scholarly journals Quality Appraisal of Guidelines on Cancer-Associated Thrombosis Using AGREE II Instrument and Analysis of Current Status of New Oral Anticoagulants

2019 ◽  
Vol 25 ◽  
pp. 107602961984656 ◽  
Author(s):  
Jiuxing Zhang ◽  
Juan Xu ◽  
Wenlong Zhang ◽  
Meiting Jiang ◽  
Juan Liu ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Oral Anticoagulants ◽  
New Oral Anticoagulants ◽  
Current Status ◽  
Supporting Evidence ◽  
Agree Ii ◽  
Prevention And Treatment ◽  
Cancer Associated Thrombosis

Cancer-associated thrombosis (CAT) studies have increased in recent years and the quality of guidelines to guide the clinical practice of CAT prevention and treatment becomes crucial. The therapy status of new oral anticoagulants (NOACs) has been established in some thrombotic diseases, but the evidence for CAT remains unconvincing. The aim of this research is to evaluate the quality of CAT guidelines and discuss the role of NOAC in CAT. A search of articles was performed using PubMed/Medline, Chinese National Knowledge Infrastructure, and other authoritative websites. Search terms included guideline or guidance, consensuses, cancer, and thrombosis. Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool was used to evaluate the qualities of the guidelines. A total of 19 guidelines were screened out and evaluated, of which 8 were recommended, 5 were recommended after revision, and 6 were not recommended. For prevention and treatment of CAT, low-molecular-weight heparin is the most recommended, followed by vitamin K antagonist, unfractionated heparin, fondaparinux, and aspirin. New oral anticoagulant is optional in some cases of CAT treatment. Based on AGREE II assessment tool, the quality of CAT guidelines is inconsistent. Attention should be drawn to the quality of CAT guidelines during clinical practice. The role of NOAC in the treatment of CAT is gradually established but requires more supporting evidence from future clinical trials.

scholarly journals Antenatal magnesium sulfate for fetal neuroprotection: a critical appraisal and systematic review of clinical practice guidelines

2019 ◽  
Vol 47 (3) ◽  
pp. 262-269 ◽  
Author(s):  
Pradeep M. Jayaram ◽  
Manoj K. Mohan ◽  
Ibrahim Farid ◽  
Stephen Lindow
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Magnesium Sulfate ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Supporting Evidence ◽  
Agree Ii ◽  
Fetal Neuroprotection ◽  
Agree Ii Tool

Abstract Background Magnesium sulfate is an accepted intervention for fetal neuroprotection. There are some perceived differences in the international recommendations on the use magnesium sulfate for fetal neuroprotection in preterm labor. Content This systematic review analyses the available clinical guidelines for the use of magnesium sulfate for fetal neuroprotection and compares the recommendations, and assesses the quality of guidelines. This provides the consensus, differences and explores the areas for future collaborative research. We searched databases of PUBMED, EMBASE, COCHRANE, Web of Science, LILACS; and included the national and the international clinical practice guidelines. We included seven guidelines out of 227 search results. We evaluated the methodological quality of guidelines using the Appraisal of Guidelines Research and Evaluation (AGREE II) tool and systematically extracted guideline characters, recommendation and supporting evidence base. Summary Five guidelines were of high quality and two were of moderate quality. One guideline achieved more than an 80% score in all the domains of AGREE II tool. All guidelines recommend use of magnesium sulfate for fetal neuroprotection. However, there are differences in other recommendations such as upper gestational age, dose, duration, repeating treatment and use of additional tocolytics. Outlook Future guidelines should include recommendations on all aspects of magnesium sulfate therapy for fetal neuroprotection. Future research and international collaboration should focus on areas where there are no international consensual recommendations.

Cancer-associated thrombosis: investigating the role of new oral anticoagulants

2015 ◽  
Vol 135 (5) ◽  
pp. 777-781 ◽  
Author(s):  
Massimo Franchini ◽  
Carlo Bonfanti ◽  
Giuseppe Lippi
Keyword(s):  
Oral Anticoagulants ◽  
New Oral Anticoagulants ◽  
Cancer Associated Thrombosis

scholarly journals Membrane condenser as emerging technology for water recovery and gas pre-treatment: current status and perspectives

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Adele Brunetti ◽  
Francesca Macedonio ◽  
Giuseppe Barbieri ◽  
Enrico Drioli
Keyword(s):  
Current Status ◽  
Innovative Technology ◽  
Water Recovery ◽  
Treatment Unit ◽  
Treatment Stage ◽  
Treatment Technologies ◽  
Pre Treatment ◽  
And Control

Abstract The recent roadmap of SPIRE initiative includes the development of “new separation, extraction and pre-treatment technologies” as one of the “key actions” for boosting sustainability, enhancing the availability and quality of existing resources. Membrane condenser is an innovative technology that was recently investigated for the recovery of water vapor for waste gaseous streams, such as flue gas, biogas, cooling tower plumes, etc. Recently, it has been also proposed as pre-treatment unit for the reduction and control of contaminants in waste gaseous streams (SOx and NOx, VOCs, H2S, NH3, siloxanes, halides, particulates, organic pollutants). This perspective article reports recent progresses in the applications of the membrane condenser in the treatment of various gaseous streams for water recovery and contaminant control. After an overview of the operating principle, the membranes used, and the main results achieved, the work also proposes the role of this technology as pre-treatment stage to other separation technologies. The potentialities of the technology are also discussed aspiring to pave the way towards the development of an innovative technology where membrane condenser can cover a key role in redesigning the whole upgrading process.

