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Clear Consensus (clear + consensus)
Selected AbstractsA new endoscopic technique for suspension of esophageal prosthesis for refractory caustic esophageal stricturesDISEASES OF THE ESOPHAGUS, Issue 3 2008E. Ancona SUMMARY., There is no clear consensus concerning the best endoscopic treatment of benign refractory esophageal strictures due to caustic ingestion. Different procedures are currently used: frequent multiple dilations, retrievable self-expanding stent, nasogastric intubation and surgery. We describe a new technique to fix a suspended esophageal silicone prosthesis to the neck in benign esophageal strictures; this permits us to avoid the frequent risk of migration of the expandable metallic or plastic stents. Under general anesthesia a rigid esophagoscope was placed in the patient's hypopharynx. Using transillumination from the optical device, the patient's neck was pierced with a needle. A n.0 monofilament surgical wire was pushed into the needle, grasped by a standard foreign body forceps through the esophagoscope and pulled out of the mouth (as in percutaneous endoscopic gastrostomy procedure). After tying the proximal end of the silicone prosthesis with the wire, it was placed through the strictures under endoscopic view. This procedure was successfully utilized in four patients suffering from benign refractory esophageal strictures due to caustic ingestion. The prosthesis and its suspension from the neck were well-tolerated until removal (mean duration 4 months). A postoperative transitory myositis was diagnosed in only one patient. One of the most frequent complications of esophageal prostheses in refractory esophageal strictures due to caustic ingestion is distal migration. Different solutions were proposed. For example the suspension of a wire coming from the nose and then fixed behind the ear. This solution is not considered optimal because of patient complaints and moreover the aesthetic aspect is compromised. The procedure we utilized in four patients utilized the setting of a silicone tube hanging from the neck in a way similar to that of endoscopic pharyngostomy. This solution is a valid alternative both for quality of life and for functional results. [source] Members of the IclR family of bacterial transcriptional regulators function as activators and/or repressorsFEMS MICROBIOLOGY REVIEWS, Issue 2 2006Antonio J. Molina-Henares Abstract Members of the IclR family of regulators are proteins with around 250 residues. The IclR family is best defined by a profile covering the effector binding domain. This is supported by structural data and by a number of mutants showing that effector specificity lies within a pocket in the C-terminal domain. These regulators have a helix-turn-helix DNA binding motif in the N-terminal domain and bind target promoters as dimers or as a dimer of dimers. This family comprises regulators acting as repressors, activators and proteins with a dual role. Members of the IclR family control genes whose products are involved in the glyoxylate shunt in Enterobacteriaceae, multidrug resistance, degradation of aromatics, inactivation of quorum-sensing signals, determinants of plant pathogenicity and sporulation. No clear consensus exists on the architecture of DNA binding sites for IclR activators: the MhpR binding site is formed by a 15-bp palindrome, but the binding sites of PcaU and PobR are three perfect 10-bp sequence repetitions forming an inverted and a direct repeat. IclR-type positive regulators bind their promoter DNA in the absence of effector. The mechanism of repression differs among IclR-type regulators. In most of them the binding sites of RNA polymerase and the repressor overlap, so that the repressor occludes RNA polymerase binding. In other cases the repressor binding site is distal to the RNA polymerase, so that the repressor destabilizes the open complex. [source] The Role of Private Equity in Life SciencesJOURNAL OF APPLIED CORPORATE FINANCE, Issue 2 2010Jeff Greene In a roundtable published in this journal a year ago, there was a clear consensus that the R&D function in big pharma was inefficient and in need of major restructuring, possibly through increased investments by venture capital and private equity firms. In this discussion, an accomplished group of industry practitioners begins by looking at the prospects for both venture capital and private equity to play meaningful roles in financing early- and mid-stage drug development. In so doing, they explore questions like the following: , Are there ways for big pharma and biotech to reduce "science risk" and make R&D funding more profitable and attractive to venture capital and private equity,and perhaps even hedge funds? , What roles do you see for specialty PE firms like Symphony Capital and Paul Capital, which are now bundling mid-stage development assets and securitizing royalties? Then the panelists turn to the broader life sciences industry and consider the outlook for leveraged private equity transactions involving marketed products, late-stage development, and services. Here they consider issues like the following: , Will PE be attracted to less-R&D-intensive activities like medtech and generics? , Have the recent consolidation through mergers and reorganization of big pharma into decentralized business units created opportunities for carve-outs of certain businesses? For big pharma and life sciences companies in general, the answers to such questions point to greater specialization and focus achieved partly through strategic alliances with venture capital, private equity, and even hedge funds, and involving marketed products and services as well as early-stage drug development. [source] Building a consensus regarding the nature and origin of mesenchymal stem cellsJOURNAL OF CELLULAR BIOCHEMISTRY, Issue S38 2002Donald G. PhinneyArticle first published online: 23 APR 200 Abstract Mesenchymal stem cells (MSCs) are believed to be the common precursors to differentiated cell lineages found in bone and bone marrow, including adipocytes, chondrocytes, osteoblasts, and hematopoiesis-supporting stroma. Apart from this fact, most aspects of MSC biology, including their ontogeny, anatomical location in marrow, and in vivo functions remain vague. Attempts to clarify these issues have produced confounding results, principally due to the fact that many researchers employ different methods to culture MSCs, assess their differentiation potential, and evaluate their capacity for self-renewal. Accordingly, the current status of the field appears fragmentary with no clear consensus on how to define the cells. In describing past and present contributions to the field of MSC research, I will demonstrate that the apparent incongruity of the literature is misleading, and that an unbiased interpretation reveals a fairly cohesive picture of MSC biology. J. Cell. Biochem. Suppl. 