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Find video protocols related to scientific articles indexed in Pubmed.
Ethical considerations in elective amputation after traumatic peripheral nerve injuries.
Neurol Clin Pract
PUBLISHED: 10-04-2014
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Traumatic peripheral nerve injuries often complicate extremity trauma, and may cause substantial functional deficits. We have encountered patients who request amputation of such injured extremities, with the goal of prosthetic replacement as a means to restore function. Data on long-term outcomes of limb salvage vs amputation are limited and somewhat contradictory, leaving how to respond to such requests in the hands of the treating physician. We present example cases, drawn from our experience with wounded soldiers in a peripheral nerve injury clinic, in order to facilitate discussion of the ways in which these patients stress the system of medical decision-making while identifying ethical questions central to responding to these requests.
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Catumaxomab for the Treatment of Malignant Ascites in Patients With Chemotherapy-Refractory Ovarian Cancer: A Phase II Study.
Int. J. Gynecol. Cancer
PUBLISHED: 09-26-2014
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The aim of this study was to investigate the efficacy and safety of intraperitoneal catumaxomab in heavily pretreated patients with chemotherapy-refractory ovarian cancer and recurrent symptomatic malignant ascites.
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Racial/Ethnic differences in process of care and outcomes among patients hospitalized with intracerebral hemorrhage.
Stroke
PUBLISHED: 09-11-2014
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Although racial/ethnic differences in care are pervasive in many areas of medicine, little is known whether intracerebral hemorrhage (ICH) care processes or outcomes differ by race/ethnicity.
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Ethical considerations in stroke patients.
Curr. Opin. Neurol.
PUBLISHED: 08-13-2014
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Medical decision-making in stroke patients can be complex and often involves ethical challenges, from the perspective of healthcare providers as well as patients and their families. Awareness of these challenges and knowledge of current ethical topics in stroke may improve the quality of care provided to stroke patients.
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Current practices in feeding tube placement for US acute ischemic stroke inpatients.
Neurology
PUBLISHED: 08-06-2014
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We sought to identify current US hospital practices for feeding tube placement in ischemic stroke.
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Are therapeutic motivation and having one's own doctor as researcher sources of therapeutic misconception?
J Med Ethics
PUBLISHED: 05-24-2014
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Desire for improvement in one's illness and having one's own doctor functioning as a researcher are thought to promote therapeutic misconception (TM), a phenomenon in which research subjects are said to conflate research with treatment.
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Palliative and end-of-life care in stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association.
Stroke
PUBLISHED: 03-27-2014
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The purpose of this statement is to delineate basic expectations regarding primary palliative care competencies and skills to be considered, learned, and practiced by providers and healthcare services across hospitals and community settings when caring for patients and families with stroke.
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Variation in do-not-resuscitate orders for patients with ischemic stroke: implications for national hospital comparisons.
Stroke
PUBLISHED: 02-12-2014
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Decisions on life-sustaining treatments and the use of do-not-resuscitate (DNR) orders can affect early mortality after stroke. We investigated the variation in early DNR use after stroke among hospitals in California and the effect of this variation on mortality-based hospital classifications.
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Risk adjustment of ischemic stroke outcomes for comparing hospital performance: a statement for healthcare professionals from the American Heart Association/American Stroke Association.
Stroke
PUBLISHED: 01-23-2014
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Stroke is the fourth-leading cause of death and a leading cause of long-term major disability in the United States. Measuring outcomes after stroke has important policy implications. The primary goals of this consensus statement are to (1) review statistical considerations when evaluating models that define hospital performance in providing stroke care; (2) discuss the benefits, limitations, and potential unintended consequences of using various outcome measures when evaluating the quality of ischemic stroke care at the hospital level; (3) summarize the evidence on the role of specific clinical and administrative variables, including patient preferences, in risk-adjusted models of ischemic stroke outcomes; (4) provide recommendations on the minimum list of variables that should be included in risk adjustment of ischemic stroke outcomes for comparisons of quality at the hospital level; and (5) provide recommendations for further research.
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Cost of deep brain stimulation for the treatment of Parkinson's disease by surgical stimulation sites.
