scholarly journals Attitudes of patients with a rheumatic disease on drug use in the COVID-19 pandemic

2021 ◽  
Vol 61 (1) ◽  
Author(s):  
Belkıs Nihan Coskun ◽  
Burcu Yagiz ◽  
Yavuz Pehlivan ◽  
Ediz Dalkilic
Keyword(s):  
Treatment Plan ◽  
Treatment Decision ◽  
Individual Choice ◽  
Tertiary Referral Center ◽  
Duration Of Illness ◽  
Discontinuation Of Treatment ◽  
Significant Difference ◽  
Rheumatic Conditions ◽  
The Individual

Abstract Background Anti-rheumatic drugs can increase the predisposition to infection, and patients may be unaware of continuing their treatment during the COVID-19 pandemic. Objective This study aimed to assess whether patients maintain their treatment for rheumatic conditions during the pandemic period and determine the factors responsible for discontinuation. Methods Patients were randomly selected from the prospectively collected database of our tertiary referral center. The patients were interviewed by telephone through a standardized closed-ended questionnaire, which is targeting the continuity of the treatment plan and the considerations related to the individual choice. The patients were asked whether they hesitated to visit the hospital for follow-up or intravenous drug administration. Results A total of 278 patients completed the questionnaire. While 62 of the patients (22.3%) had reduced or interrupted the treatment, only 11 patients (3.9%) stopped the treatment completely. A significant difference was observed between the duration of illness and the discontinuation of treatment. (p = 0.023) There was a significant difference in disease activity between the group that stopped treatment and continued treatment. (p = 0.001) There was no statistically significant difference in other demographic characteristics. One hundred thirty-five patients (48.6%) made the treatment decision by themselves, and 80% continued the treatment. Reasons for stopping the treatment were anxiety (48.4%), not being able to go to the hospital for intravenous treatment (45.1%), and not being able to find the drug (6.5%). Conclusion Since patients with long-term illnesses were found to be significantly more likely to stop their treatment, this group of patients should be monitored.

Recommendation of dose banding of cytotoxics according to pharmacokinetic criteria.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 2549-2549
Author(s):  
Etienne Chatelut ◽  
Melanie White-Koning ◽  
Ron H.J. Mathijssen ◽  
Sharyn D. Baker ◽  
Alex Sparreboom
Keyword(s):  
Capacity Planning ◽  
Simple Procedure ◽  
Drug Stability ◽  
Exposure Dose ◽  
Analytical Control ◽  
Individual Dose ◽  
Significant Difference ◽  
Patient Waiting Time ◽  
The Individual

2549 Background: Dose-banding has been recently suggested in order to optimize chemotherapy preparation. Ranges (or bands) of body surface area (BSA) are predefined. The individual dose of a particular patient is calculated according to a single BSA value per band, usually the mid-point of the BSA band in which the actual BSA of the patient lies. Thanks to this simple procedure, chemotherapy provision can be rationalized and chemotherapies can be prepared in advance for drugs with sufficient long-term drug stability. The primary purpose of dose-banding is to reduce patient waiting time and improve capacity planning of the pharmacy production, but additional benefits can also be found, such as reduced potential for medication errors, reduced drug wastage, and prospective quality control of preparations. The objective of this analysis was to compare dose-banding to individual BSA-dosing (current practice) according to pharmacokinetic (PK) criteria. Methods: Dose-banding was defined according to three bands of BSA: BSA<1.7m², 1.7m²≤BSA<1.9m², and BSA≥1.9m² for which the values of 1.55m², 1.80m², and 2.05m² were allocated, respectively. By using individual actual values of clearance of six drugs (cisplatin, docetaxel, paclitaxel, doxorubicin, topotecan, and irinotecan) from a total of 1,206 adult cancer patients, the AUCs corresponding to the two dosing methods were compared to a target value of AUC for each drug. Results: Over all 6 drugs, by using dose-banding the percent change of individual dose in comparison with BSA dosing ranged between -14% and +22%. In terms of capacity to attain the target AUC, there was no significant difference in precision when using dose-banding as compared to BSA-dosing for all drugs except paclitaxel (precision of 23.2% versus 21.8%, respectively). For all drugs including paclitaxel, distributions of AUC values were very similar with both dosing methods. Conclusions: For these 6 drugs and maybe others, dose-banding may be implemented without any risk of increasing interindividual plasma exposure. Dose-banding would make it possible to anticipate chemotherapy preparation and analytical control without any delay for the patients.

