Journal articles on the topic 'Day care centers Great Britain'
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1
Hwang, C. Philip. "Scandinavian Experience in Providing Alternative Care." Pediatrics 91, no. 1 (January 1, 1993): 264–70. http://dx.doi.org/10.1542/peds.91.1.264.
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What are Swedes like? Recently, this question received a great deal of attention in the Swedish media, because of an article published in the Daily Mail by an English journalist, Geoffrey Levy. He described Swedes as being lazy, sick, and totally unable to enjoy anything nice in life. In addition, Swedish cars are wrecks, Swedes dress sloppily, and, if you do not want to work, you do not need to—but you are still fully paid. Finally, he described family policy in Sweden: "Just imagine a country where mothers as well as fathers can stay at home 12 months, with almost full pay after a baby is born, or a country where the state pays almost 6000 pounds for every child that goes to a day-care center—this would be totally impossible in Britain." How did the Swedish public react to Geoffrey Levy's article? Surprisingly, most people agreed with his description of the Swedes. Yes, we are lazy, too many people are sick, and we are unable to enjoy the good things in life. There was only one major issue where most people disagreed with Geoffrey Levy. Very few were negative about family policy in Sweden. On the contrary, most people took parental leave, the possibility of staying at home with a sick child, and publicly funded day care for granted. In the first part of this presentation, I will describe family policy in Sweden and, in particular, how the society supports and provides care for children under school age (which in Sweden starts at 6-7).
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Mishina, Irina E., Yulia V. Chistyakova, Eugenia V. Pchelintseva, Irina V. Mitryaeva, Svetlana O. Fokicheva, Elena V. Berezina, and Denis S. Bendin. "Effectiveness of Medical Rehabilitation of Patients after a New Coronavirus Infection in a Day Hospital." Bulletin of Rehabilitation Medicine 21, no. 3 (June 30, 2022): 9–23. http://dx.doi.org/10.38025/2078-1962-2022-21-3-9-23.
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Aim. To investigate the prevalence of clinical manifestations of post-coronavirus syndrome and evaluate the effectiveness of medical rehabilitation course in patients after new coronavirus infection (COVID-19) in a day care hospital, taking into account the severity of the disease course. Material and methods. At the first stage of the study, 203 residents of the Ivanovo region (140 women and 63 men) aged 40 to 80 years who had a new coronavirus infection, who had no more than one year since the onset of the disease, were surveyed on the basis of the Ivanovo State Medical Academy (ISMA) of the Ministry of Health of Russia. For this purpose, “COVID-19 Yorkshire Rehabilitation Screening (C19-YRS)” telephone screening questionnaire was used, developed by groups of rehabilitation therapists from the training medical centers of the National Health Service of Great Britain to identify multisystem functional disorders of patients who have suffered a new coronavirus infection, and to address the need for rehabilitation intervention. At the second stage, 54 patients (38 women and 16 men) aged 29-81 years were examined, who were admitted to the 3rd stage of rehabilitation in the department of medical rehabilitation of patients with somatic diseases of the ISMA Clinic after suffering a new coronavirus infection COVID-19. Among them, 3 groups were formed depending on the severity of the infection: 16 patients with a mild course of the disease made up the 1st group, 20 patients who had a moderate course of coronavirus infection – the 2nd group, 18 patients with a severe course of COVID-19 – 3rd group. Results. The questionnaire showed that COVID-19 survivors had a multisystem decrease in functioning, which was maximally pronounced during the first month from the onset of the disease and did not return to the baseline level for 6-12 months. The most significant disturbances occurred with patients who, due to the severity of the condition, were treated in a hospital. The most lasting symptoms were impaired exercise tolerance and increased fatigue, which had a significant impact on daily life. In patients admitted for rehabilitation, functional impairments and disabilities were detected regardless of the severity of the course of the new coronavirus infection (COVID-19). In patients with a mild course of infection, they were manifested mainly by decreased tolerance to physical load, frequent disorders of sleep function, emotions, volitional and motivational functions, in some patients – by mild disorders of respiratory function and cognitive impairment in the form of reduced volume of cranio-temporal memory. In patients with moderate and severe COVID-19, against the background of impaired exercise tolerance function, sleep function, emotions, volitional and motivational functions, we mainly detected moderate and pronounced respiratory disorders, cognitive disorders, which were manifested by decreased short-term memory and attention concentration, increased attention exhaustion, and bradyphrenia. The functional disorders detected in patients primarily led to limitation of their mobility in the form of walking for long distances, ability to self-care and household activities, ability to work, which before the disease did not cause difficulties for patients. Study of the indexes in dynamics showed the effectiveness of rehabilitation measures in improving the functions, regardless of the severity of the course of coronavirus infection. Conclusion. The findings of the present study justify the necessity of early complex rehabilitation of patients by multidisciplinary rehabilitation team taking into account individually detected functional impairment. Individual rehabilitation program should be developed for each patient taking into account the revealed problems on the basis of problem-oriented approach.
