730 Establishing Thresholds for Clinically Significant Donor Skin Reduction – Initial Findings from a Physician Delphi Consensus Panel

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S196-S197
Author(s):  
Angela Gibson ◽  
Janice Smiell ◽  
Erika I Brockfeld McClure ◽  
Reema Patel ◽  
Kristi Skorija ◽  
...  
Keyword(s):  
Clinical Significance ◽  
Patient Outcomes ◽  
Treatment Modalities ◽  
Delphi Consensus ◽  
Consensus Panel ◽  
Burn Treatment ◽  
Patient Type ◽  
Donor Skin ◽  
Clinically Significant ◽  
New Treatment

Abstract Introduction Definitive closure with autograft, as a current standard of care, is a critical outcome in severe burn treatment. Harvest of donor skin for autograft is associated with pain, scarring and potential infection. New treatment modalities aim to reduce the amount of donor skin required to achieve definitive closure of the burn wound. A threshold that defines the clinically significant reduction in amount of harvested skin for the treatment of deep partial (DPT) and full-thickness (FT) burns is not available. This study convened a Delphi Consensus Panel (DCP) to determine this threshold. The DCP is an accepted method to synthesize opinions and feedback from experts and to systematically achieve consensus. Methods Panel members were burn physicians with ≥3 years of experience post-residency, with either a total career experience of caring for ≥1,000 patients or working in a facility with an annual volume of ≥200 patients and caring for ≥500 patients. Round 1 consisted of open-ended questions regarding clinical decision-making, use of skin substitutes (SS) in DPT and FT burn treatment, and what would constitute a clinically significant reduction in donor skin. Results Panelists reported using SS to promote healing and achieve definitive closure without autograft for DPT burns, and as a temporizing measure between excision and surgery for FT burns. Total body surface area (TBSA) affected by burn and burn location influenced SS use. For DPT and FT burns, other patient outcomes influencing treatment decisions were cosmesis, pain control, and reducing functional limitations. Almost all panelists reported that reduction in the amount of donor skin were important. As expected in Round 1, a range for the minimum percentage of donor skin reduction regarded as clinically significant was provided for DPT (20%-50%) and FT (10%-20%) burns. The main factors influencing these estimates were TBSA burned, patient outcomes, patient preference, and patient type. Final results will provide consensus estimates for clinical significance for donor skin reduction based on subsequent rounds. Conclusions Preliminary results indicate that reduction of the amount of donor skin is important to physicians with burn care experience, and the thresholds for clinical significant reduction in donor skin are influenced by patient outcomes and preferences, TBSA burned, and patient type. Applicability of Research to Practice These data will provide a research-based definition surrounding the clinical significance of new treatment modalities for severely burned patients.

Management of thoracic aortic lesions - the future is endovascular

VASA ◽  
2012 ◽  
Vol 41 (3) ◽  
pp. 163-176 ◽  
Author(s):  
Weidenhagen ◽  
Bombien ◽  
Meimarakis ◽  
Geisler ◽  
A. Koeppel
Keyword(s):  
Thoracic Aorta ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Clinical Decision ◽  
Clinical Results ◽  
Treatment Modalities ◽  
Traumatic Rupture ◽  
Descending Thoracic Aorta ◽  
New Treatment ◽  
Aneurysm Dissection

Open surgical repair of lesions of the descending thoracic aorta, such as aneurysm, dissection and traumatic rupture, has been the “state-of-the-art” treatment for many decades. However, in specialized cardiovascular centers, thoracic endovascular aortic repair and hybrid aortic procedures have been implemented as novel treatment options. The current clinical results show that these procedures can be performed with low morbidity and mortality rates. However, due to a lack of randomized trials, the level of reliability of these new treatment modalities remains a matter of discussion. Clinical decision-making is generally based on the experience of the vascular center as well as on individual factors, such as life expectancy, comorbidity, aneurysm aetiology, aortic diameter and morphology. This article will review and discuss recent publications of open surgical, hybrid thoracic aortic (in case of aortic arch involvement) and endovascular repair in complex pathologies of the descending thoracic aorta.

Systematic literature review of clinical outcomes in adults with metastatic or advanced synovial sarcoma

2020 ◽  
Vol 16 (35) ◽  
pp. 2997-3013
Author(s):  
Kentaro Kogushi ◽  
Michael LoPresti ◽  
Shunya Ikeda
Keyword(s):  
Synovial Sarcoma ◽  
High Frequency ◽  
Clinical Evidence ◽  
Systemic Treatment ◽  
Progression Free Survival ◽  
Treatment Modalities ◽  
Free Survival ◽  
New Treatment ◽  
Poor Outcomes

Background: Synovial sarcoma (SS) is a rare, aggressive soft tissue sarcoma with a poor prognosis after metastasis. The objective of this study was to conduct a systematic review of the clinical evidence for therapeutic options for adults with metastatic or advanced SS. Materials & methods: Relevant databases were searched with predefined keywords. Results: Thirty-nine publications reported clinical data for systemic treatment and other interventions. Data on survival outcomes varied but were generally poor (progression-free survival: 1.0–7.7 months; overall survival: 6.7–29.2 months) for adults with metastatic and advanced SS. A high frequency of neutropenia with systemic treatment and low quality of life post-progression were reported. Conclusion: Reported evidence suggests poor outcomes in adults with metastatic and advanced SS and the need for the development of new treatment modalities.