Mov. Disord.
PUBLISHED: 01-16-2014
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To assess costs and effectiveness of deep brain stimulation (DBS) of the internal globus pallidum (GPi) versus subthalamic nucleus (STN) from the provider and societal perspectives for Parkinson's disease (PD) patients in a multicenter randomized trial.
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Reading a cost-effectiveness or decision analysis study: Five things to consider.
Neurol Clin Pract
PUBLISHED: 11-01-2013
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Cost-effectiveness studies and decision analyses of neurologic practices, treatments, and technologies are increasing in the literature and have an emerging role within both medicine and neurology. Knowledge about these research approaches, how to interpret the results of such studies, as well as an understanding of their limitations will be of growing importance for the practicing neurologist. We discuss 5 aspects of these analyses to increase awareness about the uses and limitations of cost-effectiveness articles in everyday practice.
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A prospective study evaluating the clinical relevance of a chemoresponse assay for treatment of patients with persistent or recurrent ovarian cancer.
Gynecol. Oncol.
PUBLISHED: 05-09-2013
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Use of in vitro chemoresponse assays for informing effective treatment selection is a compelling clinical question and a topic of debate among oncologists. A prospective study was conducted evaluating the use of a chemoresponse assay in recurrent ovarian cancer patients.
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Estimating and communicating prognosis in advanced neurologic disease.
Neurology
PUBLISHED: 02-20-2013
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Prognosis can no longer be relegated behind diagnosis and therapy in high-quality neurologic care. High-stakes decisions that patients (or their surrogates) make often rest upon perceptions and beliefs about prognosis, many of which are poorly informed. The new science of prognostication--the estimating and communication "what to expect"--is in its infancy and the evidence base to support "best practices" is lacking. We propose a framework for formulating a prediction and communicating "what to expect" with patients, families, and surrogates in the context of common neurologic illnesses. Because neurologic disease affects function as much as survival, we specifically address 2 important prognostic questions: "How long?" and "How well?" We provide a summary of prognostic information and highlight key points when tailoring a prognosis for common neurologic diseases. We discuss the challenges of managing prognostic uncertainty, balancing hope and realism, and ways to effectively engage surrogate decision-makers. We also describe what is known about the nocebo effects and the self-fulfilling prophecy when communicating prognoses. There is an urgent need to establish research and educational priorities to build a credible evidence base to support best practices, improve communication skills, and optimize decision-making. Confronting the challenges of prognosis is necessary to fulfill the promise of delivering high-quality, patient-centered care.
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Measurement of costs and scales for outcome evaluation in health economic studies of Parkinsons disease.
Mov. Disord.
PUBLISHED: 01-09-2013
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Health economic studies in Parkinsons disease (PD) have become increasingly common in recent years. Because several methodologies and instruments have been used to assess cost and outcomes in PD, the Movement Disorder Society (MDS) commissioned a Task Force to assess their properties and make recommendations regarding their use. A systematic literature review was conducted to explore the use of those instruments in PD and to determine which should be selected for this review. We assessed approaches to evaluate cost of illness (COI), cost effectiveness, and cost utilities, which include the use of direct (standard gamble, time trade-off. and visual analogue scales) and indirect instruments to measure health status and utilities. No validated instruments/models were identified for the evaluation of COI or cost-effectiveness in patients with PD; therefore, no instruments in this group are recommended. Among utility instruments, only a few of these outcome instruments have been used in the PD population, and only limited psychometric data are available for these instruments with respect to PD. Because psychometric data for further utility instruments in conditions other than PD already exist, the standard gamble and time trade-off methods and the EQ-5D (a European quality-of-life health states instrument) and Health Utility Index instruments met the criteria for scales that are "recommended (with limitations)," but only the EQ-5D has been assessed in detail in PD patients. The MDS Task Force recommends further study of these instruments in the PD population to establish core psychometric properties. For the assessment of COI, the Task Force considers the development of a COI instrument specifically for PD, like that available for Alzheimers disease. © 2013 Movement Disorder Society.
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Robotic-assisted surgery in the management of endometrial cancer.
