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Defensive Medicine

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121. Preventing, Identifying, and Treating Prescription Drug Misuse Among Active-Duty Service Members Full Text available with Trip Pro

Preventing, Identifying, and Treating Prescription Drug Misuse Among Active-Duty Service Members Prescription drug misuse (PDM) is of critical concern for the military because of its potential impact on military readiness, the health and well-being of military personnel, and associated health care costs. The purpose of this study is to summarize insights gleaned from a series of activities that the RAND Corporation undertook for the Deputy Assistant Secretary of Defense for Readiness to address (...) this important health and military readiness issue. The authors completed a review of U.S. Department of Defense policies and a comprehensive literature review of clinical guidelines and the empirical literature on the prevention and treatment of PDM and conducted individual face-to-face interviews with 66 health and behavioral health care providers at nine medical treatment facilities across three regions within the contiguous United States to identify best practices in the prevention, identification

2017 Rand health quarterly

122. Drugs That May Cause or Exacerbate Heart Failure Full Text available with Trip Pro

Antifungal Medications Several cases of new-onset dilated cardiomyopathy with subsequent HF with amphotericin B and its liposomal formulation have been reported. In each case, HF symptoms and echocardiographic findings normalized on discontinuation of therapy, which occurred within 10 days to 6 months of drug discontinuation. Anticancer Medications Anthracyclines The anthracyclines are a highly used class of cytotoxic agents that target proliferating cells via a diverse mechanism that includes DNA (...) . Hospitalization for HF is the largest segment of those costs. It is likely that the prevention of drug-drug interactions and direct myocardial toxicity would reduce hospital admissions, thus both reducing costs and improving quality of life. Patients with HF often have a high medication burden consisting of multiple medications and complex dosing regimens. On average, HF patients take 6.8 prescription medications per day, resulting in 10.1 doses a day. This estimate does not include over-the-counter (OTC

2016 American Heart Association

123. A computational model for the evaluation of complement system regulation under homeostasis, disease, and drug intervention. Full Text available with Trip Pro

A computational model for the evaluation of complement system regulation under homeostasis, disease, and drug intervention. The complement system is an intricate defense network that rapidly removes invading pathogens. Although many complement regulators are present to protect host cells under homeostasis, the impairment of Factor H (FH) regulatory mechanism has been associated with several autoimmune and inflammatory diseases. To understand the dynamics involved in the pivotal balance between (...) that are influenced by complement dysregulation. We show that FH-mediated disorder induces substantial levels of complement activation compared to homeostasis, by generating reduced levels of C3 and FB, and to a lesser extent C5, and elevated levels of C3a-desArg, Ba, Bb, C5a-desArg, and fC5b-9. These trends are consistent with clinically observed biomarkers associated with complement-mediated diseases. Furthermore, we introduced therapy states by modeling known inhibitors of the complement system, a compstatin

2018 PLoS ONE

124. Target-directed discovery and production of pharmaceuticals in transgenic mutant plant cells Full Text available with Trip Pro

Target-directed discovery and production of pharmaceuticals in transgenic mutant plant cells Plants are a source of complex bioactive compounds, with value as pharmaceuticals, or leads for synthetic modification. Many of these secondary metabolites have evolved as defenses against competing organisms and their pharmaceutical value is "accidental", resulting from homology between target proteins in these competitors, and human molecular therapeutic targets. Here we show that it is possible (...) transporter protein. Many of the resulting selected mutants are overproducing the active metabolite found in the wild-type plant, but others overproduce active metabolites that are not readily detectable in non-mutants. This technology can access the whole genomic capability of a plant species to biosynthesize metabolites with a specific target. It has potential value as a novel platform for plant drug discovery and production, or as a means of optimizing the therapeutic value of medicinal plant

2016 Journal of biotechnology

125. Pharmaceutical Expenditure and Burden of Non-communicable Diseases in Serbia Full Text available with Trip Pro

Belgrade, Serbia. Segrt Zoran Z Military Medical Academy Medical Faculty, Management of the Military Medical Academy, University of Defense Belgrade, Serbia. Dragojevic-Simic Viktorija V Centre for Clinical Pharmacology, Military Medical Academy Medical Faculty, University of Defense Belgrade, Serbia. eng Journal Article 2016 10 13 Switzerland Front Pharmacol 101548923 1663-9812 Serbia drug utilization gross domestic product non-communicable diseases pharmaceutical expenditure 2016 07 28 2016 09 27 (...) Pharmaceutical Expenditure and Burden of Non-communicable Diseases in Serbia 27790144 2018 11 13 1663-9812 7 2016 Frontiers in pharmacology Front Pharmacol Pharmaceutical Expenditure and Burden of Non-communicable Diseases in Serbia. 373 Kovacevic Aleksandra A Centre for Clinical Pharmacology, Military Medical Academy Medical Faculty, University of Defense Belgrade, Serbia. Rancic Nemanja N Centre for Clinical Pharmacology, Military Medical Academy Medical Faculty, University of Defense