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Battaglia, Sam G., and W. R. Kiser. "Day Care Injuries." Pediatrics 98, no. 5 (November 1, 1996): 1005. http://dx.doi.org/10.1542/peds.98.5.1005.
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We would like to commend Kopjar and Wickizer1 for their recent article dealing with the safety of day care centers in Norway. With the increasing prevalence of two-career homes and single-parent homes, the need for day care is indeed great and unlikely to decrease in the near future. Given this trend, studies such as the one carried out by these authors are pertinent, poignant, and deserving of thorough evaluation. As primary care physicians, we have a responsibility to be informed regarding the safety of those day care facilities that our patient-families may choose to utilize.
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Kopjar, Branko, and Thomas Wickizer. "How Safe Are Day Care Centers? Day Care Versus Home Injuries Among Children in Norway." Pediatrics 97, no. 1 (January 1, 1996): 43–47. http://dx.doi.org/10.1542/peds.97.1.43.
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Objectives. The study's objective was to examine and compare injury rates of children ages 6 months to 6 years in day care centers and homes. More specifically, we tested the hypothesis that the injury rate is lower in day care centers than at homes, as suggested by previous studies. Methods. A comprehensive prospective injury registration was carried out in Stavanger, Norway, during 1992. We obtained data from this system to identify injuries occurring in day care centers, homes, and other places during 1992. Exposure-adjusted incidence rates were calculated to compare the risk of injury at day care centers, homes, and other places. We also obtained data from medical records on use and costs of medical care. In addition, a parent questionnaire was developed and used to gather data on the amount of injury-related restricted activity. Results. Among 9454 children ages 6 months to 6 years in Stavanger, 770 injuries occurred during 1992: 96 in day care centers, 472 at home, and 202 at other places. For children ages 6 months to 2 years, the rate of injuries was significantly lower in day care centers than at home (1.2 and 2.5, respectively, per 100 000 children-hours), but for children ages 3 to 6, the rates of injuries were similar in day care centers and at home (1.3 and 1.5, respectively, per 100 000 children-hours). The great majority of children attending day care centers were from 3 to 6 years of age. No significant differences were found in the severity of the injuries. Conclusions. For children ages 3 to 6 years, which included most of the children attending day care centers in Stavanger, Norway, day care centers were not found to be safer than homes. We think continuing attention should be paid to injury control in day care centers.
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Zorochkina, Tetiana. "Innovative approaches to improving qualifications of the primary school teachers in the Great Britain." Scientific visnyk V.O. Sukhomlynskyi Mykolaiv National University. Pedagogical Sciences 65, no. 2 (2019): 95–100. http://dx.doi.org/10.33310/2518-7813-2019-65-2-95-100.
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The article examines the approaches to improving the skills of primary school teachers in the UK. Criteria for upgrading and retraining UK teaching staff are highlighted. Teacher training courses are held at different educational institutions: at institutes of pedagogy of higher educational institutions, with independent advisory groups, with the Department of Education and Science, at teacher centers, with local educational authorities, at school. Short-term advanced training courses are divided into: one-day; three days; five to six day courses; vacation courses. Long-term courses include three-year advanced training courses. During the courses of advanced training teachers are engaged in research activities under the direction of university tutors. The main advisory and analytical body for teacher qualifications is the Royal Inspection Service. It has a widespread network across the country, comprised of local education departments. The inspectorate service is intended, based on the analysis of the quality of educational programs, to identify trends in the development of the system of advanced training, to predict the effects of planned projects, and to prepare recommendations for the Ministry of Education and Science to determine the most relevant and forward looking directions for improving the system of professional standards for teachers. The teacher education system serves a prominent system of public education. Understanding the need for organizing mass retraining of teachers in Britain has been growing in pedagogical circles since the last century, when intensive primary education was developing. Since then and to this day, discussions about the most rational ways of updating the teacher education system are not dying. The main advisory and analytical body for teacher qualifications is the Royal Inspection Service. It has a widespread network across the country, comprised of local education departments. Both local and national authorities of this service are actively involved in the analysis and evaluation of the effectiveness of all work aimed at supporting and developing the professional skills of school teachers. The inspectorate service is intended, based on the analysis of the quality of educational programs, to identify trends in the development of the system of advanced training, to predict the effects of planned projects, and to prepare recommendations for the Ministry of Education and Science to determine the most relevant and forward looking directions for improving the system of professional standards for teachers.