scholarly journals Inhibitory Effects of a Reengineered Anthrax Toxin on Canine Oral Mucosal Melanomas

Toxins ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 157 ◽  
Author(s):  
Adriana Tomoko Nishiya ◽  
Marcia Kazumi Nagamine ◽  
Ivone Izabel Mackowiak da Fonseca ◽  
Andrea Caringi Miraldo ◽  
Nayra Villar Scattone ◽  
...  
Keyword(s):  
Tumor Cells ◽  
Evaluation Criteria ◽  
Anthrax Toxin ◽  
Treatment Modalities ◽  
Inhibitory Effects ◽  
Upa Receptor ◽  
New Treatment ◽  
Oral Malignancy

Canine oral mucosal melanomas (OMM) are the most common oral malignancy in dogs and few treatments are available. Thus, new treatment modalities are needed for this disease. Bacillus anthracis (anthrax) toxin has been reengineered to target tumor cells that express urokinase plasminogen activator (uPA) and metalloproteinases (MMP-2), and has shown antineoplastic effects both, in vitro and in vivo. This study aimed to evaluate the effects of a reengineered anthrax toxin on canine OMM. Five dogs bearing OMM without lung metastasis were included in the clinical study. Tumor tissue was analyzed by immunohistochemistry for expression of uPA, uPA receptor, MMP-2, MT1-MMP and TIMP-2. Animals received either three or six intratumoral injections of the reengineered anthrax toxin prior to surgical tumor excision. OMM samples from the five dogs were positive for all antibodies. After intratumoral treatment, all dogs showed stable disease according to the canine Response Evaluation Criteria in Solid Tumors (cRECIST), and tumors had decreased bleeding. Histopathology has shown necrosis of tumor cells and blood vessel walls after treatment. No significant systemic side effects were noted. In conclusion, the reengineered anthrax toxin exerted inhibitory effects when administered intratumorally, and systemic administration of this toxin is a promising therapy for canine OMM.

scholarly journals Tuning the network charge of biohybrid hydrogel matrices to modulate the release of SDF-1

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Sebastian Kühn ◽  
Joanna Freyse ◽  
Passant Atallah ◽  
Jörg Rademann ◽  
Uwe Freudenberg ◽  
...  
Keyword(s):  
Bone Repair ◽  
Negative Charge ◽  
Polymer Networks ◽  
Signaling Molecules ◽  
Treatment Modalities ◽  
Precise Control ◽  
Integral Density ◽  
New Treatment ◽  
Two Parameters

Abstract The delivery of chemotactic signaling molecules via customized biomaterials can effectively guide the migration of cells to improve the regeneration of damaged or diseased tissues. Here, we present a novel biohybrid hydrogel system containing two different sulfated glycosaminoglycans (sGAG)/sGAG derivatives, namely either a mixture of short heparin polymers (Hep-Mal) or structurally defined nona-sulfated tetrahyaluronans (9s-HA4-SH), to precisely control the release of charged signaling molecules. The polymer networks are described in terms of their negative charge, i.e. the anionic sulfate groups on the saccharides, using two parameters, the integral density of negative charge and the local charge distribution (clustering) within the network. The modulation of both parameters was shown to govern the release characteristics of the chemotactic signaling molecule SDF-1 and allows for seamless transitions between burst and sustained release conditions as well as the precise control over the total amount of delivered protein. The obtained hydrogels with well-adjusted release profiles effectively promote MSC migration in vitro and emerge as promising candidates for new treatment modalities in the context of bone repair and wound healing.

scholarly journals Stem Cells and Gene Therapy in Progressive Hearing Loss: the State of the Art

2021 ◽  
Author(s):  
Aida Nourbakhsh ◽  
Brett M. Colbert ◽  
Eric Nisenbaum ◽  
Aziz El-Amraoui ◽  
Derek M. Dykxhoorn ◽  
...  
Keyword(s):  
Stem Cells ◽  
Gene Therapy ◽  
Hearing Loss ◽  
Treatment Modalities ◽  
Versus Gene ◽  
Vitro Model ◽  
New Treatment ◽  
Induced Pluripotent ◽  
Therapy Strategies

AbstractProgressive non-syndromic sensorineural hearing loss (PNSHL) is the most common cause of sensory impairment, affecting more than a third of individuals over the age of 65. PNSHL includes noise-induced hearing loss (NIHL) and inherited forms of deafness, among which is delayed-onset autosomal dominant hearing loss (AD PNSHL). PNSHL is a prime candidate for genetic therapies due to the fact that PNSHL has been studied extensively, and there is a potentially wide window between identification of the disorder and the onset of hearing loss. Several gene therapy strategies exist that show potential for targeting PNSHL, including viral and non-viral approaches, and gene editing versus gene-modulating approaches. To fully explore the potential of these therapy strategies, a faithful in vitro model of the human inner ear is needed. Such models may come from induced pluripotent stem cells (iPSCs). The development of new treatment modalities by combining iPSC modeling with novel and innovative gene therapy approaches will pave the way for future applications leading to improved quality of life for many affected individuals and their families.