scholarly journals Experience with various occluder types for endovascular hemodynamic isolation of the left atrium appendage in patients with non-valvular atrial fibrillation

2021 ◽  
Vol 28 (3) ◽  
pp. 45-54
Author(s):  
D. V. Pevzner ◽  
E. V. Merkulov ◽  
G. K. Arutyunyan ◽  
A. L. Komarov ◽  
O. O. Shakhmatova ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Individual Choice ◽  
Device Implantation ◽  
Comparison Groups ◽  
Anatomic Variants ◽  
Short And Long Term ◽  
The Individual

The aim of our study was to evaluate implantation efficacy and safety across various occluder types and to identify factors determining device selection.Methods. This single-site prospective observational study included patients above the age of 40 years with non-valvular atrial fibrillation (AF) and high thromboembolic risk, undergoing endovascular isolation of the left atrium appendage (LAA) with Watchman or Amplatzer Cardiac Plug/Amulet devices. Occluders were implanted to patients without either had contraindications to anticoagulant therapy (ACT) or refused ACT. We evaluated technical aspects of device implantation, short- and long-term outcomes of the intervention over 3 years of follow-up.Results. 90 patients were enrolled in the study (62 into the Watchman arm and 28 into the Amplatzer arm). Interventions were technically successful in 89 cases. In 1 patient (1/90, 1.1%) technical success was not achieved due to device migration (Amplatzer Amulet). The incidence of early (occurring within˂ 24 hours) implantation complications was 0% in the Watchman arm, and 3.6% in the Amplatzer arm (1/28) (р=0.135) (device migration). The cumulative incidence of all in-hospital complications was 11.3% and 14.3%, respectively (р=0.734). No significant differences between arms were found in the incidence of device thrombosis within 90 days post-implantation (3.3% in the Watchman’s arm and 8.3% in the Amplatzer arm, р=0.316). During the observation period, there were no significant differences in comparison groups in the incidence of net clinical efficacy endpoint events (р=0.58). The bleeding rate was 17.7% and 14.3%, respectively, р=0.769. No factors influencing the choice of the device could be identified reliably; however, there was a trend towards Watchman preference for appendage anatomic variants such as broccoli and cactus. Amplatzer was preferred in patients with contraindications to ACT.Conclusion. Implantation of Watchman and Amplatzer Amulet occluders is equally effective and safe in preventing thromboembolism in patients with AF not receiving ACT for various reasons. The individual choice of a device may be influenced by appendage anatomy and indications to occluder implantation.

scholarly journals EFFECT OF QUERСETIN AND CHLORHEXIDINE-DENT ON CHANGES IN PERIODONTIC TISSUES IN CHILDREN LIVING IN ENVIRONMENTALLY POLLUTED REGIONS OF PRECARPATHIAN REGIONS

2021 ◽  
pp. 72-75
Author(s):  
M. M. Rozhko ◽  
M. V. Pavlyshyn ◽  
A. I. Grybyk
Keyword(s):  
Treatment Plan ◽  
Full Range ◽  
Peripheral Circulation ◽  
Periodontal Tissues ◽  
Stable Conditions ◽  
Significant Difference ◽  
Complex Therapy ◽  
The Individual ◽  
Long Term Observation ◽  
Favorable Conditions