2016 Frontiers in pharmacology

126. Physical Therapy: First Line of Defense Against Sexual Dysfunction

by approximately 50%, and 73% of patients were not prescribed any medications for low back pain (Fuhrmans 2007). Early access to physical therapy can prevent unnecessary medical spending. Early access to physical therapy may prevent unnecessary medical spending We are movement experts, with defined evidence-based treatment strategies and pain management skills that allow patients to take control of their bodies, and rely less on prescription drugs for relief. The APTA campaign, , aims to educate about (...) Physical Therapy: First Line of Defense Against Sexual Dysfunction Physical Therapy: First Line of Defense Against Sexual Dysfunction - Students 4 Best Evidence A network for students interested in evidence-based health care Menu Physical Therapy: First Line of Defense Against Sexual Dysfunction Posted on March 29, 2017 by Evidence Reviews Sexual health is an important part of overall mental and physical well-being. For men and women, physical therapy in the context of sexual health takes

2017 Students 4 Best Evidence

127. Assessment and Management of Patients at Risk for Suicide: Synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines. Full Text available with Trip Pro

Assessment and Management of Patients at Risk for Suicide: Synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines. In May 2019, the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) approved an update to the 2013 joint clinical practice guideline for assessing and managing patients who are at risk for suicide. This guideline provides health care providers with a framework by which to screen for, evaluate (...) , treat, and manage the individual needs and preferences of VA and DoD patients who may be at risk for suicide.In January 2018, the VA/DoD Evidence-Based Practice Work Group convened to develop a joint VA/DoD guideline including clinical stakeholders and conforming to the National Academy of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel drafted key questions, systematically searched and evaluated the literature through April 2018, created algorithms, and advanced

2019 Annals of Internal Medicine

128. The Management of Stroke Rehabilitation: A Synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. (Abstract)

The Management of Stroke Rehabilitation: A Synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. In June 2019, the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) approved an update of the joint clinical practice guideline for rehabilitation after stroke. This synopsis summarizes the key recommendations from this guideline.In February 2018, the VA/DoD Evidence-Based Practice Work Group convened a joint (...) VA/DoD guideline development effort that included clinical stakeholders and stroke survivors and conformed to the National Academy of Medicine (formerly the Institute of Medicine) tenets for trustworthy clinical practice guidelines. The guideline panel identified key questions, systematically searched and evaluated the literature, and developed 2 algorithms and 42 key recommendations using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. Stroke survivors

2019 Annals of Internal Medicine

129. Non-Statin Therapies For LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk

to continue the statin-ezetimibe combination therapy and continue to monitor adherence to medications and lifestyle, and ongoing LDL-C response to therapy. If patients with clinical ASCVD and comorbidities require >25% additional lowering of LDL-C, a PCSK9 in- hibitor may be preferred as the initial non-statin agent. Clinicians should preferentially prescribe drugs that have been shown in RCTs to provide ASCVD risk-reduction bene?ts that outweigh the potential for adverse effects and drugdrug (...) ., adherence to a heart-healthy diet, regular exercise habits, avoidance of tobacco products, and maintenance of a healthy weight) remains a critical component of ASCVDriskreduction,bothbeforeandinconcertwiththe use of cholesterol-lowering drug therapies. In addition, referral toaregistered dietitian nutritionist (RDN) may be considered to improve understanding of heart-healthy dietary principles and individualize nutrition recom- mendations. Adherence to lifestyle modi?cation should be regularly assessed

2017 American College of Cardiology

130. Management of Opioid Therapy (OT) for Chronic Pain

clinicians or specialists to study and consider the latest information on opioid therapy (OT) and how and whether to incorporate that information or recommendations into their practice. It can be used to provide specific information to guide a patient encounter, such as looking up the dosing of a medication used less frequently or the meaning of the urine drug testing (UDT) result. The section on tapering and its accompanying appendix can be used to assist in the development of a framework for guiding (...) Management of Opioid Therapy (OT) for Chronic Pain VA/DoD CLINICAL PRACTICE GUIDELINE FOR OPIOID THERAPY FOR CHRONIC PAIN Department of Veterans Affairs Department of Defense QUALIFYING STATEMENTS The Department of Veterans Affairs and the Department of Defense guidelines are based upon the best information available at the time of publication. They are designed to provide information and assist decision making. They are not intended to define a standard of care and should not be construed