J. Obstet. Gynaecol. Res.
PUBLISHED: 12-05-2011
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Advanced laparoscopic procedures for hysterectomy and staging lymphadenectomy were not widely adopted for management of endometrial cancer despite nearly 20 years of improvements in laparoscopic technology. Many surgeons have recently embraced da?Vinci robotic-assisted laparoscopy in preference to traditional laparoscopy because of its technological advantages of wristed instrumentation, high-definition 3-D optics, ergonomics and autonomy of camera control; the majority of women with endometrial cancer in the USA now undergo robotic-assisted surgery. The purpose of this article is to review the robotic surgical techniques for hysterectomy, pelvic and aortic lymphadenectomy procedures, and the current comparative literature discussing perioperative outcomes. Additionally, literature that discusses challenges managing obese patients and robotic surgical costs are reviewed. Future multi-institutional, prospective registration studies comparing perioperative outcomes, complications, pain, recovery time, cost and long-term clinical outcomes with open, laparoscopic and robotic procedures will be necessary to completely appreciate the impact of robotic-assisted technology.
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Plasma exchange versus intravenous immunoglobulin for myasthenia gravis crisis: an acute hospital cost comparison study.
J Clin Neuromuscul Dis
PUBLISHED: 11-21-2011
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To compare the short-term financial costs of treating a patient in myasthenia gravis crisis with intravenous immunoglobulin (IVIG) versus plasma exchange.
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Getting to value in neurological care: a roadmap for academic neurology.
Ann. Neurol.
PUBLISHED: 06-18-2011
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Academic neurology is undergoing transformational changes. The public investment in biomedical research and clinical care is enormous and there is a growing perception that the return on this huge investment is insufficient. Hospitals, departments, and individual neurologists should expect more scrutiny as information about their quality of care and financial relationships with industry are increasingly reported to the public. There are unprecedented changes occurring in the financing and delivery of health care and research that will have profound impact on the mission and operation of academic departments of neurology. With the passage of the Patient Protection and Affordable Care Act (PPACA) there will be increasing emphasis on research that demonstrates value and includes the patients perspective. Here we review neurological investigations of our clinical and research enterprises that focus on quality of care and comparative effectiveness, including cost-effectiveness. By highlighting progress made and the challenges that lie ahead, we hope to create a clinical, educational, and research roadmap for academic departments of neurology to thrive in todays increasingly regulated environment.
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Health-related quality of life outcomes of docetaxel/carboplatin combination therapy vs. sequential therapy with docetaxel then carboplatin in patients with relapsed, platinum-sensitive ovarian cancer: results from a randomized clinical trial.
Gynecol. Oncol.
PUBLISHED: 04-04-2011
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A phase II clinical trial compared docetaxel in combination with carboplatin to sequential single agent docetaxel followed by carboplatin for treatment of recurrent platinum-sensitive ovarian, peritoneal, or tubal cancer. This manuscript reports prospectively collected health-related quality of life (HRQL).
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A multicenter, randomized, phase 2 clinical trial to evaluate the efficacy and safety of combination docetaxel and carboplatin and sequential therapy with docetaxel then carboplatin in patients with recurrent platinum-sensitive ovarian cancer.
Cancer
PUBLISHED: 04-01-2011
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The aim of this randomized clinical trial was to evaluate the efficacy and safety of combination (cDC) and sequential (sDC) weekly docetaxel and carboplatin in women with recurrent platinum-sensitive epithelial ovarian cancer (EOC).
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Palliative care needs and symptom patterns of hospitalized elders referred for consultation.
J Pain Symptom Manage
PUBLISHED: 03-27-2011
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To provide effective palliative care (PC) to the geriatric population, an understanding of the reasons for consultation, main diagnoses related to referral, and symptom severity in chronic disease states is essential.
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Functional characterization of a fluorescent highly tumorigenic ovarian cancer line to test cellular therapy in experimental models.
Int. J. Gynecol. Cancer
PUBLISHED: 03-25-2011
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The objective of this study was to functionally characterize a fluorescent highly tumorigenic ovarian cancer line to test cellular therapy in combination with cytokines or chemotherapies in experimental models.