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Yargin, Sergey V. "On medical insurance: considerations based on foreign experience." Health Care of the Russian Federation 60, no. 4 (May 24, 2019): 214–16. http://dx.doi.org/10.18821/0044-197x-2016-60-4-214-216.
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The health care organization in Russia is similar to the same in Great Britain where exists public medical care system. At the same time, Russian health care, being insurance, bear resemblance with German health care. The significant characteristic of insurance medicine in Germany is availability of mechanism ofprice ofpoint that is shortly discussed in this article. The application of this mechanism leads to that in overall country the price of medical service is approximately the same independently of insurer. Accordingly, most of private medical practitioners and medical organizations receive all insured patients. The similar mechanism can successfully function only on the assumption of conscientiousness and higher level of professional knowledge of physicians who are not to prescribe pharmaceuticals and diagnostic procedures without sufficient indications. The adoption of mechanism ofpoint price by Russian health care would permit to redirect part of patients insured by mandatory medical insurance to private medical centers and private medical practitioners.
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Sudarmo, Subijanto Marto, Reza Gunadi Ranuh, Alpha Fardah Athiyyah, Andy Darma, Virany Diana, Boerhan Hidajat, Siti Nurul Hidayati, and Anang Endaryanto. "The Effects of Probiotic and Prebiotic Administration in Children with Acute Diarrhea at Day-Care Centers." International Journal of Probiotics and Prebiotics 17, no. 1 (February 11, 2022): 27–32. http://dx.doi.org/10.37290/ijpp2641-7197.17:27-32.
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Prevention of diarrhea needs an appropriate immune system supported by normal microbiota composition. This study aimed to determine whether probiotic or prebiotic enriched Growing-Up Milk could significantly reduce incidence of acute diarrhea. The randomized, double-blind, placebo-controlled clinical study was conducted in Surabaya, Gresik, and Sidoarjo cities, East Java–Indonesia, between July 2007 and January 2008. This study involved healthy children aged 1–5 years at day-care centers and were randomized to receive three different Growing-Up Milk containing probiotic, prebiotic, or placebo groups (containing neither probiotic nor prebiotic). The day-care staff and parents reported the amount of milk consumed, symptoms, and duration of acute diarrhea during the observation time. A total of 162 participants were divided into probiotic (55), prebiotic (54), and placebo groups (53). The incidence of diarrhea in all the participants was 1.2%, which was the least incidence from the prebiotic group and the highest in the placebo group and significantly different (P = 0.001). The mean duration of diarrhea in all the intervention groups was lower than the placebo group, although neither was statistically nor clinically significant (P = 0.254). Administration of Growing-Up Milk enriched with probiotics or prebiotics appears to be a great opportunity in reducing the incidence of acute diarrhea in children aged 1–5 years.
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Singhal, DK, S. Acharya, and AS Thakur. "Dental Caries Experience Among Pre-School Children Of Udupi Taluk, Karnataka, India." Journal of Oral Health and Community Dentistry 9, no. 1 (January 2015): 5–9. http://dx.doi.org/10.5005/johcd-9-1-5.
