scholarly journals Why do we have to use new low flux dialysis machine for daily home dialysis

2018 ◽  
Vol 1 (2) ◽  
pp. 71-74
Author(s):  
Hafedh Fessi
Keyword(s):  
Recovery Time ◽  
Western Europe ◽  
Ultrafiltration Rate ◽  
Dialysis Dose ◽  
Good Opportunity ◽  
Home Dialysis ◽  
Session Management ◽  
The Us

After a decline at the end of 90’s, Home Hemodialysis recently found a second breath. This renewal doesn’t only concern France, but also the US and Western Europe (GB, Italy and Spain).Several studies confirm that low flux dialysat machines deliver adequate dialysis dose, based on high dialysat saturation and low daily ultrafiltration rate. Frequent sessions avoid long interdialytic interval. They also are easy to use, allow easier session management with more flexibility and mobility.Daily hemodialysis with low dialysat flux responds to new goals: improving quality of life reaching better cardiovascular parameters and reduce recovery time post dialysis.Better patient adhesion to the treatment with low flux dialysat machines allows a decrease in barriers to home memodialysis development.It gives a good opportunity today to improve dialysis quality. The role of patient care partner is determinant

scholarly journals Interaction of race and pathology for neuroendocrine tumors: Epidemiology, natural history, or racial disparity?

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 376-376
Author(s):  
Rachel M Lee ◽  
Danielle K DePalo ◽  
Alexandra G Lopez-Aguiar ◽  
Mohammad Yahya Zaidi ◽  
Flavio G. Rocha ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Neuroendocrine Tumors ◽  
Prognostic Value ◽  
Oncologic Outcomes ◽  
Gastroenteropancreatic Neuroendocrine Tumors ◽  
Curative Intent ◽  
Black And White ◽  
The Us

376 Background: The prognostic value of pathologic variables is not consistent for gastroenteropancreatic neuroendocrine tumors (GEP-NETs). We previously demonstrated a limited prognostic role of lymph node (LN) positivity in small bowel NETs (SBNET) compared to pancreatic NETs (panNET). Although minority race is often associated with worse cancer outcomes, the interaction of race with pathologic and oncologic outcomes of pts with GEP-NETS is not known. Methods: Pts with GEP-NETs who underwent curative intent resection at eight institutions of the US NET Study Group from 2000-16 were included. Given few pts of other races, only Black and White race pts were analyzed. Results: Of 2,182 pts, 1,143 met inclusion criteria. Median age was 58 yrs, median follow up was 3 yrs, 48% were male, 14% (n = 157) were Black, and 86% (n = 986) were White. Black pts were more likely uninsured (7 vs 2%, p = 0.005), had symptomatic bleeding (13 vs 7%, p = 0.006), required emergency surgery (7 vs 3%, p = 0.003), and had LN positive disease (47 vs 36%, p = 0.016). Despite this, Black pts had improved 5 yr recurrence free survival (RFS) compared to White pts (90 vs 80%, p = 0.008). The quality of care received was comparable between both groups, demonstrated by similar LN yield at surgery, neg margin resection rate, post-op complications, and need for reoperation or readmission (all p > 0.05). Black pts were more likely to have SBNET (22 vs 13%) and less likely to have panNET (43 vs 68%) compared to White pts (p < 0.001). Consistent with prior data, pts with LN pos panNET had decreased 5yr RFS (67 vs 83%, p = 0.001); however, for SBNET, LN involvement was not prognostic (77 vs 96%, p = 0.08). The prognostic value of LN pos disease was similar between Black and White pts in both SBNET (p = 0.34) and panNET (p = 0.95). Conclusions: Black pts with GEP-NET present with more advanced disease, including higher LN positivity. Despite this, Black pts have improved RFS compared to White pts. Although there may be delays in seeking or reaching care, Black pts received similar quality of care compared to White pts. The improved RFS seen in Black pts may be attributed to the epidemiologic differences in the site of presentation of GEP-NETs and variable prognostic value of LN pos disease.

scholarly journals The role of erenumab in the treatment of migraine

2020 ◽  
Vol 13 ◽  
pp. 175628642092711 ◽  
Author(s):  
Anna P. Andreou ◽  
Matteo Fuccaro ◽  
Giorgio Lambru
Keyword(s):  
Clinical Trials ◽  
Side Effects ◽  
European Medicines Agency ◽  
Human Antibody ◽  
Subcutaneous Injections ◽  
Calcitonin Gene ◽  
The Us ◽  
Different Doses

