Providence St. Joseph Health Digital Commons
Not a member yet
12290 research outputs found
Sort by
Maternal Rest Improves Fetal Growth in Small-For-Gestational Age and Growth Restricted Fetuses Defined by the Delphi Consensus Protocol.
No full textOBJECTIVE: The objective was to determine if maternal rest in the left lateral recumbent position increases the estimated fetal weight (EFW) in fetuses classified by the Delphi consensus as growth restricted (FGR) or small-for-gestational age (SGA).
STUDY DESIGN: This was a retrospective observational study of 265 fetuses classified as FGR or SGA using the Delphi consensus. After the diagnosis of FGR or SGA, the patient was asked to begin resting in the left lateral recumbent position during her waking hours for 2 weeks. The EFW was measured 2 weeks following maternal rest.
RESULTS: Of the 265 fetuses, FGR was identified in 56% (148/265) and SGA in 44% (117/265). Following maternal rest, the median values for the EFW percentile were significantly greater than at the time of diagnosis of FGR (18 vs. 5.96) and SGA (19 vs. 7.39). Following maternal rest, the EFW increased from \u3c 10th percentile (100%) to greater than the 10th percentile in 70% of FGR and 82% of SGA fetuses.
CONCLUSIONS: Fetuses with growth restriction or who were small-for-gestational age significantly increased their weight from below to above the 10th percentile following 2 weeks of maternal rest
Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines Update for the Role of Imaging in the Management of Patients With Vestibular Schwannomas.
No full textBackground: Imaging is a critical aspect of vestibular schwannoma (VS) management, influencing essentially every aspect of care including diagnosis, surveillance, treatment decision making, and follow-up after either resection or stereotactic radiosurgery. Despite this, treatment protocols are heterogeneous, and frequently based on historical practices, or low-quality evidence.
Objective: To update evidence-based guidelines for the use of imaging in the clinical management of patients with VS published by the Congress of Neurological Surgeons in 2018.
Methods: Systematic review of the literature published from 1/1/2015 to 5/20/2022 regarding imaging protocols for VS management. Salient questions were identified by a writing group of diverse individuals with topic-specific expertise. Questions were validated by the Congress of Neurological Surgeons Guidelines Committee. Following systematic review, literature tables and summary statements pertinent to the study questions were generated by the writing group, which underwent subsequent evaluation and revision by the task force before formalization.
Results: Seven questions were formulated; adequate literature was identified to formulate updated recommendations for 6 of these. Search strategy identified 1143 unique records, of which 109 underwent full-text review, and 57 were included in this study. Most studies provided level III evidence, with rare level II studies noted, yielding level III recommendations.
Conclusion: The current evidence base for imaging protocols in VS clinical management is broad, diverse, low certainty, and low quality. This in part reflects a heterogeneous disease, although variability in treatment philosophies may also influence local decision making. Key areas for future study include the clinical utility of advanced imaging techniques and head-to-head comparisons of imaging protocols for patients in common initial VS management pathways (eg, observation, resection, or stereotactic radiosurgery
Initiating Medical Therapy in Cardiogenic Shock Patients on Temporary Mechanical Circulatory Support.
No full textReal-world Utilization of an Implantable Pulmonary Artery Pressure Sensor in Female Patients: Insights from the HF2 Registry
No full textIntratumoral delivery of PD-1/PD-L1 and CTLA-4 inhibitors for recurrent/refractory solid tumors: a proof-of-concept treatment strategy.
No full textBACKGROUND: Immune checkpoint inhibitors (ICIs) are a leading immunotherapy. However, their application has not universally translated into significant benefits. A substantial number of patients either show resistance or relapse post-initial response, which emphasizes the need for more sophisticated therapeutic approaches. The drug combination is one promising route. The cancer-immunity cycle reveals the anti-tumor immune-related rate limiting steps of tumors. Theoretically, focusing on different phases of the cancer-immunity cycle can enhance therapeutic results. However, combination therapy includes a higher risk of adverse effects, which demand careful consideration.
METHODS: In this study, we combined programmed death-1 (PD-1)/ programmed death ligand-1 (PD-L1) and cytotoxic T Lymphocyte antigen 4 (CTLA-4) inhibitors with a reduced dosage but via an intra-tumor drug delivery strategy to treat recurrent/refractory (R/R) advanced solid tumors.
RESULTS: Herein, we report four patients with favorable outcomes (complete response for more than 2 years). In our cases, most TRAEs are of grade 1-2.
CONCLUSION: Intratumoral co-delivery of PD-1/PD-L1 and CTLA-4 inhibitors with reduced dosage shows promising efficacy and safety in R/R advanced solid tumors. In addition to reducing drug-related adverse events, this technology has advantages in activating tumor immunity.
CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/, identifier: NCT03755739
Inpatient utilization among Medicaid members with substance use and serious mental illness in Oregon
No full text
