scholarly journals Pressure ulcers: Current understanding and newer modalities of treatment

2015 ◽  
Vol 48 (01) ◽  
pp. 004-016 ◽  
Author(s):  
Surajit Bhattacharya ◽  
R. K. Mishra
Keyword(s):  
Pressure Ulcers ◽  
Treatment Options ◽  
Healing Process ◽  
Treatment Algorithm ◽  
Wound Debridement ◽  
Advantages And Disadvantages ◽  
Prone Area ◽  
Long Time

ABSTRACTThis article reviews the mechanism, symptoms, causes, severity, diagnosis, prevention and present recommendations for surgical as well as non-surgical management of pressure ulcers. Particular focus has been placed on the current understandings and the newer modalities for the treatment of pressure ulcers. The paper also covers the role of nutrition and pressure-release devices such as cushions and mattresses as a part of the treatment algorithm for preventing and quick healing process of these wounds. Pressure ulcers develop primarily from pressure and shear; are progressive in nature and most frequently found in bedridden, chair bound or immobile people. They often develop in people who have been hospitalised for a long time generally for a different problem and increase the overall time as well as cost of hospitalisation that have detrimental effects on patient’s quality of life. Loss of sensation compounds the problem manifold, and failure of reactive hyperaemia cycle of the pressure prone area remains the most important aetiopathology. Pressure ulcers are largely preventable in nature, and their management depends on their severity. The available literature about severity of pressure ulcers, their classification and medical care protocols have been described in this paper. The present treatment options include various approaches of cleaning the wound, debridement, optimised dressings, role of antibiotics and reconstructive surgery. The newer treatment options such as negative pressure wound therapy, hyperbaric oxygen therapy, cell therapy have been discussed, and the advantages and disadvantages of current and newer methods have also been described.

Can trust become a factor of economic growth? Dynamic changes in the level of trust of Russian youth

2020 ◽  
pp. 92-107 ◽  
Author(s):  
A. I. Bakhtigaraeva ◽  
A. A. Stavinskaya
Keyword(s):  
Institutional Environment ◽  
Negative Effects ◽  
Dynamic Changes ◽  
Generalized Trust ◽  
Level Of Education ◽  
Advantages And Disadvantages ◽  
The Future ◽  
Analysis Of Dynamics

The article considers the role of trust in the economy, the mechanisms of its accumulation and the possibility of using it as one of the growth factors in the future. The advantages and disadvantages of measuring the level of generalized trust using two alternative questions — about trusting people in general and trusting strangers — are analyzed. The results of the analysis of dynamics of the level of generalized trust among Russian youth, obtained within the study of the Institute for National Projects in 10 regions of Russia, are presented. It is shown that there are no significant changes in trust in people in general during the study at university. At the same time, the level of trust in strangers falls, which can negatively affect the level of trust in the country as a whole, and as a result have negative effects on the development of the economy in the future. Possible causes of the observed trends and the role of universities are discussed. Also the question about the connection between the level of education and generalized trust in countries with different quality of the institutional environment is raised.

Thrombopoietin Receptor Agonists in Children with Immune Thrombocytopenia: A New Therapeutic Era

2020 ◽  
Vol 20 ◽  
Author(s):  
Giuseppe Lassandro ◽  
Valentina Palladino ◽  
Giovanni Carlo Del Vecchioa ◽  
Viviana Valeria Palmieri ◽  
Paola Carmela Corallo ◽  
...  
Keyword(s):  
Immune Thrombocytopenia ◽  
Treatment Options ◽  
Thrombopoietin Receptor Agonists ◽  
Receptor Agonists ◽  
Thrombopoietin Receptor ◽  
Related Quality ◽  
Health Related

Background and Objective: Immune thrombocytopenia (ITP) is a common bleeding disorder in childhood. The management of ITP in children is controversial, requiring personalized assessment of patients and therapeutic choices. Thrombopoietin receptor agonists (TPO-RAs), eltrombopag and romiplostim, have been shown to be safety and effective for the treatment of pediatric ITP. The aim of our research is defining the role of thrombopoietin receptor agonists in the management of pediatric ITP. Method: This review focuses on the use of TPO-RAs in pediatric ITP, in randomized trials and in clinical routine, highlighting their key role in management of the disease. Results: Eltrombopag and romiplostim appear effective treatment options for children with ITP. Several clinical studies have assessed that the use of TPO-RAs increases platelet count, decreases bleeding symptoms and improves health-related quality of life. Moreover, TPO-RAs are well tolerated with minor side effects. Conclusion: Although TPO-RAs long term efficacy and safety still require further investigations, their use is gradually expanding in clinical practice of children with ITP.