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ABSTRACT Aim To determine the dental caries experience of pre-school children attending anganwadi and day care centre in Udupi Taluk. Materials and Methods A cross-sectional survey was conducted on 825 pre-school children attending Anganwadi and day care centers in Udupi Taluk. Dental caries was assessed using Dentition status and treatment needs (WHO, 1997). Data was analyzed using SPSS 16.0 with significance level at P value < 0.05. Chi-square test was used to find out the significant differences. Level of significance was taken Results Dental caries experience was significantly higher among anganwadi children (3.74±3.58) as compared to day care children (3.26±3.32). The prevalence of dental caries was 64.2% among anganwadi children and 61.0% among day care children. Girls had slightly higher mean deft score, mean number of decayed teeth, filled teeth and lower missing teeth as compared to boys. Conclusion High caries experience in this study revealed that there is a great need to plan and conduct oral health promotion initiatives and treatment activities for preschool children. The oral health education at initial stages would help in improving preventive dental behavior and attitude which is beneficial for lifelong.
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Chin, Rui-Ernn Natassia, and Mao Fong Lim. "From Infancy to Modern Day: The History of Mother and Baby Units in the United Kingdom." BJPsych Open 8, S1 (June 2022): S47. http://dx.doi.org/10.1192/bjo.2022.183.
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AimsMother and baby units (MBUs) are inpatient units where women with severe acute postpartum psychiatric problems can be cared for alongside their babies. This is currently considered to be gold-standard care, recognising the importance of early childhood bonding and family-centered care. Great Britain has spearheaded the development of the MBU, however the history of MBUs in the United Kingdom (UK) has never been published.MethodsThrough a narrative review of published and grey literature, we explore the development of the MBU in the UK, from its infancy to modern day.ResultsWe outline the history of the MBU model of care, from its early conception to current state. We also examine factors contributing towards the expansion of MBUs and more broadly, the expansion of perinatal mental health services throughout the UK. We also briefly describe the approach to MBUs worldwide, taking into consideration sociocultural differences and approaches to caring for the mother-baby dyad.ConclusionSince its conception, there has been considerable investment in and expansion of perinatal mental health services, both in community and inpatient settings. Sustained research and continued advocacy is required to expand provision of care.
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Naumenko, Natalya S., A. P. Nikonov, O. R. Astsaturova, and A. V. Belova. "STRUCTURE OF INFECTIOUS SCREENING OF PREGNANTS: RUSSIAN AND OVERALL PRACTICE." V.F.Snegirev Archives of Obstetrics and Gynecology 5, no. 1 (March 15, 2018): 26–30. http://dx.doi.org/10.18821/2313-8726-2018-5-1-26-30.
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Infectious diseases are still one of the main causes of perinatal losses worldwide. The consequences for the fetus and the newborn vary from asymptomatic infection to sepsis, malformations and the fetal death. Examination of pregnant women for the presence of infectious agents is an important part of the antenatal care program. The purpose of the work was to assess the structure of infectious screening in various medical institutions in Moscow, as well as the comparison of the recommended in Russia examinations with the main programs of antenatal monitoring in the world. Material and methods. The retrospective study was executed on the basis of four medical institutions: two state women’s clinics and two commercial clinics (the total number of patients - 902 people). The comparison was made with antenatal care programs of the antenatal observation in Centers for Disease Control and Prevention (CDC), 2015 (Centers for Disease Control and Prevention) in the United States of America, and the National Institute for Health and Care Excellence (NICE), 2017 (National Institute for Health and Medical Quality assistance), Great Britain. Results. Basic screening of pregnant women for infection in the Russian Federation includes 8 items (serological study of the blood for syphilis, HIV, hepatitis B and C, rubella, toxoplasmosis, microscopic examination of genital secretions on Neisseria gonorrhoeae and fungi of the genus Candida), which is significantly higher than in the USA and Great Britain (5 and 4 respectively). According to the results of our study, the volume of the compulsory examination of pregnant women is wider than abroad, due to serological examination of blood for the presence of antibodies to cytomegalovirus (CMV) and herpes simplex virus (HSV) of types 1 and 2, microbiological examination of genital secretions, molecular biological diagnosis (polymerase chain reaction - PCR, real-time PCR). Conclusion. Screening of pregnant women for infection in public and commercial clinics has a number of differences. The actual scope of the survey is higher than recommended by the state. The Russian list of tests in comparison with foreign analogs is much wider in terms of the number of nosologies and the frequency of the research. It is necessary to conduct multicenter epidemiological studies throughout the Russian Federation to create optimal regional programs for examining pregnant women for infection that meet the criteria for effective screening.
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Kinyingi, Jacinta Wanjiku. "Effects of raw materials on the quality of catering services at daycare centers." International Journal of Research in Business and Social Science (2147- 4478) 9, no. 2 (March 15, 2020): 96–106. http://dx.doi.org/10.20525/ijrbs.v9i2.622.
