scholarly journals Risk-stratified management strategies for HBV reactivation in RA patients receiving biological and targeted therapy: A narrative review

2019 ◽  
Vol 52 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Yi-Ming Chen ◽  
Sheng-Shun Yang ◽  
Der-Yuan Chen
Keyword(s):  
Targeted Therapy ◽  
Management Strategies ◽  
Narrative Review ◽  
Hbv Reactivation

scholarly journals A review of respiratory manifestations and their management in Ehlers-Danlos syndromes and hypermobility spectrum disorders

2021 ◽  
Vol 18 ◽  
pp. 147997312110253
Author(s):  
Karan Chohan ◽  
Nimish Mittal ◽  
Laura McGillis ◽  
Laura Lopez-Hernandez ◽  
Encarna Camacho ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Muscle Function ◽  
Respiratory Muscle ◽  
Respiratory Symptoms ◽  
Management Strategies ◽  
Narrative Review ◽  
Respiratory Muscle Function ◽  
Respiratory Management ◽  
Spectrum Disorders ◽  
Continuous Positive Pressure

Background: Ehlers-Danlos Syndromes (EDS) and Hypermobility Spectrum Disorders (HSD) are a heterogeneous group of heritable genetic connective tissue disorders with multiple characteristics including joint hypermobility, tissue fragility, and multiple organ dysfunction. Respiratory manifestations have been described in EDS patients, but have not been systematically characterized. A narrative review was undertaken to describe the respiratory presentations and management strategies of individuals with EDS and HSD. Methods: A broad literature search of Medline, Embase, Cochrane Database of Systematic Reviews, and Cochrane CENTRAL was undertaken from inception to November 2020 of all study types, evaluating EDS/ HSD and pulmonary conditions. This narrative review was limited to adult patients and publications in English. Results: Respiratory manifestations have generally been described in hypermobile EDS (hEDS), classical and vascular EDS subtypes. Depending on EDS subtype, they may include but are not limited to dyspnea, dysphonia, asthma, sleep apnea, and reduced respiratory muscle function, with hemothorax and pneumothorax often observed with vascular EDS. Respiratory manifestations in HSD have been less frequently characterized in the literature, but exertional dyspnea is the more common symptom described. Respiratory symptoms in EDS can have an adverse impact on quality of life. The respiratory management of EDS patients has followed standard approaches with thoracotomy tubes and pleurodesis for pleural manifestations, vocal cord strengthening exercises, continuous positive pressure support for sleep apnea, and exercise training. Reduced respiratory muscle function in hEDS patients responds to inspiratory muscle training. Conclusion: Respiratory symptoms and manifestations are described in EDS and HSD, and have generally been managed using conservative non-surgical strategies. Research into the prevalence, incidence and specific respiratory management strategies in EDS and HSD is needed to mitigate some of the associated morbidity.

scholarly journals How to Intervene in the Health Management of the Oncological Patient and of Their Caregiver? A Narrative Review in the Psycho-Oncology Field

2021 ◽  
Vol 11 (7) ◽  
pp. 99
Author(s):  
Gian Piero Turchi ◽  
Marta Silvia Dalla Riva ◽  
Luisa Orrù ◽  
Eleonora Pinto
Keyword(s):  
Quality Of Life ◽  
Health Management ◽  
Psychological Treatment ◽  
Management Strategies ◽  
Well Being ◽  
Narrative Review ◽  
Treatment Modalities ◽  
Oncological Patient ◽  
Post Surgery

Starting from statistical data derived from the oncological field, some articles have highlighted the importance of communication in the patient–caregiver dyad and have considered the various roles involved in a cancer diagnosis situation. Thus, the question of how to intervene in terms of “quality of life” from the time of diagnosis to the recovery or death of a cancer patient, beyond the sanitary and physical dimensions, has become relevant. Therefore, the present narrative review aims to offer an overview of the state of the art in terms of the psychological treatment modalities of cancer patients, from the diagnosis to the post-surgery period. A total of 67 articles were collected and analyzed, in relation to (1) psychological constructs employed in the oncological field, (2) intervention models and (3) quality of life and well-being measurement and evaluation tools. We described these articles, differentiating between those focusing on the role of (1) the patient, (2) the caregiver, (3) the patient–caregiver dyad and (4) healthcare professional roles. The oncological diagnosis and its repercussions in the lives of the patient and caregiver were explored and critical aspects that emerged from the literature were highlighted. In conclusion, the analysis allowed some considerations about the need to define research protocols and useful management strategies for increasing the overall health of patients with cancer diagnoses and the people who surround them.