2017 VA/DoD Clinical Practice Guidelines

131. The Judgment Defense in Medical Malpractice Full Text available with Trip Pro

The Judgment Defense in Medical Malpractice 23934031 2013 12 17 2014 11 01 1528-1132 471 11 2013 Nov Clinical orthopaedics and related research Clin. Orthop. Relat. Res. The judgment defense in medical malpractice. 3405-8 10.1007/s11999-013-3223-0 Bal B Sonny BS Department of Orthopaedic Surgery, University of Missouri, Columbia, 1100 Virginia Ave. DC953.00, Columbia, MO, 65212, USA, balb@health.missouri.edu. Brenner Lawrence H LH eng Journal Article 2013 08 10 United States Clin Orthop Relat (...) Res 0075674 0009-921X AIM IM Clinical Competence economics legislation & jurisprudence Compensation and Redress Humans Judgment Liability, Legal economics Malpractice economics legislation & jurisprudence Medical Errors legislation & jurisprudence Probability Risk Assessment Risk Factors Terminology as Topic Uncertainty 2013 07 30 2013 07 31 2013 8 13 6 0 2013 8 13 6 0 2013 12 18 6 0 ppublish 23934031 10.1007/s11999-013-3223-0 PMC3792272

2013 Clinical Orthopaedics and Related Research

132. In Defense of Basic Science Funding: Today’s Scientific Discovery Is Tomorrow’s Medical Advance Full Text available with Trip Pro

In Defense of Basic Science Funding: Today’s Scientific Discovery Is Tomorrow’s Medical Advance In this address, I will discuss the importance of basic science in tackling our health problems. I will also describe how the funding cuts are damaging our economic competitiveness and turning our young people away from science.

2013 Cold Spring Harbor perspectives in medicine

133. Effect of Battlefield Acupuncture and Physical Therapy Versus Physical Therapy Alone After Shoulder Surgery

Estimated Study Start Date : May 2018 Estimated Primary Completion Date : January 2019 Estimated Study Completion Date : June 2019 Resource links provided by the National Library of Medicine related topics: Arms and Interventions Go to Arm Intervention/treatment Experimental: BFA with Physical Therapy BFA + post-surgical protocol, intervention = battlefield acupuncture plus post-surgical protocol Device: Battlefield Acupuncture Battlefield Acupuncture uses ASP semi-permanent needles inserted (...) into their ears for pain attenuation in 5 known points. Both groups receive their respective post-surgical rehabilitation protocols Procedure: Post-surgical shoulder protocol Surgery specific post-surgical physical therapy protocol Active Comparator: Physical Therapy alone Intervention = Post-surgical protocol Procedure: Post-surgical shoulder protocol Surgery specific post-surgical physical therapy protocol Outcome Measures Go to Primary Outcome Measures : Change in Pain medication use [ Time Frame: daily

2018 Clinical Trials

134. Efficacy of Complementary and Alternative Medicine Therapies for Posttraumatic Stress Disorder

questions regarding CAM therapies for PTSD is, What effects might one expect of a given intervention relative to no intervention? This clinically relevant question is best addressed by a randomized clinical trial with a no-treatment (waitlist) comparator. However, study designs that withhold or delay treatment to those with PTSD may not be institutionally feasible or ethically defensible. Hence, alternative strategies merit consideration. 4 Efficacy of Complementary and Alternative Medicine Therapies (...) , accessible, adequate, or congruent with patient preferences. Complementary and Alternative Medicine CAM is commonly used to describe a wide range of therapies that are not generally considered standard components of modern medicine as practiced by physicians in the U.S. Yet, many CAM treatments, such as acupuncture, are part of traditional medical practices in other parts 8 Efficacy of Complementary and Alternative Medicine Therapies for Posttraumatic Stress Disorder Evidence-based Synthesis Program

2011 Veterans Affairs Evidence-based Synthesis Program Reports

135. Effects of pharmaceutical formulations containing thyme on carbon tetrachloride-induced liver injury in rats. Full Text available with Trip Pro

Effects of pharmaceutical formulations containing thyme on carbon tetrachloride-induced liver injury in rats. Herbal supplements are widely used in the treatment of various liver disases, but some of them may also induce liver injuries. Regarding the infuence of thyme and its constituents on the liver, conflicting results have been reported in the literature. The objective of this study was to examine the influence of two commonly used pharmaceutical formulations containing thyme (Thymus (...) by a marked elevation of AST and ALT activities, and histopathologic alterations. Co-administration of thyme tincture resulted in unexpected exacerbation of AST and ALT values in serum, while thyme syrup managed to reduce activites of aminotransferases, in comparison to carbon tetrachloride-treated animals.Despite demonstrated antioxidant activity, mediated through both direct free radical scavenging and activation of antioxidant defense mechanisms, thyme preparations could not ameliorate liver injury

