Rosendahlgardner5585
In this review, we examine the literature supporting treatment decision making in the front-line and relapsed/refractory settings for patients with chronic lymphocytic leukemia (CLL). In the front-line setting, novel-agent-based approaches, including continuous Bruton tyrosine kinase (BTK) inhibitor-based therapy and time-limited venetoclax with obinutuzumab, have demonstrated survival benefit over chemoimmunotherapy. While novel-agent-based front-line approaches are appropriate for most patients, fludarabine, cyclophosphamide, and rituximab (FCR) remains a consideration for a selected population of young patients with immunoglobulin heavy chain variable region gene (IGHV)-mutated disease because of the possibility of a prolonged remission following FCR. As front-line novel-agent-based approaches have not been compared directly, decision making regarding which novel-agent-based approach to use in the front-line setting is often based on comorbidities and shared decision making. In the relapsed/refractory setting, BTK inhibitors, venetoclax-based therapy, and phosphoinositide 3-kinase (PI3K) inhibitors have demonstrated survival benefit when compared with chemoimmunotherapy regimens. Data to support various treatment sequences are limited, which highlights the need for prospective data to examine the optimal treatment sequence. Finally, we examine therapies with combinations of novel agents, and novel agents in development, including covalent and noncovalent BTK inhibitors, PI3K inhibitors, B-cell lymphoma 2 (BCL2) inhibitors, immunotherapies, and cellular therapies. With effective approved options and new agents in development, the role of chemoimmunotherapy in the management of CLL has diminished.
There is limited comprehensive literature focussing on the range of patient safety incidents related to parenteral nutrition (PN).
The aim of this review was to examine patient safety incidents related to the use of PN in all patient age groups.
Literature published in the English language between January 2000 and April 2020 were searched across the MEDLINE, CINHAL and Embase databases. Articles were included if they contained PN-related patient safety incidents related to an avoidable event. No restrictions were applied to patient populations. The screening process was undertaken independently by two authors.
In total, 108 records were included in the review 52 case studies, 54 observation studies (e.g. prevalence studies, surveys) and two experimental studies. All age groups were represented, with 62% of studies in paediatrics (of which two-thirds were neonates) and 23% in adults. They included all medication processes prescribing, dispensing, compounding, administration and monitoring. Incidents were related to microbial contamination, venous access and specific components (e.g. lipid emulsion, amino acids, glucose, micronutrients and electrolytes) or the whole product. Incident outcomes ranging from near miss to death were reported. Intervention studies looked at the impact on patient safety incidents of computerised tools, healthcare processes, e.g. pharmacist screening, and standardisation. One study demonstrated more severe outcomes with paediatric than with adult PN.
This review demonstrates the vast range of PN-related patient safety incidents in all patient age groups and all medication process stages. The need for a national study looking at patient safety incidents related to PN in England is highlighted.
This review demonstrates the vast range of PN-related patient safety incidents in all patient age groups and all medication process stages. The need for a national study looking at patient safety incidents related to PN in England is highlighted.
Previous reviews have shown that exposure to acute prolonged sitting can have detrimental effects on several cardiovascular and cardiometabolic health markers. However, to date, there has been no synthesis of peripheral blood pressure data (including systolic blood pressure, diastolic blood pressure and mean arterial pressure), an important and translatable marker of cardiovascular health. Similarly, no previous study has consolidated the effects of sitting interruptions on peripheral blood pressure.
We aimed to (1) assess the effect of exposure to acute prolonged sitting on peripheral blood pressure and (2) determine the efficacy of sitting interruption strategies as a means of offsetting any negative effects. Subgroup analyses by age and interruption modality were performed to explore heterogeneity.
Electronic databases (PubMed, Web of Science and, SPORTDiscus) were searched from inception to March 2021. Reference lists of eligible studies and relevant reviews were also screened.
Inclusion criteria tion strategies.
Exposure to acute prolonged uninterrupted sitting results in significant increases in systolic blood pressure and mean arterial pressure, particularly in younger age groups. Regularly interrupting bouts of prolonged sitting, particularly with aerobic interruption strategies may reduce negative effects.
Exposure to acute prolonged uninterrupted sitting results in significant increases in systolic blood pressure and mean arterial pressure, particularly in younger age groups. Regularly interrupting bouts of prolonged sitting, particularly with aerobic interruption strategies may reduce negative effects.
Based on promising effects seen in a pilot study evaluating a generic mindfulness-based program for migraine, we developed a migraine-specific adaptation of the Mindfulness-Based Cognitive Therapy (MBCT) program. The aim of this study was to evaluate this program for feasibility and effectiveness in a randomized controlled trial.
