scholarly journals Changing the Approach to Anticoagulant Therapy in Older Patients with Multimorbidity Using a Precision Medicine Approach

2018 ◽  
Vol 15 (8) ◽  
pp. 1634
Author(s):  
Angela Koverech ◽  
Valeriano Soldati ◽  
Vittoria Polidori ◽  
Leda Pomes ◽  
Luana Lionetto ◽  
...  
Keyword(s):  
Older Patients ◽  
Clinical Care ◽  
Anticoagulation Therapy ◽  
World Population ◽  
Personalized Approach ◽  
Multiple Drugs ◽  
New Generation ◽  
Multimorbid Patients ◽  
Circulating Levels

The ageing of the world population has resulted in an increase in the number of older patients with multimorbid conditions receiving multiple therapies. This emerging clinical scenario poses new challenges, which are mostly related to the increased incidence of adverse effects. This translates into poor clinical care, reduced cost-effectiveness of drug therapies, and social isolation of multimorbid patients due to reduced autonomy. A strategy to address these emerging challenges could involve the personalization of therapies based on the clinical, molecular, and genetic characterization of multimorbid patients. Anticoagulation therapy is a feasible model to implement personalized medicine since it generally involves older multimorbid patients receiving multiple drugs. In this study, in patients with atrial fibrillation, the use of the new generation of anticoagulation therapy, i.e., direct oral anti-coagulants (DOACs), is based on a preliminary assessment of the molecular targets of DOACS and any possible drug–drug interactions. Then, the genetic polymorphism of enzymes metabolizing DOACs is studied. After DOAC prescription, its circulating levels are measured. Clinical data are being collected to assess whether this personalized approach improves the safety and efficacy profiles of anticoagulation therapy using DOACs, thereby reducing the costs of healthcare for ageing multimorbid patients.

scholarly journals Structure and processes of emergency observation units with a geriatric focus: a scoping review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Pieter Heeren ◽  
Annabelle Hendrikx ◽  
Janne Ceyssens ◽  
Els Devriendt ◽  
Mieke Deschodt ◽  
...  
Keyword(s):  
Scoping Review ◽  
Emergency Care ◽  
Older Patients ◽  
Clinical Care ◽  
Care Needs ◽  
Post Discharge ◽  
Care Services ◽  
Observation Units ◽  
Primary Care Services ◽  
Healthcare Professions

Abstract Background Combining observation principles and geriatric care concepts is considered a promising strategy for risk-stratification of older patients with emergency care needs. We aimed to map the structure and processes of emergency observation units (EOUs) with a geriatric focus and explore to what extent the comprehensive geriatric assessment (CGA) approach was implemented in EOUs. Methods The revised scoping methodology framework of Arksey and O’Malley was applied. Manuscripts reporting on dedicated areas within hospitals for observation of older patients with emergency care needs were eligible for inclusion. Electronic database searches were performed in MEDLINE, EMBASE and CINAHL in combination with backward snowballing. Two researchers conducted data charting independently. Data-charting forms were developed and iteratively refined. Data inconsistencies were judged by a third researcher or discussed in the research team. Quality assessment was conducted with the Methodological Index for Non-Randomized Studies. Results Sixteen quantitative studies were included reporting on fifteen EOUs in seven countries across three continents. These units were located in the ED, immediately next to the ED or remote from the ED (i.e. hospital-based). All studies reported that staffing consisted of at least three healthcare professions. Observation duration varied between 4 and 72 h. Most studies focused on medical and functional assessment. Four studies reported to assess a patients’ medical, functional, cognitive and social capabilities. If deemed necessary, post-discharge follow-up (e.g. community/primary care services and/or outpatient clinics) was provided in eleven studies. Conclusion This scoping review documented that the structure and processes of EOUs with a geriatric focus are very heterogeneous and rarely cover all elements of CGA. Further research is necessary to determine how complex care principles of ‘observation medicine’ and ‘CGA’ can ideally be merged and successfully implemented in clinical care.

scholarly journals Synthesis of a New Phosphonate-Based Sorbent and Characterization of Its Interactions with Lanthanum (III) and Terbium (III)

Polymers ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 1513
Author(s):  
Yuezhou Wei ◽  
Khalid A. M. Salih ◽  
Mohammed F. Hamza ◽  
Toyohisa Fujita ◽  
Enrique Rodríguez-Castellón ◽  
...  
Keyword(s):  
High Tech ◽  
Low Grade ◽  
Acid Solutions ◽  
Hydrogel Beads ◽  
Secondary Sources ◽  
Composite Sorbents ◽  
Synthesis Procedure ◽  
New Generation ◽  
Mild Acid

