Forbesjackson7461
Recently, there has been a call for research-informed and research-developed practice in health sciences education. This prompts the consideration of alternative suitable research approaches that could be used to enhance health sciences education practice, including medical radiation sciences education (MRSE) practice. In this discussion paper, the authors uphold design science research (DSR) methodology as a suitable research approach to enhance MRSE practice and research. An overview of the DSR methodology and an example of a project that used DSR methodology are presented to demonstrate the application of this methodology in MRSE practice and research. click here The paper concludes that the use of DSR methodology could be instrumental in addressing practice related challenges while developing a theoretical contribution to the discipline.The objective of this clinical practice guideline (CPG) is to provide recommendations for healthcare personnel working with patients with epilepsy, on the use of wearable devices for automated seizure detection in patients with epilepsy, in outpatient, ambulatory settings. The Working Group of the International League Against Epilepsy and the International Federation of Clinical Neurophysiology developed the CPG according to the methodology proposed by the ILAE Epilepsy Guidelines Working Group. We reviewed the published evidence using The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement and evaluated the evidence and formulated the recommendations following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. We found high level of evidence for the accuracy of automated detection of generalized tonic-clonic seizures (GTCS) and focal-to-bilateral tonic-clonic seizures (FBTCS) and recommend use of wearable automated seizure detection devices for selected patients when accurate detection of GTCS and FBTCS is recommended as a clinical adjunct. We also found moderate level of evidence for seizure types without GTCs or FBTCs. However, it was uncertain whether the detected alarms resulted in meaningful clinical outcomes for the patients. We recommend using clinically validated devices for automated detection of GTCS and FBTCS, especially in unsupervised patients, where alarms can result in rapid intervention (weak/conditional recommendation). At present, we do not recommend clinical use of the currently available devices for other seizure types (weak/conditional recommendation). Further research and development are needed to improve the performance of automated seizure detection and to document their accuracy and clinical utility.Interventions focused on utilization of epilepsy surgery can be divided into groups those that improve patients' access to surgical evaluation and those that facilitate completion of the surgical evaluation and treatment. Educational intervention, technological innovation, and effective coordination and communication can significantly improve patients' access to surgery. Patient and public facing, individualized (analog and/or digital) communication can raise awareness and acceptance of epilepsy surgery. Educational interventions aimed at providers may mitigate knowledge gaps using practical and concise consensus statements and guidelines, while specific training can improve awareness around implicit bias. Innovative technology, such as clinical decision-making toolkits within the electronic medical record (EMR), machine learning techniques, online decision-support tools, nomograms, and scoring algorithms can facilitate timely identification of appropriate candidates for epilepsy surgery with individualized gcreased funding for research). Every intervention should receive regular evaluation and feedback-driven modification to ensure appropriate utilization of epilepsy surgery.
To evaluate the effects of combined infusions of vatinoxan and dexmedetomidine on inhalant anesthetic requirement and cardiopulmonary function in dogs.
Prospective experimental study.
A total of six Beagle dogs were anesthetized to determine sevoflurane minimum alveolar concentration (MAC) prior to and after an intravenous (IV) dose (loading, then continuous infusion) of dexmedetomidine (4.5 μg kg
hour
) and after two IV doses of vatinoxan in sequence (90 and 180 μg kg
hour
). Blood was collected for plasma dexmedetomidine and vatinoxan concentrations. During a separate anesthesia, cardiac output (CO) was measured under equivalent MAC conditions of sevoflurane and dexmedetomidine, and then with each added dose of vatinoxan. For each treatment, cardiovascular variables were measured with spontaneous and controlled ventilation. Repeated measures analyses were performed for each response variable; for all analyses, p < 0.05 was considered significant.
Dexmedetomidine reduced sevoflurane MAC by 6t.
180 μg kg-1 hour-1 might improve cardiovascular function further in combination with this dose of dexmedetomidine, but beneficial effects on anesthesia plane and recovery quality may be lost.
To evaluate the effects and utility of tiletamine-zolazepam-medetomidine (TZM) and ketamine-medetomidine (KM) for anesthesia of Amur leopard cats (Prionailurus bengalensis euptailurus).
Prospective, randomized experimental trial.
A total of six female (3.70 ± 0.49 kg) and six male (5.03 ± 0.44 kg; mean ± standard deviation) Amur leopard cats aged 2-6 years.
Each animal was administered four protocols separated by ≥3 weeks. Each protocol included medetomidine (0.05 mg kg
) combined with tiletamine-zolazepam (1 mg kg
; protocol MTZ
); tiletamine-zolazepam (2 mg kg
; protocol MTZ
); ketamine (2 mg kg
; protocol MK
); or ketamine (4 mg kg
; MK
) administered intramuscularly. At time 0 (onset of lateral recumbency) and 30 minutes, heart rate (HR), respiratory rate (f
), rectal temperature, noninvasive mean arterial pressure (MAP) and hemoglobin oxygen saturation (SpO
) were recorded. Times to onset of lateral recumbency, duration of anesthesia and time to standing were recorded.