Calcitonin gene related peptide (CGRP) monoclonal antibodies (mAbs) have been the first class of specifically developed preventive treatments for migraine. Clinical trials data suggest superiority of the CGRP mAbs to placebo in terms of prevention of migraine symptoms, migraine-specific quality of life and headache related disability. Treatment-related side effects overall did not differ significantly from placebo and discontinuation rate due to side effects has been low across the clinical trials, perhaps in view of their peripheral mode of action. Along with their route and frequency of administration, these novel class of drugs may constitute an improvement compared with the established arsenal of migraine treatments. Erenumab is a fully human antibody and the only mAb acting on the CGRP pathway by blocking its receptor. It is the first of the CGRP mAb class approved by the US Food and Drug Administration (May 2018) and the European Medicines Agency (July 2018). Erenumab exists in two different doses (70 mg and 140 mg) and it is administered with monthly subcutaneous injections. This review summarises erenumab pharmacological characteristics, clinical trials data, focusing on the potential role of this treatment in clinical practice.

scholarly journals Management of Persons with Hemophilia A with Inhibitors After Emicizumab Approval

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5020-5020
Author(s):  
Anisha Patel ◽  
Karina Raimundo ◽  
Corey Stepule ◽  
Jennifer Whiteley ◽  
Richard H Ko
Keyword(s):  
Quality Of Life ◽  
Disease Management ◽  
Surgical Management ◽  
Hemophilia A ◽  
Qualitative Interviews ◽  
Years Of Experience ◽  
The Us

Abstract Introduction: Emicizumab, a bispecific antibody to factors IXa/X, was approved by the Food and Drug Administration in 2017 for prophylactic treatment of persons with hemophilia A (PwHA) with inhibitors. Compared with other treatments for PwHA, emicizumab has a novel mechanism of action. It is the first hemophilia A (HA) treatment administered subcutaneously and has a much longer half-life than previous treatments; hence, disease management with emicizumab can be different. This study aimed to evaluate how physicians manage HA in patients treated with emicizumab. Methods: This qualitative analysis is the first phase of a planned mixed-methods approach study and comprised 1-hour, blinded telephone interviews with 5 hematologists in all 4 geographic regions of the US. Physicians were included if they met the following criteria: 1) MD or DO degree; 2) board-certified hematologist; 3) practice in the US; 4) ≥2 years of experience post-residency; and 5) currently treat PwHA. To evaluate experience with emicizumab, physicians were also required to have treated a minimum number of patients receiving emicizumab (5 for physicians in hemophilia treatment centers [HTCs] and 3 for physicians in non-HTCs). A total of 5 qualitative interviews were conducted in May and June 2018 to understand the physicians' perspectives on treating PwHA with emicizumab. Interview topics included general management of PwHA, inhibitor screening and testing, management of PwHA with inhibitors, and physicians' experiences treating patients with emicizumab. We report common themes that descriptively emerged from the qualitative interviews, which will inform survey development for the quantitative phase of the study. Results: Of the 5 physicians, 3 were adult hematologists and 4 physicians reported seeing patients in an HTC. All physicians reported having at least 10 years of experience in practice post-residency. Regarding management of PwHA, physicians indicated disease severity, inhibitor status and annual bleed rate as critical factors in guiding treatment decision making. Patients who develop inhibitors require more medical engagement and frequent monitoring. Physicians reported that, from their experience, emicizumab results in a reduction in bleeds, leading to fewer office visits and less monitoring in PwHA with inhibitors. In addition, physicians reported that the need for disease management, even among patients with a phenotype with more bleeding, is lower as a result of emicizumab treatment due to decreased bleed rate and a reduction in need for additional treatments. Physicians reported that emicizumab's subcutaneous, once-weekly dosing leads to improved patients' quality of life and confidence in performing activities without bleeds. Acute bleed management with emicizumab was reported to be slightly different than before, given the boxed warning around concomitant treatment with activated prothrombin complex concentrate; however, the physicians indicated that they still recommend to treat bleeds as soon as one is suspected. Physicians articulated that some questions remain, including the role of immune therapy induction (ITI), use in low-titer inhibitors, and surgical management in patients treated with emicizumab. Physicians reported that there have been no significant access challenges and none of their patients have discontinued therapy; however, long-term monitoring and safety data are needed. Conclusions: This qualitative study suggests that management of PwHA with inhibitors receiving emicizumab is evolving. The interviewed physicians reported that their patients receiving emicizumab experience fewer bleeds and have an improved quality of life. However, questions regarding the role of ITI, surgical management, and long-term safety of emicizumab remain. Future research will provide additional insights into the current management of PwHA with inhibitors treated with emicizumab among US physicians. Disclosures Patel: Genentech Inc: Employment. Raimundo:Genentech Inc: Employment, Other: Ownership interests PLC. Stepule:MedPanel, Inc.: Employment. Whiteley:Genentech, Inc.: Employment, Other: Ownership interests none PLC. Ko:Genentech Inc: Employment; F. Hoffmann-La Roche Ltd: Other: Ownership interests non-PLC.