Imaging of Pancreatic-Neuroendocrine Tumours: An Outline of Conventional Radiological Techniques

2019 ◽  
Vol 12 (2) ◽  
pp. 135-155 ◽  
Author(s):  
Muhammad Affan Zamir ◽  
Wasim Hakim ◽  
Siraj Yusuf ◽  
Robert Thomas
Keyword(s):  
Neuroendocrine Tumours ◽  
Treatment Options ◽  
Advantages And Disadvantages ◽  
Imaging Characteristics ◽  
Fundamental Understanding ◽  
Pancreatic Neuroendocrine Tumours ◽  
Direct Management ◽  
Important Disease ◽  
Similar Imaging

IIntroduction: Pancreatic Neuroendocrine Tumours (p-NETs) are an important disease entity and comprise of peptide-secreting tumours often with a functional syndrome. : Accounting for a small percentage of all pancreatic tumours, they have a good overall survival rate when diagnosed early, with surgery being curative. The role of nuclear medicine in the diagnosis and treatment of these tumours is evident. However, the vast majority of patients will require extensive imaging in the form of conventional radiological techniques. It is important for clinicians to have a fundamental understanding of the p-NET appearances to aid prompt identification and to help direct management through neoplastic staging. Methods: This article will review the advantages and disadvantages of conventional radiological techniques in the context of p-NETs and highlight features that these tumours exhibit. Conclusion: Pancreatic neuroendocrine tumours are a unique collection of neoplasms that have markedly disparate clinical features but similar imaging characteristics. Most p-NETs are small and welldefined with homogenous enhancement following contrast administration, although larger and less welldifferentiated tumours can demonstrate areas of necrosis and cystic architecture with heterogeneous enhancement characteristics. : Prognosis is generally favourable for these tumours with various treatment options available. However, conventional radiological techniques will remain the foundation for the initial diagnosis and staging of these tumours, and a grasp of these modalities is extremely important for physicians.

Pharmacotherapy review: Emerging treatment modalities in transthyretin cardiac amyloidosis

2021 ◽  
Author(s):  
Emily Plumadore ◽  
Lindsay Lombardo ◽  
Katherine P Cabral
Keyword(s):  
Treatment Options ◽  
Disease State ◽  
Treatment Modalities ◽  
Limited Data ◽  
Limited Evidence ◽  
Agent Selection ◽  
Selection For ◽  
Tea Extract

Abstract Disclaimer In an effort to expedite the publication of articles , AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose This review aims to summarize the evidence and pharmacological characteristics of treatment options for transthyretin amyloid cardiomyopathy (ATTR-CM). Additionally, this review highlights the role of clinical pharmacists in helping to secure newly introduced therapies. Summary ATTR-CM, a disease characterized by misfolded protein that is deposited in the myocardium and disrupts cardiac functioning, has historically been underdiagnosed due to the need for invasive biopsy and an illusion of rarity. Once diagnosed, limited treatment modalities for ATTR-CM have led providers to rely on nonpharmacological remedies or off-label use of medications with limited evidence of benefit. However, recent noninvasive diagnostic advancements and heightened disease state awareness have revealed increased prevalence of ATTR-CM. This has led to the introduction of several first-in-class pharmaceuticals with actions targeted at inhibiting the various phases of amyloidosis: TTR stabilizers include diflunisal and first-in-class, Food and Drug Administration (FDA)-approved tafamidis; TTR silencers include patisiran and inotersen; fibril disrupters include doxycycline with tauroursodeoxycholic acid; and alternative agents include green tea extract and curcumin. Conclusion ATTR-CM treatments have emerged and, despite current limited data, are continuing to evolve. Tafamidis, the only agent approved by FDA for ATTR-CM, shows promise to improve survival and quality of life in patients with ATTR-CM. Pharmacists can play a key role in assisting with agent selection for this disease state, as well as providing knowledge about current and future clinical trials evaluating the safety and efficacy of the available treatment modalities.

