Clinical practice (London, England)最新文献

{"title":"Comprehensive geriatric assessment in the older cancer patient: coming of age in clinical cancer care.","authors":"Cynthia Owusu,&nbsp;Nathan A Berger","doi":"10.2217/cpr.14.72","DOIUrl":"https://doi.org/10.2217/cpr.14.72","url":null,"abstract":"<p><p>Cancer care at the extremes of life, in the young and the old, is characterized by unique issues associated with pediatrics and geriatric medicine, accentuated by the special vulnerabilities of these groups. In response to these needs, the field of pediatric oncology has been well honed to deal with the special problems associated with juvenile cancer patients. While most adult oncologists consider themselves well prepared to deal with older cancer patients, the current expansion of the geriatric population - their variable levels of fitness, frailty and vulnerability, the fact that cancer is primarily a disease of older adults, the significant expansion of agents and approaches to treat cancer, as well as their resultant toxicities and complications - has led to the development of specialized geriatric oncologists. Moreover, the special characteristics and needs of these patients have led to the evolution of new guidelines for evaluation, management and the conduct of research in older patients with cancer.</p>","PeriodicalId":72620,"journal":{"name":"Clinical practice (London, England)","volume":"11 6","pages":"749-762"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/cpr.14.72","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33020862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Externalizing Disorders and Environmental Risk: Mechanisms of Gene-Environment Interplay and Strategies for Intervention.","authors":"Diana R Samek,&nbsp;Brian M Hicks","doi":"10.2217/CPR.14.47","DOIUrl":"https://doi.org/10.2217/CPR.14.47","url":null,"abstract":"<p><p>Though heritable, externalizing disorders have a number of robust associations with several environmental risk factors, including family, school, and peer contexts. To account for these associations, we integrate a behavioral genetic perspective with principles of a developmental cascade theory of antisocial behavior. The major environmental contexts associated with child externalizing problems are reviewed, as are the processes of gene-environment interplay underlying these associations. Throughout, we discuss implications for prevention and intervention. Three major approaches designed to reduce child externalizing behavior are reviewed. Prevention and intervention programs appear to be most successful when they target individuals or communities most at risk for developing externalizing disorders, rather than applied universally. We end by commenting on areas in need of additional research concerning environmental influences on persistent externalizing behaviors.</p>","PeriodicalId":72620,"journal":{"name":"Clinical practice (London, England)","volume":"11 5","pages":"537-547"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/CPR.14.47","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32889906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Putting medical risks into perspective.","authors":"Pooja Rani Patel","doi":"10.2217/CPR.13.76","DOIUrl":"https://doi.org/10.2217/CPR.13.76","url":null,"abstract":"A patient who was interested in changing contraceptive methods presented to my clinic a couple of months ago. She was on oral contraceptives but frequently forgot to take them, so she was interested in something else. She hated injections and was averse to having somebody place a foreign object in her arm. She was very much interested in long-term contraception but did not want permanent sterilization. “How about an intrauterine device (IUD)?” I asked. “What are the risks associated with this, doctor?” I explained that the risks were minimal; the worst-case scenario was perforation of the uterus with migration of the IUD into the abdominal cavity, requiring laparoscopic surgery for removal. There was an even smaller risk that laparoscopic surgery would be unsuccessful and that she would require a laparotomy, but I again emphasized that all this was extremeley rare. She turned skeptical. “Rare? How rare?” I answered, “Only one in a 1000.” My heart dropped as I could sense that her interest was waning. She hesitated, and finally decided she would just stick to the oral contraceptives. \u0000 \u0000I have encountered this scenario one too many times. Based on the medical experience I have gained through my training and practice, I know the risks of perforation during IUD placement are extremely low, much lower than the risk of an unwanted pregnancy on oral contraceptives. But how could I have conveyed these experiences to that patient, especially with the time constraints of a contraceptive counseling visit? How could I have communicated to the patient that the placement of an IUD is very easy and safe, when she herself had never even seen how it was done? \u0000 \u0000In 1997, the NIH Consensus Panel on breast cancer screening stated that “…a woman should have access to the best possible information in an understandable and usable form” [1]. The keywords here are “understandable and usable”. Is the rate one in a 1000 really understandable to a population where at least 25% of the people are illiterate [2]? In addition, is this number really usable for anybody if not put into a context of daily experiences? The only person for whom this number is usable, in my opinion, is the gynecologist, somebody who experiences IUD placement on an almost daily basis. For the rest of the population one in a 1000 might as well be one in a 100 or one in 10,000. \u0000 \u0000Which brings me back to my point, how can we put these numbers into context for our patients? In 1987, Wilson and Crouch proposed a comparison of medical risks with nonmedical risks (i.e., risk of being involved in a car accident) in order to aid a patient’s interpretation of these risks [3]. He argued that patients may understand these risks more intuitively and therefore be able to process the numbers better. Given the fact that a patient’s assessment of risk is usually determined by emotions rather than facts, incorporating the emotions regarding daily risks may be used as a benchmark to understand the risks associated wit","PeriodicalId":72620,"journal":{"name":"Clinical practice (London, England)","volume":"11 1","pages":"35-37"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/CPR.13.76","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32260696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic kidney disease in the elderly: evaluation and management.","authors":"Mary Mallappallil,&nbsp;Eli A Friedman,&nbsp;Barbara G Delano,&nbsp;Samy I McFarlane,&nbsp;Moro O Salifu","doi":"10.2217/cpr.14.46","DOIUrl":"https://doi.org/10.2217/cpr.14.46","url":null,"abstract":"<p><p>Chronic kidney disease (CKD) is a very common clinical problem in elderly patients and is associated with increased morbidity and mortality. As life expectancy continues to improve worldwide, there is a rising prevalence of comorbidities and risk factors such as hypertension and diabetes predisposing to a high burden of CKD in this population. The body of knowledge on the approach to elderly patient with CKD is still evolving. Thus, this review seeks to explore the epidemiology and to discuss current understanding of challenges in the diagnosis and management of elderly patients CKD.