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Tolfenamic acid inhibits ovarian cancer cell growth and decreases the expression of c-Met and survivin through suppressing specificity protein transcription factors.
Gynecol. Oncol.
PUBLISHED: 03-11-2011
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The aberrant expression of hepatocyte growth factor and its receptor c-Met are associated with aggressive disease and poor prognosis in a variety of human malignancies including ovarian cancer (OC). Specificity protein (Sp) transcription factors have high relevance in the signaling cascade associated with c-Met activation. Tolfenamic acid (TA), a NSAID, is known to induce the degradation of Sp proteins, which have been negatively associated with survival in some cancer patients. Our aim was to examine the anti-OC activity of TA using in vitro and in vivo models and asses the inhibitory effects of this novel compound.
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Racial differences in mortality among patients with acute ischemic stroke: an observational study.
Ann. Intern. Med.
PUBLISHED: 02-02-2011
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Black patients are commonly believed to have higher stroke mortality. However, several recent studies have reported better survival in black patients with stroke.
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Association between stroke center hospitalization for acute ischemic stroke and mortality.
JAMA
PUBLISHED: 01-27-2011
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Although stroke centers are widely accepted and supported, little is known about their effect on patient outcomes.
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Robotic-assisted hysterectomy for endometrial cancer compared with traditional laparoscopic and laparotomy approaches: a systematic review.
Obstet Gynecol
PUBLISHED: 11-25-2010
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To summarize comparative studies describing clinical outcomes of robotic-assisted surgeries compared with traditional laparoscopic or laparotomy techniques for the treatment of endometrial cancer.
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Tolerability, efficacy, and safety of pegylated liposomal Doxorubicin in combination with Carboplatin versus gemcitabine-Carboplatin for the treatment of platinum-sensitive recurrent ovarian cancer: a systematic review.
Oncologist
PUBLISHED: 10-07-2010
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To compare the tolerability, efficacy, and safety profiles of pegylated liposomal doxorubicin in combination with carboplatin (PLD-Carbo) with those of gemcitabine-carboplatin (Gem-Carbo) for the treatment of patients with platinum-sensitive recurrent ovarian cancer (PSROC) by reviewing the published literature.
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A cost-effectiveness analysis of carotid artery stenting compared with endarterectomy.
J Stroke Cerebrovasc Dis
PUBLISHED: 09-07-2010
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Endarterectomy and angioplasty with stenting have emerged as 2 alternative treatments for carotid artery stenosis. This studys objective was to determine the cost-effectiveness of carotid artery stenting (CAS) compared with carotid endarterectomy (CEA) in symptomatic subjects who are suitable for either intervention. A Markov analysis of these 2 revascularization procedures was conducted using direct Medicare costs (2007 US$) and characteristics of a symptomatic 70-year-old cohort over a lifetime. In the base case analysis, CAS produced 8.97 quality-adjusted life-years, compared with 9.64 quality-adjusted life-years for CEA. The incremental cost of stenting was $17,700, and thus CAS was dominated by CEA. Sensitivity analyses show that the long-term probabilities of major stroke or mortality influenced the results. In the base case analysis, CEA for patients with symptomatic stenosis has a greater benefit than CAS, with lower direct costs. With 59% probability, CEA will be the optimal intervention when all of the model assumptions are varied simultaneously.
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Robotic-assisted resection of liver and diaphragm recurrent ovarian carcinoma: description of technique.
Gynecol. Oncol.
PUBLISHED: 08-31-2010
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To describe port placement and operative technique for resection of right hepatic and full-thickness diaphragm metastatic ovarian carcinoma in a patient with recurrent disease using the da Vinci® Surgical System.
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Health state preferences and decision-making after malignant middle cerebral artery infarctions.
Neurology
PUBLISHED: 07-14-2010
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Despite recent trials demonstrating improved functional outcomes in patients with malignant middle cerebral artery ischemic strokes treated with hemicraniectomy, survivors still experience significant stroke-related disability. The value assigned to health states with significant disability varies widely and may influence decisions regarding hemicraniectomy.
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Palliative care consultations in hospitalized stroke patients.