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This study examined the effect of raw materials on the quality of catering services in daycare centers in Nyeri Town Constituency, Kenya. The development and growth of a child depend to a great extent on what they consume as food. For a good development of a child, there is a need to consider the quality of food he or she takes. This is in relation to nutritional value, quantities per intake, quality in relation to cleanness, methods of cooking and its presentation to the child. This high level of participation in childcare centers is attributed to an increasing awareness that early childhood centers are considered critical support in the development of young human beings to become useful citizens. The study targeted all 16-day care centers in Nyeri Town Constituency which are licensed to operate. A total of 64 respondents were targeted which included the managers of the daycare centers and three staff members working in catering sections as follows: stores, production, and service formed the respondents. This study employed a purposive sampling technique in selecting the constituency in the county where the research was carried out. The R-value is 0.689 which indicates a strong correlation. The R2 value indicates how much of the dependent variable (quality of catering services), can be explained by the independent variable (effects of raw materials’). This study concludes that the management of the catering departments in daycare centers should ensure different types of food are stored in different rooms.
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Figueiredo Pacheco, Flávia Thamiris, Renata Kelly Novaes Rodrigues Silva, Silvia Souza de Carvalho, Felipe Carvalho Rocha, Gisele Maria Trindade das Chagas, Daisy Chagas Gomes, Hugo da Costa-Ribeiro Junior, et al. "The Predominance of Giardia duodenalis AII sub-assemblage in young children from Salvador, Bahia, Brazil." Biomédica 40, no. 3 (September 24, 2020): 557–68. http://dx.doi.org/10.7705/biomedica.5161.
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Introduction. Giardia duodenalis is an intestinal protozoan with a high prevalence in children of developing countries. Molecular studies revealed a great genetic diversity of G. duodenalis, with assemblages A and B found mainly in humans. Despite its importance, the information on the molecular epidemiology of human giardiasis is still limited in Brazil.Objective. To characterize G. duodenalis molecular isolates in children from Salvador, Bahia, Brazil.Materials and methods. Giardia duodenalis positive fecal samples were obtained from 71 children from two day care centers and 39 users of a clinical analysis laboratory. Samples were analyzed by PCR-RFLP of the glutamate dehydrogenase (gdh) and beta-giardin genes and by the sequencing of beta-giardin.Results. Of the 110 G. duodenalis samples, 80 (72.7%) amplified one or both target genes. Of these, 62 (77.5 %) were identified as assemblage A and 18 (22.5%) as assemblage B. The subassemblage AII was identified in 58.8% (n=47) of isolates followed by the sub-assemblage AI (18.8%, n=15), BIV (11.2%, n=9), and BIII (5.0%, n=4). The AII sub-assemblage was the most frequent in children of both day care centers whereas AI was found only in the group attended at the clinical laboratory. Sub-assemblage AII predominated in children under two years.Conclusions. The higher frequency of AII sub-assemblage suggests that anthroponotic transmission is more common in Salvador, but that zoonotic transmission pathways are also present and a change in susceptibility to different molecular patterns of Giardia may occur during child growth.
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Wan, Da, Hui Liu, Jiaxing Guo, Lian Guo, Dongchen Qi, Sheng Zhang, Pengbo Li, and Hiroatsu Fukuda. "Spatial Distribution and Accessibility Measurements for Elderly Day Care Centers in China’s Urban Built-up Area: The Case of Tianjin Nankai District." Buildings 12, no. 9 (September 8, 2022): 1413. http://dx.doi.org/10.3390/buildings12091413.
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The elderly community day care model is an emergent solution to the aging problem influenced by the Eastern perspective of family in China. Due to the structural problem of spatial disorder in most of China’s urban built-up areas, the planning and construction of elderly day care centers (EDCCs) is facing great challenges. This study aims to comprehensively compare the spatial distribution and accessibility measurement methods for elderly residents and EDCCs in typical Chinese urban built-up areas based on the accessibility theory and spatial analysis methods from the community living circle perspective. The results show that different spatial distribution analysis methods have their own emphases and limitations, requiring comprehensive application in practice. The potential model method is most suitable for the accessibility measurement in this scenario. The threshold setting of service distance for the urban built-up areas public service facilities in the current Chinese standard needs to be further optimized. The existing EDCCs suffer from serious quantity deficiencies and misplaced supplies in the region. These findings can reveal the EDCCs distribution characteristics of typical Chinese urban built-up areas and provide new insights for urban planners and policy makers who are assessing the equity and efficiency of public service facilities.