Fifty-four patients suffering from migraine were randomly allocated to either waitlist or the adapted MBCT. Outcomes were migraine-related parameters as well as variables of psychological functioning and coping. Assessment took place at baseline and post-intervention, for the intervention group also at follow-up (7months). The effects of the intervention were analyzed by the use of ANCOVAs and linear mixed models.
With respect to migraine parameters we did not find a significant group difference in the primary outcome (headache-related impairment), but the intervention resulted in a significant reduction of headache frequency (p = .04). In the analysis of secondary outcomes, MBCT showed superiority in four out of eight psychological parameters (perceived stress, anxiety, rumination, catastrophizing) with small to medium effect sizes. The intervention proved to be feasible and participants reported high degrees of contentment and achievement of personal goals.
The migraine-specific MBCT program did not result in improvements with regard to headache-related impairment but showed a reduction in headache frequency as well as improved psychological functioning in secondary outcomes.
This trial was registered in the German Trial Registry "Deutsches Register Klinischer Studien" (ID DRKS00007477), which is a WHO-listed primary trial register.
This trial was registered in the German Trial Registry "Deutsches Register Klinischer Studien" (ID DRKS00007477), which is a WHO-listed primary trial register.
Due to the rarity and often discrete nature of hamate body fractures, timely diagnosis requires a high level of suspicion on the part of the clinician. Here, the authors have compiled the findings from 6 cohort studies and 33 case reports describing hamate body fractures in order to summarize the natural history, management, and outcomes of these infrequent injuries.
Fractures of the hamate body typically occur in the coronal plane through axial loading of the metacarpals or loading in the transverse plane by a compressive force. Standard radiographs of the wrist frequently miss hamate fractures. Oblique and carpal tunnel views can be obtained when a fracture of the hamate is suspected. Advanced imaging with high-resolution computed tomography should also be considered if radiographs are negative and high suspicion for fracture remains or for the purpose of pre-operative planning. Co-existing injuries often include subluxation or dislocation of the 4th and 5th metacarpals with or without fracture. Non-disfracture remains or for the purpose of pre-operative planning. Co-existing injuries often include subluxation or dislocation of the 4th and 5th metacarpals with or without fracture. Non-displaced injuries that are stable may be treated non-operatively with immobilization. Displaced or unstable fracture patterns typically require closed reduction and percutaneous pinning versus open reduction internal fixation in order to restore anatomical alignment and maximize outcomes. Hamate body fractures are uncommon fractures of the carpus. When appropriately treated, patients with hamate body fractures usually recover full pain-free range of motion and preserved grip strength. selleck chemical Complications are usually secondary to late presentation or noncompliance.
Efficiency and safety are important features in the selection of lead extraction tools. We report our experience with different endovascular techniques to extract individual pacing and defibrillator leads.
This is asingle-centre study of consecutive lead extraction procedures from 1997 until 2019. link2 Atotal of 1725 leads were extracted in 775patients. Direct traction sufficed for 588 leads, and 22leads were primarily removed by surgery. The endovascular techniques used in the remainder were alaser sheath (190 leads), the femoral approach (717 leads) and rotating mechanical sheaths (208 leads).
The three approaches were comparably effective in completely removing the leads (p = 0.088). However, there were more major complications with the laser sheath than with the femoral approach or rotating mechanical sheaths (8.4%, 0.5% and 1.2%, respectively). Therefore, the procedural result-extraction without major complications-was significantly better with both the femoral approach and rotating mechanical sheaths tThe Neotropical brown stink bug, Euschistus heros (F.), feeds on stems, leaves, pods, and seeds of soybean, Glycine max (L.) Merrill. Knowledge of the damage that nymphs at different instars can cause to soybean pods and seeds, as well as efficient histological techniques for locating the salivary sheath are sparse. link3 This study developed a new double-staining method to facilitate distinguishing the salivary sheath from plant tissues and to anatomically evaluate the damage caused by nymphs of different instars as they feed on soybean pods and seeds. Five insects from each of the analyzed instars (1st, 2nd, 3rd, 4th, and 5th) per pod at the R6 stage (full pod-filling) were kept in clip cages for 48 h of feeding. The salivary sheath was analyzed to localize the damage (pod, vascular bundle, and seed) and the depth reached by the damage (categorized tissue). Double staining with xylidine ponceau and toluidine blue provided the best differentiation between the salivary sheath and watery sheath (proteins stained red) and the plant tissues (stained blue). First instar nymphs do not feed. Second instar and older nymphs caused damage to seeds, which became more severe with later developmental stages. The damage consists of coalescence of protein bodies and degradation and breakdown of the cell wall, marked by darkened regions in the embryo tissue of seeds. The information generated will contribute to new studies on feeding habits and emphasizes the need to control E. heros in early development stages.