scholarly journals Narrative Braiding and the Role of Public Officials in Transforming the Publics Conflicts

2013 ◽  
Vol 1 (1) ◽  
pp. 4 ◽  
Author(s):  
Sara Cobb
Keyword(s):  
Problem Solving ◽  
Wicked Problems ◽  
Public Deliberation ◽  
Comet Tail ◽  
Public Officials ◽  
The Us ◽  
The Government ◽  
Deliberative Processes

Deliberative processes should enable public officials to stay connected to the changing needs and interests of the communities for whom and with whom they work. Theoretically, these practices should enable public officials to help citizens negotiate with each other, and with the government, problem-solving in a way that produces timely solutions to the kinds of wicked problems that are critical to governing in the globalized context where media sensationalizes divisions that create the Us as different from Them. Theoretically, these practices should enable public officials to foster a quality of relationships within a community that supports the community to learn about itself, to become a reflecting community (Laws, 2010). However, it is all too often the case that these practices enact the form of engagement only, without significantly altering the nature of relationships or the (his)stories that are the comet tail of wicked problems. This paper offers a narrative lens on deliberation, describing a practice called braiding, which would allow public officials to weave together the storylines and the identities that anchor them, creating the conditions for public deliberation that could actually transform the publics conflicts.

Evaluation of the Role of Nutrition in Lobster Recruitment

1986 ◽  
Vol 43 (11) ◽  
pp. 2320-2327 ◽  
Author(s):  
J. D. Castell ◽  
J. C. Kean
Keyword(s):  
Amino Acids ◽  
Essential Amino Acids ◽  
Field Application ◽  
Nutritional Requirements ◽  
Egg Viability ◽  
Good Opportunity ◽  
Broodstock Nutrition

Many of the hypotheses and proposals presented here on the role of nutrition in lobster recruitment have been derived from research on other aquatic animals. Little research has focused on the determination of nutritional requirements of lobsters and even that has been primarily with small juveniles (36–1000 mg). Despite the tacit acknowledgement that maternal fecundity and egg viability are a function of quantity and quality of available food, little is known about the nutrition of reproductively mature lobsters. The importance of broodstock nutrition and possible methods for evaluating nutritional status are discussed. Information on protein, essential amino acids, vitamins, minerals, carbohydrates, and lipids is summarized. Additionally, some proposals for field application of nutritional response criteria used in the laboratory are discussed. Though research on larvae adult broodstock nutrition, effects of environmental factors (e.g. temperature, salinity, photoperiod, etc.), as well as many other aspects of nutrition is yet to be done, there is "good opportunity" for nutrition to be a significant part of the current lobster recruitment research program.

scholarly journals Screening and prevention of colorectal cancer

BMJ ◽  
2021 ◽  
pp. n1855
Author(s):  
Priyanka Kanth ◽  
John M Inadomi
Keyword(s):  
Colorectal Cancer ◽  
New Technologies ◽  
Current Status ◽  
Non Invasive ◽  
The Past ◽  
The Us ◽  
Screening And Prevention ◽  
Current Emphasis

Abstract Mortality from colorectal cancer is reduced through screening and early detection; moreover, removal of neoplastic lesions can reduce cancer incidence. While understanding of the risk factors, pathogenesis, and precursor lesions of colorectal cancer has advanced, the cause of the recent increase in cancer among young adults is largely unknown. Multiple invasive, semi- and non-invasive screening modalities have emerged over the past decade. The current emphasis on quality of colonoscopy has improved the effectiveness of screening and prevention, and the role of new technologies in detection of neoplasia, such as artificial intelligence, is rapidly emerging. The overall screening rates in the US, however, are suboptimal, and few interventions have been shown to increase screening uptake. This review provides an overview of colorectal cancer, the current status of screening efforts, and the tools available to reduce mortality from colorectal cancer.

scholarly journals Digitalization of the Economy: the New Role of Social Media

2021 ◽  
Vol 13 (2) ◽  
pp. 006-026
Author(s):  
Rustem M. Nureev ◽  
◽  
Islam D. Surkhaev ◽  
Keyword(s):  
Social Networks ◽  
Western Europe ◽  
Electoral System ◽  
Developed Countries ◽  
The United States ◽  
The Internet ◽  
Finance Management ◽  
Conflicting Information