J Palliat Med
PUBLISHED: 04-14-2010
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To determine the pattern and characteristics of palliative care (PC) consultations in patients with stroke and compare them with the characteristics of nonstroke consultations.
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Are quality improvements associated with the Get With the Guidelines-Coronary Artery Disease (GWTG-CAD) program sustained over time? A longitudinal comparison of GWTG-CAD hospitals versus non-GWTG-CAD hospitals.
Am. Heart J.
PUBLISHED: 02-16-2010
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Previous reports have demonstrated that participation in GWTG-CAD, a national quality initiative of the American Heart Association, is associated with improved guideline adherence for patients hospitalized with CAD. We sought to establish whether these benefits from participation in GWTG-CAD were sustained over time.
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Utilization, diagnosis, treatment and cost of migraine treatment in the emergency department.
Headache
PUBLISHED: 09-02-2009
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To determine the percentages of patients receiving migraine-specific therapy and to estimate the rate of unnecessary neuroimaging studies in the emergency department (ED).
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Patient and organizational factors related to education and support use by Veterans with Parkinsons disease.
Mov. Disord.
PUBLISHED: 07-17-2009
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Patient education and support services are recognized in the Department of Veterans Affairs (VA) as important to the patient-centered treatment of Parkinsons disease. Indeed, educating patients is one of the missions of the VAs six specialty Parkinsons Disease Research, Education and Clinical Centers (PADRECCs). We compared VA education/support services utilization by whether or not a patients VA Medical Center (VAMC) contained a PADRECC. Our sample included Parkinsons disease patients from VAMCs with (n = 882) and without (n = 1,448) PADRECCs. Patients completed surveys that asked about demographic/individual characteristics, health status/function, and education/support utilization. Results showed that 15.8% (n = 354) of all patients utilized education/support services. Patients at PADRECC VAMCs were generally healthier and more educated than other VAMC patients. After statistically controlling for these differences, however, being a patient at a PADRECC VAMC site and using only VA providers (as compared to a combination of VA and non-VA providers) were significant predictors of education/support utilization. Further, proportionally more PADRECC VAMC site patients reported higher satisfaction and receiving a broad range of information from different modalities as compared to other VAMC patients. These findings suggest that PADRECC VAMCs are providing educational/support activities consistent with these specialty centers goals.
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Robotic-assisted laparoscopic hysterectomy and lymphadenectomy for endometrial cancer: Analysis of surgical performance.
Gynecol. Oncol.
PUBLISHED: 06-25-2009
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To provide an objective analysis of surgical performance of robotic-assisted laparoscopic hysterectomy (RALH) with lymphadenectomy for endometrial cancer during the learning phase of the procedure and to assess opportunities for improvement.
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A review of the evidence for the use of telemedicine within stroke systems of care: a scientific statement from the American Heart Association/American Stroke Association.
Stroke
PUBLISHED: 05-07-2009
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The aim of this new statement is to provide a comprehensive and evidence-based review of the scientific data evaluating the use of telemedicine for stroke care delivery and to provide consensus recommendations based on the available evidence. The evidence is organized and presented within the context of the American Heart Associations Stroke Systems of Care framework and is classified according to the joint American Heart Association/American College of Cardiology Foundation and supplementary American Heart Association Stroke Council methods of classifying the level of certainty and the class of evidence. Evidence-based recommendations are included for the use of telemedicine in general neurological assessment and primary prevention of stroke; notification and response of emergency medical services; acute stroke treatment, including the hyperacute and emergency department phases; hospital-based subacute stroke treatment and secondary prevention; and rehabilitation.
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Financing of U.S. biomedical research and new drug approvals across therapeutic areas.
PLoS ONE
PUBLISHED: 02-16-2009
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We estimated U.S. biomedical research funding across therapeutic areas, determined the association with disease burden, and evaluated new drug approvals that resulted from this investment.
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Emergence of robotic assisted surgery in gynecologic oncology: American perspective.
Gynecol. Oncol.
PUBLISHED: 01-24-2009
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To discuss the emergence of robotic surgery in gynecologic oncology and describe the growth of robotic surgery in a university medical center and a community based practice.