scholarly journals An Algorithmic Approach to Minimally Invasive Management of Nontraumatic Chylothorax

2020 ◽  
Vol 37 (03) ◽  
pp. 269-273
Author(s):  
Luis D. Goity ◽  
Maxim Itkin ◽  
Gregory Nadolski
Keyword(s):  
Treatment Options ◽  
Treatment Algorithm ◽  
Rare Condition ◽  
Pleural Space ◽  
Positive Outcomes ◽  
Algorithmic Approach ◽  
Appropriate Treatment ◽  
Contrast Enhanced ◽  
Invasive Management

AbstractChylothorax is a rare condition characterized by lymph accumulation in the pleural space. When it occurs independent of trauma, it is even more rare and difficult to treat as identification of lymphatic leak is unpredictable. In addition, treatment of this condition with conventional lymphangiography and thoracic duct embolization may not result in positive outcomes. As such, the role of contrast-enhanced dynamic magnetic resonance lymphangiography to guide treatment is key to maximizing success with the advantage of localizing the site of lymphatic leak. Herein, we summarize etiologies of nontraumatic chylothorax, offer an updated treatment algorithm to stratify affected patients and determine appropriate treatment options, and review procedural techniques critical to efficient and effective treatment.

scholarly journals The Expanding Role of Real-World Evidence Trials in Health Care Decision Making

2019 ◽  
Vol 14 (1) ◽  
pp. 174-179 ◽  
Author(s):  
David C. Klonoff
Keyword(s):  
Real World ◽  
Clinical Evidence ◽  
Real World Data ◽  
Medical Products ◽  
Advantages And Disadvantages ◽  
Randomized Controlled ◽  
Real World Evidence ◽  
Care Decision

Real-world evidence (RWE) is the clinical evidence about benefits or risks of medical products derived from analyzing real world data (RWD), which are data collected through routine clinical practice. This article discusses the advantages and disadvantages of RWE studies, how these studies differ from randomized controlled trials (RCTs), how to overcome barriers to current skepticism about RWE, how FDA is using RWE, how to improve the quality of RWE, and finally the future of RWE trials.

Modification Effects in Argon Plasma Treated S1O2 Spin-On Glass

1995 ◽  
Vol 381 ◽  
Author(s):  
Min Park ◽  
Joong Whan Lee ◽  
Jin Gun Koo ◽  
Kyung Soo Kim ◽  
Hyung Joun Yoo ◽  
...  
Keyword(s):  
Plasma Treatment ◽  
Treatment Time ◽  
Argon Plasma ◽  
Treatment Temperature ◽  
Adsorption Sites ◽  
Long Time ◽  
As Adsorption ◽  
Wet Etch

AbstractWe demonstrated that the quality of siloxane spin-on glass (SOG) films, widely used as interlevel planarization dielectrics, is improved significantly by curing in argon plasma. The wet etch rate of SOG film decreases with increasing plasma treatment temperature or treatment time, and is much lower than that cured in a furnace. Long-time plasma treatment reduces the density of silanols (Si-OH) and methyl (−CH3) group, which act as adsorption sites of water. The results were compared with those obtained from the N2O (or H2 ) plasma treated SOG films. The modification of the SOG film by Ar plasma is related to the radiation damage and the reconstruction of the atomic structure during the plasma exposure. The role of metastable Ar (Ar*) appears to be very important to improve the SOG film; SOG film is more relaxed by the energy released from the conversion of Ar* to Ar.

scholarly journals Proposal of the concept of smart cities development strategy in Montenegro