The aim of the research is to increase the effectiveness of treatment of patients with chronic catarrhal gingivitis living in ecologically favorable conditions and in ecologically polluted regions of Precarpathian, by adding to the complex therapy of quercetin and chlorhexidine dent. The results of research by a number of scientists indicate that the use of quercetin in complex therapy helps to restore the antioxidant system, improve oxygen uptake by tissues and peripheral circulation, improve the rheological properties of the patient's blood. These properties of the drug were used by us in the research. We studied changes in periodontal tissues in children living in ecologically favorable conditions and in ecologically polluted regions of Precarpathian, conducted a comparative characterization of changes in periodontium and proposed a treatment plan for patients with chronic catarrhal gingivitis, supplemented with chlorhexidine dent and quercetin. We examined 60 children with chronic catarrhal gingivitis living in the contaminated areas of Precarpathian (Burshtyn) and 15 people with intact periodontium living in environmentally stable conditions. All patients underwent a full range of treatment measures, taking into account the removal of dental plaque and rehabilitation of the oral cavity. In 1 group of patients (30 people) patients were treated with chlorhexidine, calendula and chamomile infusion and 1% mefenamine paste. Patients of group 2 (30 people) - the drug quercetin on the mucous membrane of the gums under the individual gingival cap and chlorhexidine dent in the form of oral baths. In order to compare the two groups, an index assessment of the condition of periodontal tissues and a study of rheographic parameters of periodontal tissues were performed. The results of the research did not show a significant difference between clinical and laboratory parameters in patients 1 and 2 groups before treatment (p> 0.05), but they differed significantly from those in the comparison group (p <0.05), which indicates the fact that unfavorable environmental living conditions have an impact on the course of periodontal disease in children. We obtained a significant difference in the blood supply to periodontal tissues in patients with chronic catarrhal gingivitis compared with (p <0.05). The results of the research showed that the use of quercetin and 0.12% chlorhexidine solution in the complex treatment of patients with chronic catarrhal gingivitis provided a significant improvement in clinical parameters and laboratory characteristics of periodontal tissues in children living in different environmental conditions, and provided stabilization of these indicators in long-term observation. The use of the proposed scheme of treatment of patients with chronic catarrhal gingivitis stimulates metabolic processes in periodontal tissues, reduces cyanosis, edema of periodontal tissues according to the results of rheography of periodontal tissues. After treatment, we observe the normalization of the rheological characteristics of the gums, which indicates an improvement in blood circulation in the periodontal tissues in these patients (normalization of qualitative and quantitative characteristics of rheograms).

scholarly journals Effectiveness of Mulligans Mobilisation with Movement on Shoulder Dysfunction: A Systematic Review

2020 ◽  
Author(s):  
V Meena ◽  
Jibu George Varghese
Keyword(s):  
English Language ◽  
Cochrane Review ◽  
Long Term Effects ◽  
Eligibility Criteria ◽  
Shoulder Dysfunction ◽  
Significant Difference ◽  
Wear And Tear ◽  
Randomised Control Trials ◽  
The Individual

Introduction: Shoulder dysfunction is common musculoskeletal disorder. This is due to repeated wear and tear of structures around the shoulder joint causing the malpositioning of shoulder. The Mulligan Mobilisation with Movement (MWM) has shown good results in treating the shoulder dysfunction. Aim: To systemically review the available literature of MWM is effective in improving pain, Range Of Motion (ROM) and functioning in patients with shoulder dysfunction. Materials and Methods: Five electronic databases like MEDLINE, PUBMED, Cochrane (CENTRAL), PEDro, and Google Scholar were searched up from March 2019 to September 2019 for randomised control trails of MWM in shoulder dysfunction subjects. The key words used were mobilisation with movement, mulligan’s mobilisation with movement, shoulder dysfunction. Eligibility criteria were Randomised Control Trials (RCT) with 6 out of 12 Cochrane review group for risk of bias assessment published in English language. Results: Nine out of ten studies showed significant changes in mulligan’s MWM group than the general treatment, active ROM exercises, sham’s technique, stretching’s strengthening and stabilisation exercises, end range and mid-range mobilisations, electrotherapeutic modalities and only one showed no significant difference between the two groups but improvements in the pain, ROM, strength and functioning of the subjects with shoulder dysfunction. Conclusion: On overall study of mulligan’s MWM treatment in shoulder dysfunction it has very good improvements on outcome measures such as ROM, pain, strength and functional ability. Further more studies are required for knowing the individual effects of mulligan’s MWM and its short term, long term effects.