The article is devoted to the analysis of social networks, the role of which is constantly growing in the context of the digitalization of the economy. The Internet has become an important prerequisite for their spread. If at the beginning of 1990, even in the most developed countries, less than 1% of the population used the Internet, then by 2020 the level of its prevalence in North America and Western Europe exceeded 90%, and in the countries of East, Southeast and West Asia, and Latin America has exceeded 2/3. We live in a rapidly changing world, when the number of active Internet users exceeded 4.66 billion people in early 2021. The speed of obtaining information is currently an important factor in economic activity. Therefore, contacts are growing rapidly, which is reflected in e-mail, which has become an integral part of modern life, pushing far back other forms of communication (newspapers, mail, telegraph, etc.). The rapid acceleration of conflicting information increases the risk of decision-making, many of which must be made in the face of uncertainty. With the growth of social networks, the density of contacts increases and the importance of a fuller use of network benefits increases. Not only is the number of participants changing, but so is the quantity and quality of the most popular websites. Citizens of modern states are more informed than their previous generations. Conducting an electoral system under such conditions turns out to be a task with many unknowns. In these conditions, voting manipulation takes on new features, which were clearly manifested during the American presidential campaigns in the United States in 2008, 2012, 2016. In addition, opportunities are being created to improve the quality of public finance management by increasing the openness of budgeting at the federal and regional levels, that is, the actual implementation of the Vernon Smith auction in practice, which will be an important step in the formation of a genuine civil society.

scholarly journals The relevance of ultrasound examination of the foot and ankle in patients with rheumatoid arthritis – a review of the literature

2019 ◽  
Vol 21 (2) ◽  
pp. 175 ◽  
Author(s):  
Oana Șerban ◽  
Maria Bădărînză ◽  
Daniela Fodor
Keyword(s):  
Rheumatoid Arthritis ◽  
Ultrasound Examination ◽  
Joint Damage ◽  
The Other ◽  
Foot And Ankle ◽  
Review Of The Literature ◽  
The Us ◽  
Ankle And Foot

Rheumatoid arthritis (RA) is an inflammatory disease characterized by symmetrical involvement of the joints and tendons, especially of the hands and wrists, but also of the feet and ankles from the very beginning of the disease. For the patient, the foot and ankle involvement is equally important as the other joints, since it affects the functionality of the feet and the quality of life of the patients. It is already known that subclinical involvement of the ankles and feet occurs even in patients that are considered in clinical remission, thus they do not need for changes of therapy, but still might benefit from it. In spite of this, theclinicians do not give enough care to the ankle and foot in RA patients, especially if asymptomatic, resulting future deformities, joint damage and feet disability. In order to show the importance of the feet and ankles in RA patients and to demonstrate the indispensable role of ultrasonography (US) for that purpose, at the same time displaying the US abnormalities that should draw our attention, we performed this review of the literature. 

scholarly journals PPIP5K2 and PCSK1 are Candidate Genetic Contributors to Familial Keratoconus

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Mariam Lofty Khaled ◽  
Yelena Bykhovskaya ◽  
Chunfang Gu ◽  
Alice Liu ◽  
Michelle D. Drewry ◽  
...  
Keyword(s):  
Gene Trap ◽  
Whole Exome ◽  
The Us ◽  
Related Quality ◽  
First Time

AbstractKeratoconus (KC) is the most common corneal ectatic disorder affecting >300,000 people in the US. KC normally has its onset in adolescence, progressively worsening through the third to fourth decades of life. KC patients report significant impaired vision-related quality of life. Genetic factors play an important role in KC pathogenesis. To identify novel genes in familial KC patients, we performed whole exome and genome sequencing in a four-generation family. We identified potential variants in the PPIP5K2 and PCSK1 genes. Using in vitro cellular model and in vivo gene-trap mouse model, we found critical evidence to support the role of PPIP5K2 in normal corneal function and KC pathogenesis. The gene-trap mouse showed irregular corneal surfaces and pathological corneal thinning resembling KC. For the first time, we have integrated corneal tomography and pachymetry mapping into characterization of mouse corneal phenotypes which could be widely implemented in basic and translational research for KC diagnosis and therapy in the future.

Pharmaceutical Marketing

2018 ◽  
Author(s):  
Stuart O. Schweitzer ◽  
Z. John Lu
Keyword(s):  
Drug Market ◽  
Drug Advertising ◽  
Off Label ◽  
Direct To Consumer ◽  
On Demand ◽  
The Us ◽  
Pharmaceutical Promotion ◽  
Direct To Consumer Advertising

The pharmaceutical industry has been heavily criticized for the amount it spends, as well as for the tactics it uses to promote drugs. This chapter begins by providing an overview of pharmaceutical promotion in recent years, and then offers a closer examination of each major promotional channel, including detailing, free samples, journal advertising, sponsorship of medical conferences, direct-to-consumer advertising, and e-promotion. It systematically reviews the contemporary health economics literature on the effect of pharmaceutical promotion on demand, pricing, utilization, and quality of care. The role of the FDA in regulating drug advertising is also examined, including the debate on whether the agency’s responsibility in this area should be expanded or curtailed. The last section of the chapter examines the issues of false or misleading advertising and off-label promotion. The focus in this chapter is on the US drug market.

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