2015 BMC Complementary and Alternative Medicine

136. RPB5-mediating protein promotes cholangiocarcinoma tumorigenesis and drug resistance by competing with NRF2 for KEAP1 binding. (Abstract)

and is associated with poor prognosis. CONCLUSION: These findings reveal that RMP is involved in the oxidative stress defense program and could be exploited for targeted cancer therapies.© 2019 by the American Association for the Study of Liver Diseases. (...) RPB5-mediating protein promotes cholangiocarcinoma tumorigenesis and drug resistance by competing with NRF2 for KEAP1 binding. Cancer cell survival depends on the balance between reactive oxygen species production and scavenging, which is mainly regulated by NRF2 during tumorigenesis. Here, we demonstrated that deletion of RBP5-mediating protein (RMP) in an autonomous mouse model of intrahepatic cholangiocarcinoma (ICC) delays tumor progression. RMP-overexpressing tumor cells exhibited enhanced

2019 Hepatology

137. Relationships among CFTR expression, HCO3− secretion, and host defense may inform gene- and cell-based cystic fibrosis therapies Full Text available with Trip Pro

Relationships among CFTR expression, HCO3− secretion, and host defense may inform gene- and cell-based cystic fibrosis therapies Cystic fibrosis (CF) is caused by mutations in the gene encoding the cystic fibrosis transmembrane conductance regulator (CFTR) anion channel. Airway disease is the major source of morbidity and mortality. Successful implementation of gene- and cell-based therapies for CF airway disease requires knowledge of relationships among percentages of targeted cells, levels (...) of CFTR expression, correction of electrolyte transport, and rescue of host defense defects. Previous studies suggested that, when ∼10-50% of airway epithelial cells expressed CFTR, they generated nearly wild-type levels of Cl(-) secretion; overexpressing CFTR offered no advantage compared with endogenous expression levels. However, recent discoveries focused attention on CFTR-mediated HCO3 (-) secretion and airway surface liquid (ASL) pH as critical for host defense and CF pathogenesis. Therefore, we

2016 Proceedings of the National Academy of Sciences of the United States of America

138. Cross-sectional survey on defensive practices and defensive behaviours among Israeli psychiatrists. Full Text available with Trip Pro

Cross-sectional survey on defensive practices and defensive behaviours among Israeli psychiatrists. Psychiatry is a low-risk specialisation; however, there is a steady increase in malpractice claims against psychiatrists. Defensive psychiatry (DP) refers to any action undertaken by a psychiatrist to avoid malpractice liability that is not for the sole benefit of the patient's mental health and well-being. The objectives of this study were to assess the scope of DP practised by psychiatrists (...) and to understand whether awareness of DP correlated with defensive behaviours.A questionnaire was administered to 213 Israeli psychiatry residents and certified psychiatrists during May and June 2015 regarding demographic data and experience with malpractice claims, medicolegal literature and litigation. Four clinical scenarios represented defensive behaviours and reactions (feelings and actions) to malpractice claims.Forty-four (20.6%) certified psychiatrists and four (1.9%) residents were directly involved

2017 BMJ open

139. In defense of medical societies – especially ACP

In defense of medical societies – especially ACP db's Medical Rants » Blog Archive » In defense of medical societies – especially ACP Internal medicine, American health care, and especially medical education 9 Posted by rcentor | Posted on 25-05-2016 Category : A recent comment attacked medical societies as being impotent on several issues. The commenter clearly expects these societies to work quick visible changes. Here is my take: My recent leadership role at ACP makes this answer biased (...) out their English overlords. Medicine deperately needs its William Wallace to rally the troops to preserve their professional integrity, autonomy, the doctor patient relationship and, yes, their Freedom. said on 30-05-2016 I would be interested if your defense of ACP would include the authorship and promulgation of the “professionalism ” of the Charter for a new millennium which imposes an obligation to work for social justice and to be a steward of medical resources. rcentor said on 30-05-2016

2016 db's Medical Rants blog

140. Cryptogenic Stroke and High-Risk Patent Foramen Ovale: The DEFENSE-PFO Trial Full Text available with Trip Pro

Cryptogenic Stroke and High-Risk Patent Foramen Ovale: The DEFENSE-PFO Trial Recent reports showing the favorable role of patent foramen ovale (PFO) closure in patients with cryptogenic stroke have raised the issue of selecting optimal candidates.This study, DEFENSE-PFO (Device Closure Versus Medical Therapy for Cryptogenic Stroke Patients With High-Risk Patent Foramen Ovale), evaluated whether the benefits of PFO closure can be determined on the basis of the morphologic characteristics (...) . (Device Closure Versus Medical Therapy for Cryptogenic Stroke Patients With High-Risk Patent Foramen Ovale [DEFENSE-PFO]; NCT01550588).Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

2018 EvidenceUpdates

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