance time was significantly shorter after the RTTDC training (139.2 ± 87.1 vs 110 ± 66.3 min, P = .003). The overall transfer time was also significantly reduced following the RTTDC training (257.4 ± 110.8 vs 219.2 ± 86.5 min, P = .002). Patients receiving pretransfer imaging had a significantly higher transfer time both before and after RTTDC training (all Ps.01). Mortality was nearly halved (6.2% vs 3.4%) after the RTTDC training.The RTTDC training was associated with reduced transfer acceptance time and reduced transfer time.
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المؤلفون: Anna A. Kuang, Brian S. Diggs, Nick O. Esmonde, Heike Gries, Martin A. Schreiber, Nathan R. Selden, David Martin, Jeffrey L. Koh
المصدر: Journal of Craniofacial Surgery. 27:1527-1531
مصطلحات موضوعية: medicine.medical_specialty, Population, Blood Loss, Surgical, Hemorrhage, 030230 surgery, Hematocrit, Craniosynostosis, Craniosynostoses, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Blood product, Antifibrinolytic agent, Humans, Medicine, education, Retrospective Studies, education.field_of_study, Surgical team, medicine.diagnostic_test, business.industry, Infant, General Medicine, Perioperative, medicine.disease, Antifibrinolytic Agents, Surgery, Tranexamic Acid, Otorhinolaryngology, Anesthesia, business, 030217 neurology & neurosurgery, Tranexamic acid, medicine.drug
الوصف: Pediatric cranial vault remodeling for repair of craniosynostosis is associated with significant blood loss and transfusion requirements. Beginning in 2011, the authors evaluated the impact tranexamic acid (TXA) on blood loss and blood product transfusion for children less than 15 months of age undergoing primary surgical repair of nonsyndromic single suture craniosynostosis.Following institutional review board approval, the authors performed a retrospective study of all children undergoing surgical correction of craniosynostosis at Oregon HealthScience University from 2005 to 2015. All available records were reviewed, and patient data were collected from the time of preoperative evaluation until discharge, comparing patient and clinical variables before and after the implementation of perioperative TXA.Of a total of 259 patients with craniosynostosis, 187 had nonsyndromic single-suture involvement; 69 of these patients (36.9%) received TXA. A single surgical team (AAK and NRS) performed all operations. Median age at the time of surgery was 8.1 months (interquartile range [IQR] of 6.0-9.8 months). The TXA group had a significant reduction in estimated intraoperative blood loss (26 mL/kg versus 36 mL/kg, P 0.001), cell saver volume transfused 6 mL/kg versus 10 mL/kg, P 0.001), red cell transfusion volume (32 mL/kg versus 42 mL/kg, P 0.001), exposure to plasma transfusion (0% versus 24% P 0.001), exposure to cryoprecipitate transfusion (0% versus 16%, P 0.001), and exposure to platelet transfusion (0% versus 7.6% P = 0.03). Despite reduced red cell transfusion, the TXA-treated patients exhibited similar postoperative hematocrits (30.4 versus 30.3 P = 0.906) to those not treated with TXA. Use of TXA was associated with reduced length of stay (4 days IQR 3-4 versus 4 days IQR 4-5, P 0.001) and reduced postoperative output from surgically placed drains (181 mL versus 311 mL P 0.001). There was no difference in postoperative complications between groups and no deaths in either group.The introduction of TXA for nonsyndromic single-suture synostosis repair at our institution has significantly reduced blood loss and blood product and plasma transfusion during and following primary cranial vault remodeling for single suture craniosynostosis. Postoperative hematocrit was similar in the TXA-treated and untreated groups despite reduced red cell transfusion in the treated group. In addition, TXA use in this population has eliminated the need for plasma transfusion, and is associated with a shorter hospital stay. No difference in postoperative complications was observed. Our data provide support for further investigation of TXA treatment to improve clinical outcomes in children undergoing pediatric cranial vault remodeling.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::9a995e7704c58fd784d2f1f9cd88d528
https://doi.org/10.1097/scs.0000000000002835 -
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المصدر: Echocardiography (Mount Kisco, N.Y.). 35(5)
مصطلحات موضوعية: Male, medicine.medical_specialty, Heart Ventricles, Ventricular Dysfunction, Right, Population, Constriction, Pathologic, 030204 cardiovascular system & hematology, Metabolic equivalent, Hiatal hernia, 03 medical and health sciences, 0302 clinical medicine, Left atrial, Internal medicine, medicine, Ventricular outflow tract, Humans, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Heart Atria, education, Aged, Retrospective Studies, education.field_of_study, Exercise Tolerance, business.industry, Stomach, Compression (physics), medicine.disease, Echocardiography, Doppler, medicine.anatomical_structure, Hernia, Hiatal, Echocardiography, Cardiology, Ventricular Function, Right, Atrial Function, Left, Female, Cardiology and Cardiovascular Medicine, business, Large hiatal hernia, Follow-Up Studies
الوصف: INTRODUCTION Large hiatal hernia (HH) is often associated with left atrial (LA) compression, anteroposterior cardiac compression (manifesting as reduced right ventricular outflow tract (RVOT) diameter), and left ventricular (LV) compression (manifesting as systolic paradoxical outward motion (LV-PM) of the posterobasal LV segment). Exercise impairment, also common in this population, improves following HH surgery. We aimed to identify echocardiographic parameters independently associated with exercise impairment due to HH-mediated cardiogenic compression. METHODS Patients with a large HH (>30% intra-thoracic stomach, n = 163) referred for cardiac evaluation were included. Echocardiographic parameters were retrospectively analyzed in relation to HH-related LA compression severity and the presence of LV-PM. Echocardiographic parameters independently associated with exercise capacity were identified by multivariable analysis. RESULTS Mean baseline metabolic equivalents were reduced (70 ± 28% predicted). Moderate-severe LA compression and LV-PM were present in 91 of 163 (56%) and 65 of 162 (40%) patients, respectively. Patients with moderate-severe LA compression and LV-PM had decreased LA and LV dimensions. Moderate-severe LA compression was also associated with reduced RVOT diameter while LV-PM predicted a greater reduction in LV volumes. LA compression and RVOT diameter were independently associated with baseline exercise capacity and increased following HH surgery performed in a subgroup (n = 72, LA diameter: 14 ± 5 vs 20 ± 4 mm/m2 ; RVOT diameter: 17 ± 3 vs 19 ± 3 mm/m2 , P
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