Analysis of the interventions in antineoplastic therapy by a clinical pharmacy service at a tertiary hospital in Brazil

2021 ◽  
pp. 107815522110176
Author(s):  
Camile da Rocha ◽  
Juliane Carlotto ◽  
Jose Zanis Neto
Keyword(s):  
Monoclonal Antibodies ◽  
Antineoplastic Therapy ◽  
Clinical Significance ◽  
Clinical Pharmacy ◽  
Tertiary Hospital ◽  
Clinical Pharmacy Service ◽  
Drug Related Problems ◽  
Lack Of Information ◽  
Clinically Significant ◽  
Pharmaceutical Interventions

Background Medication errors are avoidable occurrences that can assume clinically significant dimensions and impose relevant costs to the health system, especially in the context of antineoplastic therapy. Objective Assess the clinical significance and economic impacts of a clinical pharmaceutical service. This retrospective study consists of an analysis of pharmacy interventions and drug-related problems found in a review of electronic prescriptions referring to antineoplastic therapy of a public teaching tertiary hospital in Brazil. Method Retrospective descriptive study obtained from electronic records of drug-related problems and pharmaceutical interventions related to antineoplastic therapy for oncological and hematological diseases, obtained through the pharmacotherapy review service. The accepted interventions were analyzed for the financial impact generated, evaluating your direct costs. The perception of clinical significance of a random sample of interventions was ascertained by the experts' opinion, using the Delphi method. Results The most frequent problem was a “lack of information to professionals” (25.06%), “problems as to the frequency and interval of doses” (22.90%), and “medication underdosing” (16.20%). Dose adjustment (31.50%) and clarifications (30.90%) were the most frequent pharmaceutical interventions. In the second round of Delphi, experts rated 77.77% of interventions as extremely significant and very significant. The main drugs reported in the interventions were cyclophosphamide, carboplatin, methotrexate, folinic acid, and monoclonal antibodies. The savings amounted to US$1,193,970.18 and involved mainly bortezomib, dactinomycin, and monoclonal antibodies. Conclusion Clinical pharmacy services contributed to the rational use of medicines presenting clinical significance and avoiding waste of financial resources.

scholarly journals Patient Experiences of Postinfectious Olfactory Dysfunction

ORL ◽  
2021 ◽  
pp. 1-5
Author(s):  
Carl M Philpott ◽  
James Boardman ◽  
Duncan Boak
Keyword(s):  
Online Survey ◽  
Unmet Need ◽  
Olfactory Dysfunction ◽  
Treatment Modalities ◽  
Medical Practitioners ◽  
Clinical Trials Unit ◽  
New Treatment ◽  
The Uk ◽  
Patients Experience ◽  
Age Range

<b><i>Introduction:</i></b> To highlight the importance of the need for new treatment modalities, this study aimed to characterise the experience of patients with postinfectious olfactory dysfunction (PIOD) in terms of the treatment they received. <b><i>Methods:</i></b> An online survey was hosted by the Norwich Clinical Trials Unit on the secure REDCap server. Members of the charity Fifth Sense (the UK charity that represents and supports people affected by smell and taste disorders) were invited to participate. <b><i>Results:</i></b> There were 149 respondents, of whom 127 had identified themselves as having (or had) PIOD. The age range of respondents to the survey was 28–85 years, with a mean of 58 ± 12 years, with the duration of their disorder &#x3c;5 years in 63% of cases. Respondents reported experiencing variable treatment with oral and/or intranasal steroids given typically (28%), often with no benefit, but with 50% receiving no treatment whatsoever; only 3% reported undertaking olfactory training. Over two-thirds of patients experience parosmia and, up to 5 years from the onset of the problem, were still actively seeking a solution. <b><i>Conclusion:</i></b> There appears to be a need to encourage greater use of guidelines for olfactory disorders amongst medical practitioners and also to develop more effective treatments for patients with PIOD, where there is clearly an unmet need.

New Therapeutics for Ulcerative Colitis

2021 ◽  
Vol 72 (1) ◽  
pp. 199-213
Author(s):  
Robert P. Hirten ◽  
Bruce E. Sands
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Disease ◽  
Clinical Remission ◽  
Treatment Options ◽  
Treatment Modalities ◽  
Therapeutic Approaches ◽  
Stages Of Development ◽  
The Future ◽  
New Treatment ◽  
Novel Therapeutic

Ulcerative colitis (UC) is a relapsing and remitting inflammatory disease of the colon with a variable course. Despite advances in treatment, only approximately 40% of patients achieve clinical remission at the end of a year, prompting the exploration of new treatment modalities. This review explores novel therapeutic approaches to UC, including promising drugs in various stages of development, efforts to maximize the efficacy of currently available treatment options, and non-medication-based modalities. Treatment approaches which show promise in impacting the future of UC management are highlighted.

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