Overall, animares. However, the low doses of the anesthetic agents are recommended because there was no difference in duration of anesthesia between the dose rates studied.
To develop and validate the Patient-Reported Outcome Measure for Vascular Malformation (PROVAM) questionnaire to assess the health-related quality of life in patients with vascular malformations.
We developed and validated PROVAM using a mixed methods design during a prospective clinical trial at a vascular anomalies clinic. From July 2019 to February 2020, 108 consecutive patients completed 130 questionnaires. The 30-item instrument assessed the domains of pain, emotional/social well-being, functional impact, and treatment satisfaction. link2 Two additional items assessed ease of understanding and relevance. The primary outcomes of instrument reliability and validity were evaluated across several indices. The secondary outcome of responsiveness evaluated total score changes for patients who completed questionnaires both before and after treatment.
Instrument reliability, as measured by Cronbach alpha, was ≥0.79 for pain, emotional/social well-being, and functional impact domains. Primary domain structure was confirmed by factor analysis (P <. 001) and convergent construct validity for all but 1 Likert scale item. In the subgroup analysis of 13 participants who completed PROVAM before and after treatment, instrument responsiveness, as measured by the total score, showed a significant decrease (median,-10 points; interquartile range [IQR],-3 to-16; P= .04). Participants found the questions easy to understand (median, 5 points; IQR, 4-5 on a 5-point scale) and relevant (median score, 4; IQR, 3-5).
Preliminary data support the reliability and validity of PROVAM in measuring the health-related quality of life in patients with vascular malformations.
Preliminary data support the reliability and validity of PROVAM in measuring the health-related quality of life in patients with vascular malformations.Neratinib is an irreversible, pan-human epidermal growth factor inhibitor that has shown efficacy across human epidermal growth factor receptor 2 (HER2)-positive breast cancer settings. Neratinib is indicated for use as extended adjuvant therapy for HER2-positive early-stage breast cancer or, in combination with capecitabine, in the treatment of HER2-positive metastatic breast cancer. The primary tolerability concern with neratinib is diarrhea, and severe diarrhea early in treatment can lead to a substantial proportion of patients discontinuing neratinib, which may lead to reduced or nonexistent efficacy. link3 In order to establish a set of treatment recommendations for use of neratinib, on May 12, 2020, an expert panel of oncologists and gastroenterologists met virtually to discuss the role of neratinib in the treatment of patients with HER2-positive breast cancer. The panel reviewed the current data on neratinib, including efficacy across settings and diarrhea management strategies. Based on these data and their clinical experience, the panelists developed a set of recommendations to guide selection of patients for neratinib, implement weekly dose escalation at initiation of therapy, and prophylactically manage diarrhea.
This study explored the impact of multiple prognostic factors on patient overall survival (OS) and real-world progression-free survival (rwPFS) for patients with hormone receptor-positive (HR
)/human epidermal growth factor 2 negative (HER2
) metastatic breast cancer (MBC).
This retrospective study used electronic health record data of patients in the United States from community oncology practices from January 1, 2008 to April 30, 2017. Eligibility included HR
/HER2
MBC diagnosis in 2008 or later and prior systemic therapy for MBC. An index variable was created to assess the effect of multiple clinical prognostic factors collectively, including liver metastases (LM), primary endocrine resistance (PER), negative progesterone receptor (PR
) status, and high tumor grade (TG). Patients were grouped based on the number of prognostic factors present at MBC diagnosis 0, 1, and 2+. Differences in rwPFS and OS from start of first-line therapy were evaluated by the Kaplan-Meier method and multivariable Cox proportional hazards regression.
Approximately 29.1% of the 378 eligible patient sample had 0, 36.0% had 1, and 34.9% had 2+ prognostic factors. For the patients with 1 of the prognostic factors, 24.3% had high TG, 14.7% were LM+, 39.7% had PER, and 21.3% were PR
. Univariate and multivariate results showed that rwPFS and OS were significantly (P< .05) shorter in patients with 1 and 2+ prognostic factors compared with patients with0.
The individual prognostic factors and the prognostic factor index may enable early identification of patients with a less favorable prognosis across the HR
/HER2
MBC population and help inform treatment decisions in difficult-to-treat populations.
The individual prognostic factors and the prognostic factor index may enable early identification of patients with a less favorable prognosis across the HR+/HER2- MBC population and help inform treatment decisions in difficult-to-treat populations.