High-tech applications require increasing amounts of rare earth elements (REE). Their recovery from low-grade minerals and their recycling from secondary sources (as waste materials) are of critical importance. There is increasing attention paid to the development of new sorbents for REE recovery from dilute solutions. A new generation of composite sorbents based on brown algal biomass (alginate) and polyethylenimine (PEI) was recently developed (ALPEI hydrogel beads). The phosphorylation of the beads strongly improves the affinity of the sorbents for REEs (such as La and Tb): by 4.5 to 6.9 times compared with raw beads. The synthesis procedure (epicholorhydrin-activation, phosphorylation and de-esterification) is investigated by XPS and FTIR for characterizing the grafting route but also for interpreting the binding mechanism (contribution of N-bearing from PEI, O-bearing from alginate and P-bearing groups). Metal ions can be readily eluted using an acidic calcium chloride solution, which regenerates the sorbent: the FTIR spectra are hardly changed after five successive cycles of sorption and desorption. The materials are also characterized by elemental, textural and thermogravimetric analyses. The phosphorylation of ALPEI beads by this new method opens promising perspectives for the recovery of these strategic metals from mild acid solutions (i.e., pH ~ 4).

Production of inhibin A and inhibin B in boars: Changes in testicular and circulating levels of dimeric inhibins and characterization of inhibin forms during testis growth

2007 ◽  
Vol 33 (4) ◽  
pp. 410-421 ◽  
Author(s):  
Katsuhiko Ohnuma ◽  
Hiroyuki Kaneko ◽  
Junko Noguchi ◽  
Kazuhiro Kikuchi ◽  
Manabu Ozawa ◽  
...  
Keyword(s):  
Inhibin B ◽  
Inhibin A ◽  
Circulating Levels

scholarly journals Circulating Cytokine Levels as Markers of Inflammation in Philadelphia Negative Myeloproliferative Neoplasms: Diagnostic and Prognostic Interest

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Julie Mondet ◽  
Kais Hussein ◽  
Pascal Mossuz
Keyword(s):  
Current Knowledge ◽  
Myeloproliferative Neoplasms ◽  
Phenotypic Correlation ◽  
Hematopoietic Malignancies ◽  
Markers Of Inflammation ◽  
Functional Symptoms ◽  
Cytokine Levels ◽  
Clinical Interest ◽  
Circulating Levels

Cytokines are well known mediators of numerous physiological and pathological processes. They contribute to the regulation of normal hematopoiesis but increasing data suggest that they also have a clinical impact in some hematopoietic malignancies. In particular, there is evidence that cytokines are implicated in the functional symptoms of Philadelphia negative myeloproliferative neoplasms (Ph− MPNs), suggesting that evaluation of circulating levels of cytokines could be of clinical interest for the characterization of patients at the time of diagnosis and for disease prognosis. In this review, we present the current knowledge on alteration of circulating cytokine profiles in MPNs and their role in myelofibrosis pathogenesis. Phenotypic correlation, prognostic value of cytokines, and impact of JAK inhibitors are also discussed.

scholarly journals IMPACT OF SOCIAL MEDIA ON SALES FUNNELS IN B2C AND B2B SEGMENTS IN THE REPUBLIC OF NORTH MACEDONIA

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Martin Kiselicki ◽  
Saso Josimovski ◽  
Lidija Pulevska Ivanovska ◽  
Mijalce Santa
Keyword(s):  
Social Media ◽  
New Technologies ◽  
Secondary Data ◽  
Primary Data ◽  
World Population ◽  
Social Media Platforms ◽  
The Republic ◽  
New Generation ◽  
Sales Funnel ◽  
Media Data

The research focuses on introducing social media platforms as either a complementary or main channel in the company sales funnel. Internet technologies and Web 2.0 continue to provide innovations in digital marketing, with the latest iteration being lead generation services through social media. Data shows that almost half of the world population is active on social media, with the new Generation Alpha being projected to be entirely online dependent and proficient in the use of new technologies. The paper provides an overview of the digitalization of sales funnels, as well as the benefits that social media platforms can offer if implemented correctly. Secondary data provides the basis for transforming sales funnels with social media, where previous research provides limited data on the effectiveness of these types of efforts. Primary data demonstrates that introducing social media platforms can provide improvements of up to 3 to 4 times in analyzed case studies, as well as the shorter time when deciding about purchase in use case scenarios. Social media advertising can also be utilized to shorten the sales funnel process and serve as a unified point of entrance and exit in the first few stages.

