Field Of Clinical Management Research Articles

Molecular Targets and Emerging Therapies for Advanced Gallbladder Cancer.

Simple SummaryBiliary tract cancers (BTCs) are rare tumors with devastating prognosis. Gallbladder cancer (GBC) is the most common BTC, and even though recent advances have been carried out in the field of clinical management, research for molecular targets for precision medicine is proceeding at slow steps. This review discuss the molecular targets highlighted to date, focusing on clinical trials exploring the efficacy of precision medicine and immunotherapeutic compounds for the treatment of advanced GBC. Points of strength and weakness of each molecular biomarker are discussed, designing new landscapes for new therapeutic approaches for this malignancy, and suggesting new roles for cytotoxic agents, to date considered the gold standard for patients’ clinical management.Biliary tract cancers (BTCs), for their low incidence, have been often considered together. Gallbladder cancer (GBC) is the most common biliary tract malignancy, characterized by late diagnosis and poor prognosis, and although it is considered a rare tumor in western countries, other areas of the world show considerable incidence rates. In 2010, results from the large phase III ABC-02 clinical trial on GBC identified the gemcitabine and cisplatin combination as the most effective first-line regimen for both GBC and other BTCs. Since then, various systemic therapies have proven active in BTCs in both first- and second-line settings. Molecular profiling has highlighted important genetic differences between GBC and other BTCs, opening new ways for targeted therapy in advanced disease where standard chemotherapies show marginal benefit. Genome-wide data analysis have shown that GBC molecular landscape offer possible strategies for precision medicine approaches, and a better molecular understanding of the GBC is needed to better stratify patients for treatment. In this review, we discuss the molecular targetable agents for GBC, including the results that emerged by clinical trials exploring new treatment strategies.

PSICOSE E PSICANÁLISE: OBSERVAÇÕES SOBRE O DIAGNÓSTICO

Este trabalho se propõe a discutir questões referentes ao diagnóstico das psicoses na psicanálise e na psiquiatria, assinalando distinções entre as duas lógicas diagnósticas presentes em cada disciplina; o artigo procura, ainda, apresentar, de maneira detalhada, a perspectiva psicanalítica sobre a psicose. Através de uma revisão de literatura, os autores fazem uma exposição sobre as psicoses em diferentes momentos das obras de Freud e de Lacan, atravessando conceitos fundamentais para o entendimento de cada concepção. Por fim, é indicado como a psicose ganha o estatuto de estrutura clínica e as consequências disso para o manejo clínico.

Clinical judgment and best evidence: will I be sued if I do not follow the guidelines?

Clinical judgment and best evidence: will I be sued if I do not follow the guidelines? Tarun K Sharma,1 Stephen A Vernon 1Worcestershire Acute Hospitals NHS Trust, 2University Hospital, Nottingham, UKAbstract: Optometrists are increasing their roles into the field of clinical management. Making management decisions and treating patients increases the risk of litigation. Guidelines have been developed to assist in the clinical care of patients and are being increasingly used in litigation cases to assist in the decision making process. This article outlines the status of litigation as it relates to current optometric and ophthalmic practice, and discusses clinical management in the context of guidelines. In some countries, including the UK, optometrists are becoming the principal providers of primary eye care in the community, with their role expanding beyond traditional refractive practice into the realm of the treatment of medical conditions. The delivery of health care in the modern era is becoming increasingly challenging as a result of improving patient knowledge via the Internet, and a commensurate rise in patient expectations. In addition, close scrutiny by the media and those in the legal profession has appeared to drive an increase in claims against practitioners. Practitioners are vulnerable to litigation when patients consider that their care has fallen below acceptable standards. This article discusses the current status of guidelines with respect to potential litigation in the context of clinical care as it relates to expanding roles within optometric practice.Keywords: guidelines, litigation, optometrists