38: 7,12, 2002. © 2002 Wiley-Liss, Inc. [source] Psychopathy: A confusing clinical constructJOURNAL OF FORENSIC NURSING, Issue 1 2008BSc. (Hons.) Psych., Christine A. Kirkman C. Psychol., R.M.N. Abstract Although psychopathy has traditionally been cited as a disorder of personality, confusion arises as the term is used interchangeably with the terms antisocial personality disorder and dissocial personality disorder, both of which are largely behaviorally based. This paper aims to provide an overview of the literature on the topic of psychopathy, which examines this conundrum. Included in the discussion are definitions of psychopathy, incidence, approaches to diagnosis, and the debates that surround causes, manifestations, and treatability. Experimental studies and theoretical papers have been included if considered to be informative and of relevance to forensic nursing practice. The review demonstrates that studies are fragmented and no clear consensus seems to emerge concerning any of the discussion areas or even the construct of psychopathy itself. It is concluded that further research is required in psychopathy as encountered in both institutional and community settings. Until complete clarification is provided by the research community, forensic nurses need to maintain positive views about their own role when working with people with this challenging condition and strive to maintain a therapeutic ward atmosphere. [source] Management of well-differentiated thyroid carcinoma presenting within a thyroglossal duct cystJOURNAL OF SURGICAL ONCOLOGY, Issue 3 2002Snehal G. Patel MD Abstract Background and Objective Well-differentiated thyroid carcinoma (WDTC) is diagnosed in approximately 1.5% of thyroglossal duct cysts (TGDC). No clear consensus exists regarding further management after adequate excision of the cyst, especially the role of total thyroidectomy and postoperative radioactive iodine therapy. The current review was undertaken in an attempt to clarify these issues. Methods Demographic, clinical, tumor, treatment, pathology, and outcome data on 57 eligible patients reported in recent literature were pooled together with 5 patients treated at our institution for this analysis. Results A Sistrunk operation was performed for resection of the thyroglossal duct cyst in the majority (90%) of patients. Histologic examination of the tumor in the cyst revealed that papillary carcinoma was the most frequent (92%) histologic type. A total thyroidectomy was performed consequent to the diagnosis of thyroglossal duct cyst carcinoma in approximately half of the 62 patients. A malignant tumor was reported in 27% of the thyroidectomy specimens. Postoperative radioactive iodine therapy was administered in 16 (26%) patients. With a median follow-up of 71 months (range 1,456 months), the 5- and 10-year Kaplan,Meier overall survival was 100 and 95.6%, respectively. There were no disease-related deaths reported in any of the patients. Univariate analysis revealed that the only significant predictor of overall survival was the extent of primary surgery for the thyroglossal cyst. The addition of total thyroidectomy to Sistrunk operation did not have a significant impact on outcome (P,=,0.1). Patients treated with postoperative radioactive iodine (RAI) fared significantly worse than those that did not need RAI, which may be explained by the fact that this modality would generally be used in patients with higher risk tumors. Conclusions The Sistrunk operation is adequate for most patients with incidentally diagnosed TGDC carcinoma in the presence of a clinically and radiologically normal thyroid gland. Results of adequate excision using the Sistrunk operation are excellent and the concept of risk-groups should be used to identify patients, who would benefit from more aggressive treatment. J. Surg. Oncol. 2002;79:134,139. © 2002 Wiley,Liss, Inc. [source] Pathophysiology of the antiphospholipid syndromeJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 8 2005P. G. DE GROOT Summary., Antiphospholipid syndrome is a distinct disorder with the clinical features of recurrent thrombosis in the venous or arterial circulation and fetal losses. Its serological marker is the presence of antiphospholipid antibodies in the blood of these patients. The relation between the presence of antibodies against anionic phospholipids and thromboembolic complications is well established over the last 25 years but the pathophysiology of the syndrome is largely unclear. Even after all these years, there is a persisting debate about the specificity and sensitivity of the assays for the detection of antiphospholipid antibodies. We now accept that antibodies to ,2-glycoprotein I rather than to anionic phospholipids are the major pathological antibodies, although there is no clear consensus on how the presence of these antibodies correlates with the different clinical manifestations of the syndrome. In this review, we discuss the current methods of detection of the antibodies and our insight into the pathobiology of the syndrome. We propose a mechanism for describing how the presence of anti- ,2-glycoprotein I antibodies relates to the different clinical manifestations observed. [source] Commentary: Brunker C. (2006).NURSING IN CRITICAL CARE, Issue 2 2008Assessment of sedated head-injured patients using the Glasgow Coma Scale: an audit The Glasgow Coma Scale (GCS) is widely used to assess head-injured patients. However, patients with acute severe head injury are typically managed with varying