New Oral Anticoagulants Versus Low Molecular Weight Heparins for the Treatment of Cancer-associated Thrombosis: a Cost-effectiveness Analysis

2021 ◽  
Author(s):  
Kaidireyahan Wumaier ◽  
Wenqian Li ◽  
Naifei Chen ◽  
Jiuwei Cui
Keyword(s):  
Molecular Weight ◽  
Cost Effectiveness ◽  
Oral Anticoagulants ◽  
New Oral Anticoagulants ◽  
Low Molecular Weight ◽  
Test Model ◽  
Low Molecular Weight Heparins ◽  
Gastrointestinal Malignancy ◽  
Cancer Associated Thrombosis ◽  
The Cost

Abstract Background: Recently, new oral anticoagulants (NOACs) have been included in guidelines for the treatment of cancer-associated thrombosis (CAT) to be extended to suitable cancer patients. The purpose of this study was to compare the cost-effectiveness of using NOACs and low molecular weight heparins(LMWHs) for treating CAT from the perspective of the Chinese healthcare system. Methods: A Markov model was constructed to estimate the cost-effectiveness of the two strategies with a 6-month and 5-year time horizon. Input parameters were either sourced from the clinical trial, published literature. The primary outcome of the model was reported as incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were performed to test model uncertainty. Results: The 6-month cost of NOACs was $ 654.65 with 0.40 QALYs while the 6-month cost of LMWHs was $ 1719.31 with 0.37 QALYs. Similarly, treatment with NOACs had a lower cost ($ 657.85 vs. $ 1716.56) and more health benefits (0.40 QALY vs. 0.37 QALY) than treatment with LMWHs in a subgroup of patients with gastrointestinal malignancy. We found treatment with NOACs would result in a large reduction in cost($ 1447.22 vs. $ 3374.70) but a small reduction in QALYs (3.07 QALY vs. 3.09 QALY) compared with LMWHs over a 5-year time frame, resulting in an ICER of $ 112895.50/QALY. Sensitivity analysis confirmed the robustness of the results. Conclusion: As compared to LMWHs, NOACs can be a cost-saving anticoagulant choice for the treatment of CAT in the general oncology population and gastrointestinal malignancy population.Classification codes: I.

scholarly journals Nitric oxide-dependent regulation of sweet pepper fruit ripening

2019 ◽  
Vol 70 (17) ◽  
pp. 4557-4570 ◽  
Author(s):  
Salvador González-Gordo ◽  
Rocío Bautista ◽  
M Gonzalo Claros ◽  
Amanda Cañas ◽  
José M Palma ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Fruit Ripening ◽  
Biochemical Analysis ◽  
Sweet Pepper ◽  
Supporting Evidence ◽  
Functional Categories ◽  
Fatty Acid Profiling ◽  
Pepper Fruit

Abstract Ripening is a complex physiological process that involves changes in reactive nitrogen and oxygen species that govern the shelf-life and quality of fruits. Nitric oxide (NO)-dependent changes in the sweet pepper fruit transcriptome were determined by treating fruits at the initial breaking point stage with NO gas. Fruits were also harvested at the immature (green) and ripe (red) stages. Fruit ripening in the absence of NO resulted in changes in the abundance of 8805 transcripts whose function could be identified. Among these, functional clusters associated with reactive oxygen/nitrogen species and lipid metabolism were significantly modified. NO treatment resulted in the differential expression of 498 genes framed within these functional categories. Biochemical analysis revealed that NO treatment resulted in changes in fatty acid profiling, glutathione and proline contents, and the extent of lipid peroxidation, as well as increases in the activity of ascorbate peroxidase and lipoxygenase. These data provide supporting evidence for the crucial role of NO in the ripening of pepper fruit.

scholarly journals Therapeutic effects of lignans in women in perimenopausal and postmenopausal periods (review of literature)

2021 ◽  
Vol 8 (1) ◽  
pp. 26-34
Author(s):  
Lyudmila A. Ozolinya ◽  
Valentina V. Litvinova
Keyword(s):  
Emotional Disorders ◽  
Alternative Methods ◽  
Therapeutic Effects ◽  
Female Population ◽  
Perimenopausal Women ◽  
Prevention And Treatment ◽  
Low Incidence ◽  
Positive Effect