scholarly journals Comparative analysis of Bricker versus Wallace ureteroenteric anastomosis and identification of predictors for postoperative ureteroenteric stricture

2021 ◽  
Author(s):  
U Krafft ◽  
O Mahmoud ◽  
J Hess ◽  
J.P Radtke ◽  
A Panic ◽  
...  
Keyword(s):  
Renal Function ◽  
Urinary Diversion ◽  
Surgical Care ◽  
University Hospital ◽  
Stricture Formation ◽  
Significant Difference ◽  
The Individual ◽  
The University ◽  
Anastomotic Techniques

Abstract Purpose Ureteroenteric anastomosis after cystectomy is usually performed using the Bricker or Wallace technique. Deterioration of renal function is the most common long-term complication of urinary diversion (UD). To improve surgical care and optimize long-term renal function, we compared the Bricker and Wallace anastomotic techniques and identified risk factors for ureteroenteric strictures (UES) in patients after cystectomy. Material and methods Retrospective, monocentric analysis of 135 patients who underwent cystectomy with urinary diversion at the University Hospital Essen between January 2015 and June 2019. Pre- and postoperative renal function, relevant comorbidities, prior chemo- or radiotherapy, pathological findings, urinary diversion, postoperative complications, and ureteroenteric strictures (UES) were analyzed. Results Of all 135 patients, 69 (51.1%) underwent Bricker anastomosis and 66 (48.9%) Wallace anastomosis. Bricker and Wallace groups included 134 and 132 renal units, respectively. At a median follow-up of 14 (6–58) months, 21 (15.5%) patients and 30 (11.27%) renal units developed UES. We observed 22 (16.6%) affected renal units in Wallace versus 8 (5.9%) in Bricker group (p < 0.001). A bilateral stricture was most common in Wallace group (69.2%) (p < 0.001). Previous chemotherapy and 90-day Clavien-Dindo grade ≥ III complications were independently associated with stricture formation, respectively (OR 9.74, 95% CI 2–46.2, p = 0.004; OR 4.01, 95% CI 1.36–11.82, p = 0.013). Conclusion The results of this study show no significant difference in ureteroenteric anastomotic techniques with respect to UES development regarding individual patients but suggest a higher risk of bilateral UES formation in patients undergoing Wallace anastomosis. This is reflected in the increased UES rate under consideration of the individual renal units.

IMMUNOREACTIVE GROWTH HORMONE IN PLASMA AND URINE IN LONG TERM INSULIN TREATED DIABETICS IN RELATION TO DIABETIC RETINOPATHY

1974 ◽  
Vol 75 (1) ◽  
pp. 64-74 ◽  
Author(s):  
Kristian F. Hanssen
Keyword(s):  
Growth Hormone ◽  
Diabetic Retinopathy ◽  
List Type ◽  
Positive Correlation ◽  
Significant Difference ◽  
Median Plasma ◽  
Insulin Dependent ◽  
The Mean ◽  
The Individual

ABSTRACT In 15 long term insulin dependent diabetics with a normal excretion of albumin in the urine (< 25 mg/24 h), plasma immunoreactive growth hormone (IRHGH) was measured serially together with the urinary immunoreactive growth hormone (IRHGH) during 24 hours. A positive correlation was shown between mean plasma IRHGH and urinary IRHGH in the individual patient (0.05 > P > 0.02). No significant difference between median plasma IRHGH in the diabetics and controls was observed. However, urinary IRHGH was higher in the diabetics than in the controls (0.05 > P > 0.02). A near positive correlation was shown between urinary IRHGH and glucosuria (R = 0.50, 0.1 > P > 0.05). No correlation was shown between the degree of diabetic retinography and the mean plasma IRHGH or urinary IRHGH.