scholarly journals A narrative review of targeted therapy in meningioma, pituitary adenoma, and craniopharyngioma of the skull base

2020 ◽  
Vol 9 (6) ◽  
pp. 75-75
Author(s):  
Nina L. Martinez ◽  
Omaditya Khanna ◽  
Christopher J. Farrell
Keyword(s):  
Targeted Therapy ◽  
Pituitary Adenoma ◽  
Skull Base ◽  
Narrative Review

scholarly journals RAF and MEK inhibitor therapy in adult patients with brain tumors: a case-based overview and practical management of adverse events

2020 ◽  
Vol 7 (4) ◽  
pp. 369-375
Author(s):  
Karisa C Schreck ◽  
Mallika P Patel ◽  
Jan Wemmer ◽  
Stuart A Grossman ◽  
Katherine B Peters
Keyword(s):  
Targeted Therapy ◽  
Management Strategies ◽  
High Grade Glioma ◽  
Mek Inhibitor ◽  
Braf V600e ◽  
Genetic Mutations ◽  
Small Subset ◽  
Duration Of Treatment ◽  
Mek Inhibitors ◽  
Oncology Providers

Abstract AbstractTargeted therapy has gained mainstream attention with notable successes against specific genetic mutations in many cancers. One particular mutation, the BRAF V600E mutation, is present in a small subset of gliomas in adults. Although clinical experience and trial data of RAF-targeted therapy in adults with glioma are lacking at this time, the poor prognosis of adult high-grade glioma has led neuro-oncology practitioners to consider the use of targeted therapy in these patients. In this manuscript, we describe the use of RAF and MEK inhibitors in adults with recurrent glioma. We discuss the utility of these agents, describe their toxicities, and give examples of management strategies. Given the significant toxicities of RAF and MEK inhibitors, along with the long potential duration of treatment, neuro-oncology providers should counsel patients carefully before initiating therapy and monitor them closely while undergoing treatment with RAF-targeted therapy.

Moderate to Severe Acute Respiratory Distress Syndrome Management Strategies: A Narrative Review

2019 ◽  
Vol 32 (3) ◽  
pp. 347-360 ◽  
Author(s):  
Mitchell S. Buckley ◽  
Amy L. Dzierba ◽  
Justin Muir ◽  
Jeffrey P. Gonzales
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Clinical Evidence ◽  
Distress Syndrome ◽  
Fluid Management ◽  
Management Strategies ◽  
Neuromuscular Blocking ◽  
Narrative Review ◽  
Lung Protective Ventilation

Acute respiratory distress syndrome (ARDS) remains a common complication associated with significant negative outcomes in critically ill patients. Lung-protective mechanical ventilation strategies remain the cornerstone in the management of ARDS. Several therapeutic options are currently available including fluid management, neuromuscular blocking agents, prone positioning, extracorporeal membrane oxygenation, corticosteroids, and inhaled pulmonary vasodilating agents (prostacyclins and nitric oxide). Unfortunately, an evidence-based, standard-of-care approach in managing ARDS beyond lung-protective ventilation remains elusive, contributing to significant variability in clinical practice. Although the optimal therapeutic strategy for managing moderate to severe ARDS remains extremely controversial, therapies supported with more robust clinical evidence should be considered first. The purpose of this narrative review is to discuss the published clinical evidence for both pharmacologic and nonpharmacologic management strategies in adult patients with moderate to severe ARDS as well as to discuss practical considerations for implementation.

scholarly journals CRITICAL PREPAREDNESS, READINESS AND RESPONSE TO COVID-19 PANDEMIC: A NARRATIVE REVIEW

2020 ◽  
Vol 8 (2) ◽  
pp. 21
Author(s):  
Ravindra Pathirathna ◽  
Pamila Adikari ◽  
Dedunu Dias ◽  
Udara Gunathilake
Keyword(s):  
Emergency Response ◽  
Emergency Preparedness ◽  
Disease Transmission ◽  
Management Strategies ◽  
Narrative Review ◽  
World Health ◽  
Contact Tracing ◽  
Prevention Measures ◽  
Priority Areas ◽  
Health Organization