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Phase II trial of single agent cetuximab in patients with persistent or recurrent epithelial ovarian or primary peritoneal carcinoma with the potential for dose escalation to rash.
Gynecol. Oncol.
PUBLISHED: 01-21-2009
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Determine if cetuximab dose escalation to induce grade 2 rash correlates with anti-tumor activity and if sera-based markers could predict likelihood of response.
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Funding of Parkinson research from industry and US federal and foundation sources.
Mov. Disord.
PUBLISHED: 01-13-2009
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Funding for biomedical and neuroscience research has increased over the last decade but without a concomitant increase in new therapies. This studys objectives were to determine the level and principal sources of recent funding for Parkinson disease (PD) research and to determine the current state of PD drug development. We determined the level and principal sources of recent funding for PD research from the following sources: US federal agencies, large PD foundations based in the United States, and global industry. We assessed the status of PD drug development through the use of a proprietary drug pipeline database. Funding for PD research from the sources examined was approximately $1.1 billion in 2003 and $1.2 billion in 2005. Industry accounted for 77% of support from 2003 to 2005. The number of drugs in development for PD increased from 67 in 2003 to 97 in 2007. Of the companies with at least one compound in development for PD in 2007, most were small (62% had annual revenue of less than $100 million), and most (53%) were based outside the United States. These companies will likely require partnerships to drive successful development of new PD therapies.
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Synergistic cytotoxicity of interferonalpha-2b and interleukin-2 in combination with PBMC against ovarian cancer: development of an experimental model for cellular therapy.
Gynecol. Oncol.
PUBLISHED: 01-03-2009
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Current therapies for ovarian cancer (OC) patients have a modest impact on long-term survival justifying the need for novel treatment strategies. We developed in vitro and in vivo systems to test the effects of cytokines in combination with peripheral blood mononuclear cells (PBMC) on OC cells.
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Analysis of disease recurrence and survival for women with uterine malignancies undergoing robotic surgery.
Gynecol. Oncol.
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To evaluate recurrence-free survival (RFS) and overall survival (OS) for patients who underwent robotic-assisted laparoscopic hysterectomy (RALH) for uterine malignancies.
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A multicenter evaluation of adjuvant therapy in women with optimally resected stage IIIC endometrial cancer.
Gynecol. Oncol.
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To determine if there is an advantage to combination chemotherapy and radiation for optimally resected stage IIIC endometrial cancer (EC).
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A phase II, randomized, placebo-controlled study of vismodegib as maintenance therapy in patients with ovarian cancer in second or third complete remission.
Clin. Cancer Res.
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Hedgehog pathway inhibition has been suggested as a potential maintenance treatment approach in ovarian cancer through disruption of tumor-stromal interactions. Vismodegib is an orally available Hedgehog pathway inhibitor with clinical activity in advanced basal cell carcinoma and medulloblastoma. This phase II, randomized, double-blind, placebo-controlled trial was designed to provide a preliminary estimate of efficacy in patients with ovarian cancer in second or third complete remission (CR).
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Parkinsons disease medication use and costs following deep brain stimulation.
Mov. Disord.
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The costs of treating Parkinsons disease (PD) are significant. Medication reductions usually occur following deep brain stimulation (DBS), but less is known about the relative costs of DBS targets, the globus pallidum (GPi) or the subthalamic nucleus (STN). This article reports medication costs between best medical therapy (BMT) and DBS over 6 months postintervention and by DBS target over 36 months postsurgery. Prescription use and costs for patients (n = 161) with advanced PD from a multisite randomized trial of BMT and DBS were examined overall and by drug category. Medication adjustment occurred at the discretion of the neurologists. PD medications were extracted from the Department of Veterans Affairs Decision Support System database. Levodopa equivalents (LEDD) were significantly lower for DBS than for BMT patients at 6 months (1101 vs 1398 mg; P = .005), but costs were similar (US$1750 vs US$1589; P = .55). LEDD decreased following GPi and STN DBS (1395-1161 mg, P = .014; and 1347-891 mg, P < .0001, respectively) in the first 6 months, but was lower for STN than for GPi over 36 months following DBS (P = .03). Total PD medication costs per 6-month intervals decreased over 36 months (P < .0001), but did not differ by target (P = .50) in the mixed-model analysis. However, cumulative medication costs over 36 months were lower for the STN than for GPi patients. PD medication use and costs decreased following DBS in either target over 36 months, but cumulative costs were less for STN than for GPi.