</p>","PeriodicalId":72620,"journal":{"name":"Clinical practice (London, England)","volume":"11 5","pages":"525-535"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/cpr.14.46","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32976343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Linking sleep duration and obesity among black and white US adults.","authors":"Margaret Donat, Clinton Brown, Natasha Williams, Abhishek Pandey, Christie Racine, Samy I McFarlane, Girardin Jean-Louis","doi":"10.2217/cpr.13.47","DOIUrl":"10.2217/cpr.13.47","url":null,"abstract":"<p><strong>Aims: </strong>The effect of race/ethnicity on the risk of obesity associated with short or long sleep durations is largely unknown. This study assessed whether the sleep-obesity link differentially affects black and whites.</p><p><strong>Methods: </strong>Analysis was based on data obtained from 29,818 adult American respondents from the 2005 National Health Interview Survey, a cross-sectional household interview survey.</p><p><strong>Results: </strong>Multivariate-adjusted odds ratios for obesity associated with short sleep (≤6 h) among blacks and whites were 1.98 (95% CI: 1.69-2.30) and 1.20 (95% CI: 1.10-1.31), respectively, and with long sleep (≥9 h) for blacks and whites were 1.48 (95% CI: 1.14-1.93) and 0.77 (95% CI: 0.67-0.89), respectively (all p < 0.001).</p><p><strong>Conclusion: </strong>Race/ethnicity may have significantly influenced the likelihood of reporting obesity associated with short and long sleep durations. Relative to white respondents, an excess of 78% of black respondents showed increased obesity odds associated with short sleep. Black long sleepers also showed increased odds for obesity, but white long sleepers may be at a reduced obesity risk.</p>","PeriodicalId":72620,"journal":{"name":"Clinical practice (London, England)","volume":"10 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/cpr.13.47","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31956867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapeutic challenges in advanced renal cell carcinoma.","authors":"Daniel C Cho","doi":"10.2217/cpr.12.77","DOIUrl":"10.2217/cpr.12.77","url":null,"abstract":"<p><p>The therapeutic landscape of advanced renal cell carcinoma has grown increasingly more complex with the recent approval of several molecularly targeted agents. While researchers focus on developing predictive algorithms and identifying novel therapeutic targets and agents, clinical practitioners continue to face many practical challenges when determining therapeutic strategies for individual patients. This review will discuss several of these challenges including patient selection strategies, sequential therapy, optimal dose and schedule of various drugs, and therapeutic options for patients with nonclear-cell renal cell carcinoma.</p>","PeriodicalId":72620,"journal":{"name":"Clinical practice (London, England)","volume":"10 1","pages":"39-46"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3558941/pdf/nihms437210.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31302858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethnicity and assisted reproductive technologies.","authors":"Alicia Armstrong, Torie C Plowden","doi":"10.2217/cpr.12.65","DOIUrl":"10.2217/cpr.12.65","url":null,"abstract":"<p><p>Racial and ethnic disparities have been reported in every field of medicine. High costs associated with infertility treatment and restricted access to care has made assisted reproductive technologies particularly susceptible and vulnerable to disparity. Despite advances in the field, emerging literature has continued to demonstrate poorer outcomes in minority women receiving treatment with assisted reproductive technologies.</p>","PeriodicalId":72620,"journal":{"name":"Clinical practice (London, England)","volume":"9 6","pages":"651-658"},"PeriodicalIF":0.0,"publicationDate":"2012-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3595611/pdf/nihms436000.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31316554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of medical foods and nutritional approaches in the treatment of Alzheimer's disease.","authors":"Papan Thaipisuttikul,&nbsp;James E Galvin","doi":"10.2217/cpr.12.3","DOIUrl":"https://doi.org/10.2217/cpr.12.3","url":null,"abstract":"<p><p>Alzheimer's disease, the most common cause of dementia, has a high global economic impact. To date, there is no curative treatment; therefore, many efforts are directed not only at novel potential disease-modifying treatments and interventions, but also to develop alternative symptomatic and supportive treatments. Examples of these efforts include the medical foods. There are three medical foods that claim to offer symptomatic benefits: Axona(®), Souvenaid(®) and CerefolinNAC(®). Axona supplies ketone bodies as alternative energy source to neurons. Souvenaid provides precursors thought to enhance synaptic function. CerefolinNAC addresses the role of oxidative stress related to memory loss. The current scientific evidence on these medical foods is reviewed in this article. Furthermore, we also review the concept and evidence supporting use of the Mediterranean diet, a possible alternative to medical foods that, if implemented correctly, may have lower costs, fewer side effects and stronger epidemiological health outcomes.</p>","PeriodicalId":72620,"journal":{"name":"Clinical practice (London, England)","volume":"9 2","pages":"199-209"},"PeriodicalIF":0.0,"publicationDate":"2012-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/cpr.12.3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31198222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}