Alexandersenho1732
Three themes emerged about sustained practice change (i) communication, (ii) respect and understanding of roles, and (iii) ability to try new things. Notable changes included improved team working and feelings of competence, positive attitude to residents rather than blame for agitation and avoidance, and more pleasant activities. Leadership support was important.
It is possible to sustain some change over years in care homes. This study indicates factors which help or impede. These factors individually and together could lead to long-term improved quality of life of residents in homes where it is implemented and sustained.
It is possible to sustain some change over years in care homes. This study indicates factors which help or impede. These factors individually and together could lead to long-term improved quality of life of residents in homes where it is implemented and sustained.Nitrites are chemicals that are abundant in the environment, widely used as preservatives for meat, and in pharmaceuticals. Volatile products containing nitrites have been used recreationally for the euphoric effect associated with mild hypoxia. Dietary exposure to small amounts is considered harmless. Deaths by ingestion of nitrite salts are not common, but accidental exposure and as suicidal and homicidal agents have been noted. Death is a consequence of oxidation of hemoglobin ferrous (Fe+2 ) iron (Hb) to the ferric (Fe+3 ) form (methemoglobin, MetHb), causing a reduction in the oxygen-carrying capacity of the blood. We report three cases of ingestion of sodium nitrite in two college students (one mildly decomposed) and one adult in early middle age. All of the decedents in these cases developed fatal methemoglobinemia. Sodium nitrite in chemical form was found near the bodies. MetHb was detected in the postmortem blood of each decedent. The MetHb concentrations in the two decedents with a short postmortem interval were less than MetHb concentrations reported in the current literature. The MetHb concentrations reported in the mildly decomposed person were greater than for the other two, but still less than the concentration previously considered lethal. The data from these cases indicate that levels of MetHb can vary widely in fatal cases, and should not be used as the sole criterion for determination of a death caused by sodium nitrite. Following a discussion of the cases, there is a review of the pathophysiology of MetHb production and a current literature review.
Radiomic features of cone-beam CT (CBCT) images have potential as biomarkers to predict treatment response and prognosis for patients of prostate cancer. Previous studies of radiomic feature analysis for prostate cancer were assessed in a variety of imaging modalities, including MRI, PET, and CT, but usually limited to a pretreatment setting. However, CBCT images may provide an opportunity to capture early morphological changes to the tumor during treatment that could lead to timely treatment adaptation. This work investigated the quality of CBCT-based radiomic features and their relationship with reconstruction methods applied to the CBCT projections and the preprocessing methods used in feature extraction. Afimoxifene Moreover, CBCT features were correlated with planning CT (pCT) features to further assess the viability of CBCT radiomic features.
The quality of 42 CBCT-based radiomic features was assessed according to their repeatability and reproducibility. Repeatability was quantified by correlating radiomic featognostic models for prostate cancer.
Methods for reconstruction and preprocessing that improve CBCT radiomic feature repeatability often decrease reproducibility. The best approach may be to use methods that strike a balance repeatability and reproducibility such as iCBCT-Sharp-VeryLow-1-Lloyd-256 that has 17 repeatable and eight reproducible radiomic features. Previous radiomic studies that only used pCT radiomic features have generated prognostic models of prostate cancer outcome. Since our study indicates that CBCT radiomic features correlated well with a subset of pCT radiomic features, one may expect CBCT radiomics to also generate prognostic models for prostate cancer.
A phase 1 study was conducted to determine the maximum tolerated dose of bendamustine when given in combination with clofarabine, etoposide, and dexamethasone daily for 5 days in children and adolescents with relapsed or refractory hematologic malignancies.
Patients younger than 22 years with second or greater relapsed or refractory acute leukemia or lymphoma after 2 or more prior regimens were eligible. With the rolling 6 design, participants received escalating doses of bendamustine (30, 40, or 60 mg/m
/d) in combination with clofarabine (40 mg/m
), etoposide (100 mg/m
), and dexamethasone (8 mg/m
) daily for 5 days. Optional pharmacokinetic studies were performed in cycle 1 on day 1 and day 5.
Sixteen patients were enrolled. Six patients were treated at the dose level of 30 mg/m
/d, 6 were treated at the dose level of 40 mg/m
/d, and 4 were treated at the dose level of 60 mg/m
/d. The dose-limiting toxicity was prolonged myelosuppression. The combination was otherwise well tolerated. Th clofarabine, and etoposide has been used in relapsed and refractory pediatric patients with hematologic malignancies. This study shows that substituting bendamustine for cyclophosphamide in combination with clofarabine and etoposide is safe and effective.
Improvements to the existing chemotherapy regimen are still needed for patients who relapse after targeted therapies and immunotherapies and for those who are not eligible for or have no access to such therapies. A regimen combining cyclophosphamide, clofarabine, and etoposide has been used in relapsed and refractory pediatric patients with hematologic malignancies. This study shows that substituting bendamustine for cyclophosphamide in combination with clofarabine and etoposide is safe and effective.
Social support is crucial for successful recovery after hematopoietic stem cell transplantation (HSCT) and has the potential to affect patient quality of life (QOL) and health outcomes. However, there are limited data on the relationship between a patient's perception of his or her social support and these outcomes.
The authors conducted a secondary analysis of 250 autologous and allogeneic HSCT recipients enrolled in 2 supportive care trials at Massachusetts General Hospital from April 2011 through February 2016. They assessed social support as a patient's perception of his or her social well-being via the social well-being subscale of the Functional Assessment of Cancer Therapy. The authors used multivariate regression analyses to examine the relationship between pretransplant social well-being and QOL (Functional Assessment of Cancer Therapy-Treatment Outcome Index), psychological distress (Hospital Anxiety and Depression Scale), posttraumatic stress disorder [PTSD] symptoms (PTSD Checklist), fatigue (Functional Assessment of Cancer Therapy-Fatigue), and health care utilization (hospitalizations and days alive and out of the hospital) 6 months after HSCT.