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Early stroke mortality, patient preferences, and the withdrawal of care bias.
Neurology
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Early mortality is a potential measure of the quality of care provided to hospitalized stroke patients. Whether in-hospital stroke mortality is reflective of deviations from evidence-based practices or patient/family preferences on life-sustaining measures is unclear.
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Sham surgery controls in Parkinsons disease clinical trials: views of participants.
Mov. Disord.
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Sham surgery controls are increasingly used in neurosurgical clinical trials in Parkinsons disease (PD) but remain controversial. We interviewed participants of such trials, specifically examining their understanding and attitudes regarding sham surgery.
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Metastatic leiomyosarcoma of the uterus with heterologous differentiation to malignant mesenchymoma.
Int. J. Gynecol. Pathol.
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Heterologous differentiation in metastatic leiomyosarcomas of uterine origin is an extremely rare phenomenon. We report a remarkable case of a metastatic leiomyosarcoma from the uterus with an unusual pattern of tumor progression to malignant mesenchymoma after chemotherapy. The patient, an 80-yr-old woman with a history of metastatic leiomyosarcoma of the uterus to the lungs, presented with a large intra-abdominal mass. Histologic examination of the intraperitoneal mass demonstrated a high-grade sarcoma containing various heterologous malignant mesenchymal elements including osteosarcoma, chondrosarcoma, a liposarcoma-like area, and osteoclast-like multinucleated giant cells. Only the identification of small areas of smooth muscle differentiation revealed the true nature of the tumor as a metastatic leiomyosarcoma with aberrant sarcomatous differentiation. This unique presentation emphasizes the importance of clinicopathologic correlation in the diagnosis of tumors with unusual histology.
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Does a uterine manipulator affect cervical cancer pathology or identification of lymphovascular space involvement?
Gynecol. Oncol.
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Uterine manipulators are a useful adjunct for robotic-assisted radical hysterectomy (RARH), but some surgeons avoid their use for fear of altering pathology or interpretation of lymphovascular space involvement (LVSI). We retrospectively compared clinico-pathological data and tumor pathology from patients with cervical cancer operated by laparotomy vs. RARH.
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Cellular therapy for ovarian cancer: experimental and clinical perspectives.
Curr. Med. Chem.
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Ovarian cancer is the leading cause of death among gynecologic malignancies and the 5th leading cause of cancer deaths for women in the United States. Two-thirds of patients present with advanced-stage disease (Stage III and IV) and the majority will suffer recurrence of disease, require ongoing treatment, and eventually succumb to chemotherapy-resistant disease. To potentially circumvent chemo-resistance in recurrent ovarian cancer, immunotherapy is being explored as a novel treatment option. Our laboratory findings demonstrate that immune effector cells from healthy donors elicit a significant cytotoxic response in the presence of IL-2 and IFN alpha- 2b against ovarian cancer in vitro; however, peripheral blood mononuclear cells (PBMC) isolated from ovarian cancer patients fail to elicit a similar response. A major obstacle to immunotherapy is the immunosuppressive environment supported by tumors, which limits the immune systems ability to fight the tumor. Myeloid-derived suppressor cells are an immature population of myeloid cells, which have recently been implicated to play a major role in immunosuppression and tumor evasion. In addition to novel immunotherapies, new diagnostic and prognostic markers are being identified through applying molecular tools/approaches in clinical and pathological analyses of this malignancy, which will provide additional therapeutic targets. To test these experimental therapeutic options, pre-clinical murine models of ovarian cancer are being developed. Ultimately, treatment of ovarian cancer will benefit from the careful alignment of appropriate target, drug, patient, and trial design. This article provides an objective overview of cellular therapy (the use of immune cells to elicit an anti-tumor response) for ovarian cancer highlighting both experimental and clinical perspectives.
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Challenges in assessing hospital-level stroke mortality as a quality measure: comparison of ischemic, intracerebral hemorrhage, and total stroke mortality rates.