Impact of Oncotype-DX testing on choice of chemotherapy.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e12049-e12049
Author(s):  
Walter Yip ◽  
Krzysztof Dobosz ◽  
Caroline Illmann ◽  
Kaylie Willemsma ◽  
Christine E. Simmons
Keyword(s):  
Early Stage ◽  
Treatment Plan ◽  
Oncotype Dx ◽  
Long Term Outcomes ◽  
Myelosuppressive Chemotherapy ◽  
Short Course ◽  
Significant Difference ◽  
Short Course Chemotherapy ◽  
Treatment Plans

e12049 Background: The Oncotype DX test has been shown to change treatment plans in ~30% of cases, but it is unclear if it changes the type of chemotherapy offered. We sought to determine if the availability of Oncotype DX testing in BC resulted in a change in the type of chemotherapy regimens used on early stage breast cancer pts. Methods: This was a cohort study in which pts treated in the 2 years prior to the availability of Oncotype Dx testing were compared to pts treated in the 2 years after it became available in BC. Charts were audited and divided into pre- and post- availability of Oncotype DX testing. The groups were compared for differences in length of chemotherapy (12 vs > 12 weeks), type of agents used (anthracycline vs non-anthracycline) and myelosuppressive potential of regimen chosen. Results: A total of 831 pts fulfilled enrollment criteria; 360 were seen in the pre Oncotype era and 471 were seen in the post Oncotype era. A total of 250 (30.1%) pts were treated with chemotherapy in both cohorts with a median age of 59 for both groups (range of 29-80 and 24-80 respectively, p = NS). There was a decrease of 11.5% in pts receiving chemotherapy from 36.6% to 25.1% (p = 0.0003). Of the pts who received chemotherapy, there was a shift away from regimens containing anthracycline (49.2% vs 32.2%, p = 0.0070) and a shift towards more myelosuppressive chemotherapy regimens (p = 0.0344). There was a significant difference in the duration of chemotherapy regimens chosen with post Oncotype era pts receiving short course chemotherapy 69.5% of the time, compared to only 56.8% in the pre Oncotype era (p = 0.0491). Conclusions: The availability of Oncotype DX testing has resulted in a shift towards use of shorter, more myelosuppressive, non-anthracycline containing chemotherapy protocols. Since being publicly available, fewer pts are receiving chemotherapy but our data suggests a 10% change in treatment plan compared to the 30% change seen in other literature. Further study is warranted to ensure long term outcomes are not negatively impacted by the move towards shorter chemotherapy regimens.

Tolerability of radiation with concurrent temozolomide and effect on survival in chemo-refractory CNS lymphoma.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14554-e14554
Author(s):  
Anna Mary Brown Laucis ◽  
Katherine Selwa ◽  
Yilun Sun ◽  
Michelle Miran Kim ◽  
Kyle Clifford Cuneo ◽  
...  
Keyword(s):  
Low Dose ◽  
Treatment Plan ◽  
Central Nervous System Lymphoma ◽  
Cns Lymphoma ◽  
High Dose ◽  
Median Dose ◽  
Neurocognitive Dysfunction ◽  
Significant Difference ◽  
Grade 3