Background: The COVID-19 was declared as a pandemic by the World Health Organization (WHO). Globally, countries took actions to slow the spread and avoid overwhelming the health system. The WHO issued interim guidelines on critical preparedness, readiness and response actions against COVID-19 to assist level of preparedness and readiness.Aim: This study reviewed the work of Australia, Singapore, Sri Lanka and the United Kingdom on actions and priority areas of work as described in interim guidelines by the WHO in relation to the first two phases of disease transmission scenario.Methods: A non-systematic narrative review was conducted. Relevant documents available in selected websites were searched. The data generated were compiled, and information was synthesised within the WHO framework for critical preparedness, readiness and response actions against COVID-19. Further, scenarios of “no cases” and “sporadic cases” were analysed against the actions and priority areas of work of said framework.Results: Study revealed differences in implementation approach of strategic actions and priority areas of work, such as in terms of activation, timeliness of implementing emergency response plans, variations in case management strategies as seen in contact tracing, management of asymptomatic contacts, isolation, quarantine and selection of cohort for laboratory investigation. Besides, gaps were found in availability and activation of business continuity plans.Conclusion: Global political and health authorities need much robust mechanisms for preparedness, response and coordination of contagious diseases with similar nature. Even the occurrence of one case shall trigger stringent transmission prevention measures and initiate the actions and priority areas of work as stated in the WHO interim guideline.Keywords: pandemics, emergency response, health policy, COVID-19, emergency preparedness. 

scholarly journals Hematological Malignancies and HBV Reactivation Risk: Suggestions for Clinical Management

Viruses ◽  
2019 ◽  
Vol 11 (9) ◽  
pp. 858 ◽  
Author(s):  
Alessandra Zannella ◽  
Massimo Marignani ◽  
Paola Begini
Keyword(s):  
Hematological Malignancies ◽  
Management Strategies ◽  
Clinical History ◽  
Immunosuppressive Drugs ◽  
Viral Reactivation ◽  
Current Evidence ◽  
Hbv Reactivation ◽  
Virus Reactivation ◽  
Effective Prevention ◽  
Clinical Consequences

It is well known that hepatitis B virus reactivation (HBVr) can occur among patients undergoing treatment for hematological malignancies (HM). The evaluation of HBVr risk in patients undergoing immunosuppressive treatments is a multidimensional process, which includes conducting an accurate clinical history and physical examination, consideration of the virological categories, of the medication chosen to treat these hematological malignancies and the degree of immunosuppression induced. Once the risk of reactivation has been defined, it is crucial to adopt adequate management strategies (should reactivation occur). The purpose of treatment is to prevent dire clinical consequences of HBVr such as acute/fulminant hepatitis, and liver failure. Treatment will be instituted according to the indications and evidence provided by current international recommendations and to prevent interruption of lifesaving anti-neoplastic treatments. In this paper, we will present the available data regarding the risk of HBVr in this special population of immunosuppressed patients and explore the relevance of effective prevention and management of this potentially life-threatening event. A computerized literature search was performed using appropriate terms to discover relevant articles. Current evidence supports the policy of universal HBV testing of patients scheduled to undergo treatment for hematological malignancies, and clinicians should be aware of the inherent risk of viral reactivation among the different virological categories and classes of immunosuppressive drugs.

Dermatologic Adverse Events of Systemic Anticancer Therapies: Cytotoxic Chemotherapy, Targeted Therapy, and Immunotherapy

2020 ◽  
pp. 485-500
Author(s):  
Alana Deutsch ◽  
Nicole R. Leboeuf ◽  
Mario E. Lacouture ◽  
Beth N. McLellan
Keyword(s):  
Targeted Therapy ◽  
Adverse Events ◽  
Anticancer Agents ◽  
Management Strategies ◽  
Survival Rates ◽  
Well Being ◽  
Cytotoxic Chemotherapy ◽  
Patient Treatment ◽  
Substantial Impact ◽  
Dermatologic Adverse Events

Over the past 2 decades, rapid advancement in systemic anticancer therapeutics has led to astounding improvement in survival rates of patients with cancer. However, this celebrated progress has brought with it an evolving spectrum of drug toxicities that limit their prodigious capabilities. Cutaneous adverse events are of the most frequent of these toxicities, with substantial impact on quality of life and commonly resulting in dose reduction or change in therapy. Thus, familiarity with the array of dermatologic manifestations caused by these drugs is prudent for patient treatment. As such, the advent of dedicated oncodermatologists, and their introduction into multidisciplinary cancer care, has been crucial in optimizing treatment through therapeutic achievement and overall well-being. This review will address the epidemiology, clinical presentations, and management strategies of the major dermatologic adverse events of systemic anticancer agents, including cytotoxic chemotherapy, targeted therapy, and immunotherapy.

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