Stroke
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Public reporting efforts currently profile hospitals based on overall stroke mortality rates, yet the "mix" of hemorrhagic and ischemic stroke cases may impact this rate.
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Detection of sentinel lymph nodes in patients with endometrial cancer undergoing robotic-assisted staging: a comparison of colorimetric and fluorescence imaging.
Gynecol. Oncol.
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To retrospectively compare results from lymphatic mapping of pelvic sentinel lymph nodes (SLN) using fluorescence near-infrared (NIR) imaging of indocyanine green (ICG) and colorimetric imaging of isosulfan blue (ISB) dyes in women with endometrial cancer (EC) undergoing robotic-assisted lymphadenectomy (RAL). A secondary aim was to investigate the ability of SLN biopsies to increase the detection of metastatic disease.
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Comparison of the cytotoxic response against ovarian cancer by immune effector cells isolated and expanded from normal donors and ovarian cancer patients.
Cytotherapy
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The aim of this study was to compare the cytotoxic response against ovarian cancer (OC) cells elicited by different immune effector cells in combination with the cytokines interleukin (IL)-2 and interferon (IFN) ?-2b.
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Short- and long-term morbidity and outcomes after robotic surgery for comprehensive endometrial cancer staging.
Gynecol. Oncol.
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Although intra-operative and immediate postoperative complications of robotic surgery are relatively low, little is known about long-term morbidity. We set out to assess both short- and long-term morbidities after robotic surgery for endometrial cancer staging.
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Comparison of enrollees and decliners of Parkinson disease sham surgery trials.
Mov. Disord.
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Concerns have been raised that persons with serious illnesses participating in high-risk research, such as PD patients in sham surgery trials, have unrealistic expectations and are vulnerable to exploitation. A comparison of enrollees and decliners of such research may provide insights about the adequacy of decision making by potential subjects. We compared 61 enrollees and 10 decliners of two phase II neurosurgical intervention (i.e., cellular and gene transfer) trials for PD regarding their demographic and clinical status, perceptions and attitudes regarding research risks, potential direct benefit, and societal benefit, and perspectives on the various potential reasons for and against participation. In addition to bivariate analyses, a logistic regression model examined variables regarding risks and benefits as predictors of participation status. Enrollees perceived lower risk of harm while tolerating higher risk of harm and were more action oriented, but did not have more advanced disease. Both groups rated hope for benefit as a strong reason to participate, whereas the fact that the studys purpose was not solely to benefit them was rated as "not a reason" against participation. Hope for benefit and altruism were rated higher than expectation of benefit as reasons in favor of participation for both groups. Enrollees and decliners are different in their views and attitudes toward risk. Although both are attracted to research because of hopes of personal benefit, this hope is clearly distinguishable from an expectation of benefit and does not imply a failure to understand the main purpose of research.
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Symptomatic and palliative care for stroke survivors.
J Gen Intern Med
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Stroke is the leading cause of disability and one of the most common causes of death worldwide. Outside the setting of acute management, secondary prevention and stroke rehabilitation, little has been written to address the ongoing symptomatic and palliative needs of these patients and their families. In this literature review, we look beyond secondary prevention with the aim of providing evidence-informed management guidelines for the myriad and often under-recognized symptomatic and palliative care needs of stroke survivors. Some of the most common and disabling post-stroke symptoms that are reviewed here include central post-stroke pain, hemiplegic shoulder pain, painful spasticity, fatigue, incontinence, post-stroke seizures, sexual dysfunction, sleep-disordered breathing, depression and emotionalism. We review the role of caregivers and explore ways to support them and, lastly, remind the reader to be perceptive to the patients spiritual needs. The literature is most robust, including controlled trials, for central post-stroke pain and depression. Synthesis and discussion outside these areas are frequently limited to smaller studies, case reports and expert opinion. While some data exists to guide informed decision-making, there is an urgent need to document best practice and identify appropriate clinical standards for the full spectrum of symptoms experienced by stroke survivors. We present the current and established data to aid health care providers in symptomatic and palliative management of stroke survivors.
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JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.

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In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.