e14554 Background: There is no consensus for the treatment of central nervous system lymphoma (CNSL) refractory to first line high dose methotrexate-based chemotherapy. Whole brain radiation (WBRT) has often been used but may lead to unacceptable neurocognitive dysfunction. We examined our institutional experience with treating CNSL with radiotherapy (RT) and concurrent temozolomide (TMZ) including the resultant acute and long term toxicities. Methods: This single institution IRB approved retrospective study examined treatment, toxicity, and outcome variables in adults with primary or secondary CNS lymphoma. Inclusion criteria were brain-directed RT and development of the treatment plan at our institution. Three main RT field designs were used, including low and high dose WBRT and low dose WBRT with a focal boost to residual disease (WBRT+boost). We assessed relationships between treatment approach (RT field design and concurrent TMZ use) and clinical outcomes and toxicities using multivariable logistic regression models and Kaplan-Meier methods. Toxicity was recorded using the Common Terminology Criteria for Adverse Events version 5. Results: A total of 93 patients with median age of 57 years (range 24 – 86) treated from 2004 – 2019 were included, and 26 patients received concurrent TMZ. The RT field design of low dose WBRT (median dose: 23.4Gy) plus focal boost (median dose: 21.6Gy) was associated with favorable overall survival (OS) and progression free survival (PFS) without any significant difference in Grade 3+ toxicity compared to low dose WBRT (p = 0.20) or WBRT without boost (p = 0.80). Concurrent TMZ with RT was associated with significantly improved OS (HR 0.46, p = 0.025) and CNS PFS (HR 0.49, p = 0.019). Four of nine (44%) Grade 3+ non-hematologic toxicities occurred in patients receiving concurrent TMZ (p = 0.40). The most common non-hematologic toxicities included fatigue and nausea. Long term neurocognitive dysfunction was similar whether or not patients received concurrent TMZ (21% in TMZ group vs 23% in non-TMZ group; OR 0.87, 95% CI 0.25 – 2.68, p = 0.82) and irrespective of RT field design (WBRT+boost vs low dose WBRT p = 0.25, WBRT+boost vs WBRT without boost p = 0.19). Conclusions: Our findings suggest that concurrent TMZ use with brain RT for chemo-refractory CNSL is a promising strategy, with improved survival and no major additional toxicity. Further research that includes rigorous neurocognitive assessments is needed in prospective clinical trials to guide treatment approaches using concurrent TMZ with brain RT in CNSL patients.

NASH EQUILIBRIUM IN TWO-SIDED MATE CHOICE PROBLEM

2008 ◽  
Vol 10 (04) ◽  
pp. 421-435 ◽  
Author(s):  
VLADIMIR MAZALOV ◽  
ANNA FALKO
Keyword(s):  
Nash Equilibrium ◽  
Search Model ◽  
Individual Choice ◽  
Choice Problem ◽  
Expected Payoff ◽  
Last Stage ◽  
Nash Equilibrium Strategies ◽  
The Individual

We consider a two-sided search model in which individuals from two distinct populations would like to form a long-term relationship with a member of the other population. The individual choice is determined by the quality of the partner. Initially the quality of individuals in the population is uniform. At every stage the individuals randomly matched from their populations recognize the quality of the partner. If they accept each other they create a couple and leave the game. The partner's quality is the payoff. Unmatched players go to the next stage. At the last stage the individuals accept any partner. Each player aims to maximize her/his expected payoff. In this paper explicit formulas for Nash equilibrium strategies are derived. Also, the model with incoming individuals is analyzed.

scholarly journals Comparison of Cone-Beam Computed Tomography and Periapical Radiography in Predicting Treatment Decision for Periapical Lesions: A Clinical Study

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Ashok Balasundaram ◽  
Punit Shah ◽  
Michael M. Hoen ◽  
Michelle A. Wheater ◽  
Josef S. Bringas ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cone Beam Computed Tomography ◽  
Treatment Plan ◽  
Treatment Decision ◽  
Lesion Size ◽  
Cone Beam ◽  
Radiographic Examination ◽  
Periapical Lesions ◽  
Significant Difference ◽  
Choice Of Treatment

Objectives. To compare the ability of endodontists to determine the size of apical pathological lesions and select the most appropriate choice of treatment based on lesions’ projected image characteristics using 2 D and 3 D images.Study Design. Twenty-four subjects were selected. Radiographic examination of symptomatic study teeth with an intraoral periapical radiograph revealed periapical lesions equal to or greater than 3 mm in the greatest diameter. Cone-beam Computed tomography (CBCT) images were made of the involved teeth after the intraoral periapical radiograph confirmed the size of lesion to be equal to greater than 3 mm. Six observers (endodontists) viewed both the periapical and CBCT images. Upon viewing each of the images from the two imaging modalities, observers (1) measured lesion size and (2) made decisions on treatment based on each radiograph. Chi-square test was used to look for differences in the choice of treatment among observers.Results. No significant difference was noted in the treatment plan selected by observers using the two modalities (χ2(3)=.036,P>0.05).Conclusion. Lesion size and choice of treatment of periapical lesions based on CBCT radiographs do not change significantly from those made on the basis of 2 D radiographs.

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