Tehnika ◽  
2020 ◽  
Vol 75 (6) ◽  
pp. 646-653
Author(s):  
Ivana Buzdovan ◽  
Marko Asanović ◽  
Nataša Gospić
Keyword(s):  
Development Strategy ◽  
Smart City ◽  
Technological Development ◽  
Smart Cities ◽  
Local Level ◽  
Advantages And Disadvantages ◽  
Economic Sustainable Development

This study elaborates the elements which are important in the development of the smart city strategy, both at national and local level. They should provide a good foundation for the development of a longterm sustainable and comprehensive smart city concept. When developing the strategy itself, it is necessary to follow the examples of the smart cities in Europe, Region and based on their experience, to identify advantages and disadvantages in order to form clear goals and vision. This study also gives the proposal for defining the elements necessary for establishing the smart cities development strategy as a solution for improving the quality of life in cities, and therewith overall social and economic sustainable development of a country. Montenegro and the city of Budva have been developed as a case study. Montenegro is keeping pace with technological development and therewith the need to define a development strategy for its smart cities. This study emphasizes the role of state bodies, institutions and citizens themselves in that process.

scholarly journals SIMULATION TRAINING IN THE FORMATION OF FUTURE DOCTORS AS A WAY OF DEVELOPING THEIR PRACTICAL EXPERIENCE

2021 ◽  
pp. 92-105
Author(s):  
Liudmyla Dushyk ◽  
Valentina Mykhaylychenko ◽  
Olexii Tsivenko
Keyword(s):  
Simulation Training ◽  
Standardized Patients ◽  
Practical Experience ◽  
Standardized Patient ◽  
Advantages And Disadvantages ◽  
Sequence Of Events ◽  
Quality Of Medical Care ◽  
Role Of Teachers

It is shown that the use of simulation technologies in the learning process allows medical students to gain practical experience and qualitatively increase the level of their professionalism against the background of the appropriate level of theoretical knowledge. The content of simulation training as an art to imitate reality, the sequence of events and actions or the mental process of training in the quality of medical care to patients is considered. Its advantages and disadvantages are revealed. An analysis of the effectiveness of simulation training with the involvement of a standardized “patient” during the internship by students of the Department of Surgical Diseases. The role of teachers of the department is shown, who observed the behavior of the “standardized patient” and evaluated the results of students’ work according to the scoring system, according to the criteria. A detailed analysis of the training results, a joint discussion of measures aimed at improving treatment and diagnostic tactics and errors were conducted. Methodical recommendations for training have been developed. It is concluded that the method of “standardized patients” is an effective way to gain practical experience of clinical competence and its evaluation. The worldwide spread of this method indicates the need for its intensive implementation in Ukraine.

scholarly journals Role of Mast Cells in the Pathogenesis of Pruritus in Mastocytosis

2021 ◽  
Author(s):  
Dominika Kwiatkowska ◽  
Adam Reich
Keyword(s):  
Mast Cells ◽  
Neurogenic Inflammation ◽  
Treatment Options ◽  
Sensory Nerve ◽  
Neurokinin A ◽  
Calcitonin Gene ◽  
Abnormal Accumulation ◽  
Mutual Communication

Pruritus can be defined as an unpleasant sensation that evokes a desire to scratch and significantly impairs patients’ quality of life. Pruritus is widely observed in many dermatoses, including mastocytosis, a rare disease characterized by abnormal accumulation of mast cells, which can involve skin, bone marrow, and other organs. Increasing evidence highlights the role of mast cells in neurogenic inflammation and itching. Mast cells release various pruritogenic mediators, initiating subsequent mutual communication with specific nociceptors on sensory nerve fibres. Among important mediators released by mast cells that induce pruritus, one can distinguish histamine, serotonin, proteases, as well as various cytokines. During neuronal-induced inflammation, mast cells may respond to numerous mediators, including neuropeptides, such as substance P, neurokinin A, calcitonin gene-related peptide, endothelin 1, and nerve growth factor. Currently, treatment of pruritus in mastocytosis is focused on alleviating the effects of mediators secreted by mast cells. However, a deeper understanding of the intricacies of the neurobiology of this disease could help to provide better treatment options for patients.

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