doses of sedative drugs that may interfere with GCS assessments. There is a question as to whether GCS assessments are useful and justified when the patient is sedated. The limited literature available is briefly reviewed. The aim of the audit described in this paper was to gain an overview of current practice among the neuroscience intensive care units in the UK, in search of any consensus. Thirty questionnaires were distributed and 23 returned (a 77% response). The results show considerable variations in practice and, in particular, differences between those units that treat only neuroscience patients and those that manage general intensive care patients as well. This audit demonstrates a lack of clear consensus and highlights the need for more research. Abstract reprinted from the British Journal of Neuroscience Nursing, volume 2, Brunker C, ,Assessment of sedated head-injured patients using the Glasgow Coma Scale: an Audit.', pages 276,280. © 2006, reproduced with permission from MA Healthcare Limited. [source] Using health information technology to improve drug monitoring: a systematic reviewPHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 12 2009Geoffrey L. Hayward MD Abstract Purpose To conduct a systematic review of current evidence regarding the use of health information technology (HIT) interventions to improve drug monitoring in ambulatory care. Methods We searched PubMed, CINAHL, the Cochrane Library, and other computerized databases from 1 January 1998 to 30 June 2008 using the key words "drug monitoring," "medical records systems, computerized," "ambulatory care," and "outpatients." We manually reviewed reference lists of articles identified through computer searches and asked experts in the field to review our search strategy and results for completeness. Results Seven relevant studies were identified. Four of these studies assessed real-time interventions that used alerts to physicians at the time of medication ordering to ensure adequate monitoring, only one of which showed an improvement in monitoring. Of three studies using HIT outside the physician encounter, two suggested some improvement in monitoring rates. Methodological limitations were apparent in all studies identified. Conclusions Few studies have assessed the effectiveness of HIT interventions to improve drug monitoring, and among them, there is no clear consensus regarding the most consistently effective approaches to reducing drug monitoring errors. There is a clear need for well designed randomized trials to evaluate possible interventions to reduce drug monitoring errors. Such studies should incorporate health outcomes and detailed cost analyses to further characterize the feasibility of successful interventions. Copyright © 2009 John Wiley & Sons, Ltd. [source] Mental health issues of peacekeeping workersPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 5 2002JUN SHIGEMURA Abstract The end of the Cold War has brought a dramatic change to the international political situation and the role of the United Nations peacekeeping operations (PKO) has drawn increased attention. While many reports on PKO have focused on political or sociologic considerations, the mental health of the peacekeepers themselves has received little attention and psychiatric problems that can have a negative impact on mission success have been largely ignored. Participation in PKO creates a number of stressors and serious psychiatric and/or physical disorders may result. Yet, there is little research on this topic, either domestically or globally, and the methodology for clinical intervention remains in an early stage of development. We have reviewed previous reports to determine how various stressors before, during and after deployment affect the participants. Research in associated fields (e.g. crisis workers and military personnel) are also reviewed and their application to peacekeeping psychiatry is discussed. It must be admitted that the significance of PKO is arguable and each PKO is unique in terms of the nature of its mission and the local situation. Yet, the relationship between the psychiatric status of the personnel and the characteristics of an individual mission has never been studied. At present, no clear consensus regarding a framework for psychiatric intervention exists. Studies that enhance the recognition and significance of peacekeeping psychiatry are likely to improve the efficacy of PKO. [source] Anticoagulation prophylaxis for central venous catheter-associated thrombosis in cancer patients: An Australian perspectiveASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Issue 1 2008Suzanne KOSMIDER Abstract Background: The use of indwelling central venous catheters (CVC) for chemotherapy delivery is essential for people receiving therapies by protracted venous infusion and for patients with difficult venous access. Complications include infection and catheter-related thrombosis. Strategies have been suggested to prevent catheter-related thrombosis, however, there is no clear consensus on how to proceed. Guidelines recommend against the use of prophylactic anticoagulation in adult patients with solid organ malignancies and an indwelling CVC. We investigated the practice of Australian medical oncologists. Methods: A written questionnaire was mailed to all members of the Medical Oncology Group of Australia assessing practices of prophylactic anticoagulation in adult patients with solid organ malignancies and CVC. Results: Responses were obtained from 141 (55%) medical oncologists and from 40 advanced trainees. Ten percent (n = 4) of oncology trainees and 18.4% (n = 26) of medical oncologists routinely administered anticoagulants to patients with a CVC without a previous history of line-related thrombus. The most common strategy employed (73% of those using anticoagulation) was to recommend 1 mg of warfarin. Conclusions: The results demonstrate that a significant number of patients in Australia receive routine anticoagulation, the most popular strategy being the use of low-dose warfarin. Based on our results there is a clear need for further education regarding the lack of supporting data and the potential harm that may ensue. [source] | |||||||||||||