Today, there is a tendency towards an increase of the number of the female population that has crossed the line of menopause, which makes it more urgent to improve the quality of life of women and to develop safe methods for the prevention and treatment of climacteric syndrome (CS), which is an integral medical, social and economic problems. In view of the presence of contraindications for use and defined risks of complications with the use of hormone menopausal therapy (HRT), it is necessary to develop alternative methods for the prevention and treatment of perimenopausal symptoms. This literary review of domestic and foreign sources demonstrates information about the role of the plant lignan 7-hydroxymatairezinol (7-HMR) in maintaining the physical and psychoemotional health of women in the period of peri- and postmenopause. As a result of the analysis of the therapeutic effects of the 7-HMR molecule, the ability to relieve the main symptoms of CS (neurovegetative presentations and emotional disorders), to improve the general state of health and metabolic profile of perimenopausal women was revealed. High safety and low incidence of side effects were noted, as well as a positive effect on the dynamics of body weight. The presence of a stable anti-inflammatory and antioxidant activity 7-HMR makes it possible to recommend this lignan to women in the climacteric period as an effective drug for the prevention of the formation of immune deficiency, which contributes to the development of oncological and autoimmune diseases. The proven antitumor activity confirms the promise of using the 7-HMR for the implementation of oncopreventive measures in women of peri- and postmenopausal age.

scholarly journals Success of Online CME at Improving Knowledge and Confidence Around Guideline-Directed Management of Cancer-Associated Thrombosis

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 13-13
Author(s):  
Caroline Padbury ◽  
Margaret Harris ◽  
Michael LaCouture ◽  
Jelena Spyropoulos
Keyword(s):  
Clinical Practice ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Treatment Guidelines ◽  
Conflicts Of Interest ◽  
Oral Anticoagulants ◽  
Roundtable Discussion ◽  
Patients With Cancer ◽  
Cancer Associated Thrombosis ◽  
Post Assessment

Title:Success of Online CME at Improving Knowledge and Confidence Around Guideline-Directed Management of Cancer-Associated Thrombosis Study Objectives:Recent guidance statements recommend the use of direct oral anticoagulants (DOACs) as primary thromboprophylaxis in ambulatory patients with cancer who are starting chemotherapy and in patients with cancer and acute venous thromboembolism at low risk of bleeding and no drug-drug interactions.[Farge 2019; Key 2020] Yet, many clinicians lack knowledge and confidence with integrating DOACs into management strategies for patients with cancer in accordance to guideline recommendations.[Cushman 2015; Khorana 2016] We sought to determine if online continuing medical education (CME) could improve the knowledge and confidence of hematologists/oncologists regarding guideline-directed use of DOACs in the management of cancer-associated thrombosis. Methods:This CME intervention comprised of a 30-minute online video-based roundtable discussion among experts in the field of cancer-associated thrombosis management. Responses to 3 multiple-choice, knowledge questions and 1 self-efficacy, 5-point Likert scale confidence question were analyzed using a repeated pairs pre-/post-assessment study design. A chi-square test (P <.05 is considered significant) assessed pre- to post-activity change . The activity launched December 23, 2019, and data were collected through February 24, 2020. Results:In total, 71 Hematologists/Oncologists were included in this study. Overall, there were knowledge and confidence improvements seen among all groups from pre- to post-assessment: 27% of hematologists/oncologists (P<.01) improved at identifying guideline-directed therapy regarding recommended thromboprophylaxis in patients with cancer per guideline recommendations.27% of hematologists/oncologists (P<.01) improved at selecting guideline-appropriate treatment options for cancer-associated thrombosis.44% of hematologists/oncologists had an increase in confidence in managing thrombosis in patients with cancer. Continued educational gaps: 25% of hematologists/oncologists failed to select guideline recommended DOAC therapy for thromboprophylaxis in cancer patients.45% of hematologists/oncologists failed to select guideline recommended DOAC therapy for treatment of thrombosis in cancer patients.66% of hematologists/oncologists still remain at only a rating of 1 to 3 on a scale of 1 to 5 in their confidence managing thrombosis in patients with cancer. Conclusion:This study demonstrates the success of online, CME-accredited, video-based roundtable discussion with experts in the field on significantly improving knowledge and confidence of hematologists/oncologists related to the guideline-recommended use of DOACs in the management of cancer-associated thrombosis. Continued gaps were also identified for future educational targets. Sources of support: Developed through an independent educational grant from Janssen in partnership with the University of Chicago. References: Cushman M, Creager MA. Improving awareness and outcomes related to venous thromboembolism. JAMA. 2015;314(18):1913-4. Farge D, Frere C, Connors JM, et al. 2019 International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. The Lancet Oncology. 2019;20(10):e566-581. Key NS, Khorana AA, Kuderer NM, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO Clinical Practice Guideline Update. J Clin Oncol. 2020 Feb 10;38(5):496-520. Khorana AA, Yannicelli D, McCrae KR, et al. Evaluation of US prescription patterns: are treatment guidelines for cancer-associated venous thromboembolism being followed? Thromb Res. 2016 Sep;145:51-3. Disclosures No relevant conflicts of interest to declare.

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