Search results for "optimal"

Evidence-based Guidelines for the Management of Exocrine Pancreatic Insufficiency After Pancreatic Surgery

2016

Objective: To provide evidence-based recommendations for the management of exocrine pancreatic insufficiency (EPI) after pancreatic surgery. Background: EPI is a common complication after pancreatic surgery but there is certain confusion about its frequency, optimal methods of diagnosis, and when and how to treat these patients. Methods: Eighteen multidisciplinary reviewers performed a systematic review on 10 predefined questions following the GRADE methodology. Six external expert referees reviewed the retrieved information. Members from Spanish Association of Pancreatology were invited to suggest modifications and voted for the quantification of agreement. Results: These guidelines analyz…

Home Parenteral Nutrition

2012

Parenteral nutrition (PN) involves the administration of fluids and nutrients using routes other than the gut, although usually involves central venous catheters (CVC). Home PN (HPN) refers to instances where this nutritional support is administered in the patient's home. Although this form of treatment is expensive and complex, it facilitates patients’ social rehabilitation, returning them to their home environment, reducing healthcare costs, and improving quality of life (QoL). Pediatric patients present specific technical characteristics, as not only should a proper nutritional status be maintained, but also optimal growth and development.

Optimal carbohydrate antigen 125 cutpoint for identifying low-risk patients after admission for acute heart failure

2022

Introduction and objectives: Carbohydrate antigen 125 (CA125) has been shown to be useful for risk stratification in patients admitted with acute heart failure (AHF). We sought to determine a CA125 cutpoint for identifying patients at low risk of 1-month death or the composite of death/HF readmission following admission for AHF.Methods: The derivation cohort included 3231 consecutive patients with AHF. CA125 cutoff values with 90% negative predictive value (NPV) and sensitivity up to 85% were identified. The adequacy of these cutpoints and the risk of 1-month death/HF readmission was then tested using the Royston-Parmar method. The best cutpoint was selected and externally validated in a co…

Update in the Percutaneous Management of Coronary Chronic Total Occlusions

2018

Percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) has been rapidly evolving during recent years. With improvement in equipment and techniques, high success rates can be achieved at experienced centers, although overall success rates remain low. Prospective, randomized-controlled data regarding optimal use and indications for CTO PCI remain limited. CTO PCI should be performed when the anticipated benefit exceeds the potential risk. New high-quality studies of the clinical outcomes and techniques of CTO PCI are needed, as is the expansion of expert centers and operators that can achieve excellent clinical outcomes in this challenging patient and lesion subgroup. In…

Updated diagnosticprognostic paradigm for CAD: a narrative review.

2020

Cardiovascular diseases are the first cause of death globally; early detection of coronary artery disease (CAD) is a challenge for clinicians and radiologists. Over the past 2 decades there have been several improvements in the methods for the assessment of diagnosis and prognosis in patients with suspected CAD; most of these methods are imaging methods and they operate with high-end technologies. Cardiac computed tomography (CCT) as we know it today was introduced in 1998 and has ever progressed with constant pace. The first decade was the technical validation phase of the method while the second decade was the clinical validation phase. CCT has developed an excellent diagnostic and progno…

Effects of the number of removed lymph nodes on survival outcome in patients with sentinel node-negative breast cancer.

2021

Abstract Background Sentinel lymph node biopsy is the gold standard surgical technique for axillary staging in patients with clinically node-negative. However, it is still uncertain what is the optimal number of sentinel lymph nodes (SLNs) to be removed to reduce the false-negative rate. The aim of this study was to investigate whether patients with a single negative SLN have a worse prognosis than those with two or more negative SLNs. Methods A retrospective review was conducted on a large series of SLN-negative breast cancer patients. Survival outcomes and regional recurrence rate were evaluated according to the number of removed SLNs. Secondly, the contribution of different adjuvant ther…

Direct Oral Anticoagulants in the Setting of Catheter Ablation of Atrial Fibrillation: State of art

2021

Atrial fibrillation (AF) represents the arrhythmia of greatest clinical impact and catheter ablation of AF (CAAF) has become the most effective strategy for rhythm control in selected patients. Therefore, appropriate anticoagulation strategies are of paramount importance for patients undergoing CAAF, especially those at high risk, such those with high CHA2DS2VASc scores. Optimal management of anticoagulation before, during, and after CAAF is crucial. Several studies have evaluated the use of different anticoagulation strategies in the periprocedural period. Randomized controlled trial seem to suggest that in patients undergoing CAAF, uninterrupted (or minimally interrupted) direct oral anti…

Construction of the client in physiotherapy student's practical learning sessions: a discourse analytic study

2008

In recent years, there has been a tendency to stress the active role and equal partnership of clients in social and healthcare. Moreover, research in the role of clients has attracted growing interest. Clinical education has been seen as an excellent arena for learning the distinctiveness of the interaction between the client and the professional physiotherapist by giving students the chance to participate in actual healthcare encounters. This study focuses on examining the construction of various client roles through interactions between participants in practical learning sessions that physiotherapy students took part in. These sessions were real professional physiotherapy encounters. Qual…

Some Considerations Regarding the Pro and Con articles between Drs. Hedenstierna and Pelosi on Intraoperative Ventilation and Pulmonary Outcomes

2017

Meta-analysis of the efficacy of different training strategies in animal models of ischemic stroke.

2013

Background and Purpose— Although several studies have shown beneficial effects of training in animal stroke models, the most effective training strategy and the optimal time to initiate training have not been identified. The present meta-analysis was performed to compare the efficacy of different training strategies and to determine the optimal time window for training in animal stroke models. Methods— We searched the literature for studies analyzing the efficacy of training in animal models of ischemic stroke. Training was categorized into forced physical training, voluntary physical training, constraint-induced movement therapy, and skilled reaching training. Two reviewers independently …