Theoretical characterization of the electronic properties of heterogeneous vertical stacks of 2D metal dichalcogenides containing one doped layer

2020 ◽  
Vol 22 (25) ◽  
pp. 14088-14098
Author(s):  
Amine Slassi ◽  
David Cornil ◽  
Jérôme Cornil
Keyword(s):  
Transition Metal ◽  
Electronic Properties ◽  
Van Der Waals ◽  
Transition Metal Dichalcogenides ◽  
Optoelectronic Devices ◽  
Metal Dichalcogenides ◽  
Theoretical Characterization ◽  
New Generation

The rise of van der Waals hetero-structures based on transition metal dichalcogenides (TMDs) opens the door to a new generation of optoelectronic devices.

scholarly journals Brave New Lungs: Aging in the Shadow of COVID-19

2020 ◽  
Author(s):  
Alexandra C H Nowakowski
Keyword(s):  
Lung Disease ◽  
Lived Experience ◽  
Older Patients ◽  
Obstructive Lung Disease ◽  
Healthy Aging ◽  
Age Of Onset ◽  
Clinical Care ◽  
Lung Damage ◽  
Gathering Data ◽  
Severe Lung

Abstract As the COVID-19 pandemic continues to affect communities worldwide, this novel disease is leaving many survivors with severe lung damage. Among older patients, advanced lung damage is more likely. Survivors of all ages who have extensive lung impacts are likely to be new to managing those issues. Supporting healthy aging for these patients will require both gathering data about their unique experiences and using the existing evidence basis about adapting to managing obstructive lung disease. This article outlines key priorities for research with COVID-19 survivors aging with permanent lung damage and highlights unique considerations for people older at age of onset. It also outlines the relevance of findings from this research for clinical care supporting people newly aging with advanced lung disease from COVID-19. In the process, it summarizes lessons from established patient populations aging with progressive lung disease—using cystic fibrosis as a prominent example from the author’s lived experience—that may enhance the experiences of older COVID-19 survivors.

PULMONARY HYPERTENSION IN PAEDIATRIC PATIENTS: DATA FROM THE COMPERA-KIDS REGISTRY

2015 ◽  
Vol 101 (1) ◽  
pp. e1.47-e1
Author(s):  
Matthias Gorenflo ◽  
David Pittrow ◽  
Dörte Huscher ◽  
Victoria Ziesenitz ◽  
Joseph Pattathu ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Treatment Options ◽  
Anticoagulation Therapy ◽  
Right Heart Catheterization ◽  
Functional Class ◽  
Right Atrial ◽  
Heart Catheterization ◽  
Study Cohort ◽  
Paediatric Patients

BackgroundPulmonary hypertension (PH/PAH) can have many possible causes in childhood. The aim of the COMPERA registry is the characterization of patients of all ages with PH/PAH and their treatment patterns.MethodsSince June 2013, paediatric patients can be included in the COMPERA registry (ClinTrials.gov: NCT01347216) which has originally been established for adult patients with pulmonary hypertension in 2007.ResultsUntil 2015, 78 patients <18 years (47 Pat <6 years) with pulmonary hypertension were enrolled, of whom 65.4% had PAH due to congenital heart disease (PAH-CHD), 25.6% had idiopathic PAH (iPAH), 3 had persistent PH of the newborn, 2 had PH associated with interstitial lung disease, and two had other PH. The patients were 6.1±6.0 years old, 52.6% girls; NYHA functional class I/II in 55.0%, and III in 42.3%. Mean disease duration after diagnosis was 37.7±55.8 months. Right heart catheterization data were available for 82.1% of the patients. Mean pulmonary artery pressure was 42.8±19.4 mmHg, right atrial pressure was 8.0±8.8 mmHg, cardiac index was 3.6±1.2 l/min/m2. Monotherapy was received by 65.4% of the patients whereas 33.4% of the patients had combination therapy. Phosphodiesterase-5 inhibitors (PDE5I) were administered to 76.9% of the patients, 35.9% of the patients received endothelin receptor antagonists and 3.8% received prostacyclins. About 24% of patients received anticoagulation therapy.ConclusionThe most common form of PH in this study cohort is PAH-CHD, followed by iPAH. Treatment options for children primarily comprise PDE5I. Only a small number of paediatric patients receive anticoagulation therapy.

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