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Francois, U., J. P. Balinda, M. Hagenimana, R. Samuel, E. Arielle, and M. A. Muhimpundu. "Scaling Up of Cervical Cancer Screening at Primary Health Care Level in Rwanda." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 54s. http://dx.doi.org/10.1200/jgo.18.78700.
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Background: Rwanda is a high cervical cancer-burden country, with an age standardized rate (ASR) of cervical cancer incidence of 41.8 cases per 100,000 people in 2012. In the same year, cervical cancer mortality lay at 26.2 deaths per 100,000 people. Aim: To address this burden, Rwanda initiated the vision inspection with acetic acid (VIA) screening-based strategy in 2013 in line with WHO recommendations for low- and middle-income countries. The target audience of the program was set for women between the ages of 30 and 49 and remains today. Here, we describe the implementation status of the program at the primary health care level; health centers and district hospitals in Rwanda. Methods: Integrating into Rwanda's existing health system, the program was purposefully rooted in health centers, with a pathway designed for women who screen positive to be referred to the district hospital for cryotherapy or LEEP, according to the lesions' size. Nurses, midwives and medical officers from health centers and district hospitals are trained through a 10-day curriculum (5 days for theory and 5 days for practice) before initiating the provision of services to clients in routine care. Monitoring of the program is conducted through both quarterly, on-site mentorship and screening indicators that are integrated into Rwanda's Health Management Information System (HMIS), through which facilities report on monthly basis. Results: Since its initiation in August 2013, Rwanda's cervical cancer screening program has been established in 21 of 38 (55%) district hospitals and 256 health centers in their catchment area. Training has been an integral component as well, with at least two nurses/midwives trained at implementing health centers and a medical officer with two nurses/midwives trained on cervical cancer screening and the treatment of precancerous lesions at district hospital. In addition, district hospitals have been equipped with cryotherapy, LEEP, and colposcopy machines. Over this program's implementation three-and-a-half-year course, 38,000 women have been screened for cervical cancer. Conclusion: Using a simple VIA-based strategy, Rwanda has been able to swiftly and effectively increase the number of health facilities implementing cervical cancer screening program. Though additional innovative implementation strategies are still needed to proportionally increase women's screening coverage, these initial steps hold great promise in Rwanda's ability to effectively implement a sustainable cervical cancer screening program.
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Petersenn, Stephan, Jürgen Honegger, and Marcus Quinkler. "National German Audit of Diagnosis, Treatment, and Teaching in Secondary Adrenal Insufficiency." Hormone and Metabolic Research 49, no. 08 (March 28, 2017): 580–88. http://dx.doi.org/10.1055/s-0043-105077.
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AbstractGreat heterogeneity seems to exist regarding diagnosis, therapy, and teaching of patients with secondary adrenal insufficiency (SAI) across Germany resulting in different diagnosis and treatment strategies. The aim of the work was to present the first national audit on diagnosis, treatment, and patient teaching of SAI reflecting common clinical practice in Germany. A self-designed questionnaire was sent via e-mail to all members of the German Endocrine Society (approx. 120 centers). Returned questionnaires (response rate 38.3%) were checked for duplicity of institutions and analyzed. Diagnostic testing focuses on those patients with relevant risk for adrenal insufficiency. Basal serum cortisol is mostly used as screening test. Short synacthen and CRH tests are the preferred confirmatory tests, however, cut-off values vary due to different assays used. Patients with radiation, second surgery, progressive disease or new symptoms are followed by serial re-testing. Perioperative management and frequency of postoperative re-evaluations differ among centers. Hydrocortisone is the preferred glucocorticoid for replacement therapy, but daily doses vary considerably (10–30 mg/day). Some centers perform hormone measurements for dose adjustment of glucocorticoid replacement therapy whereas others rely on clinical judgement. Patients’ teaching is done in 84% of centers, but only half of the centers include patients’ relatives. Homogeneity exists in patients’ teaching regarding intercurrent illnesses (fever, diarrhoea). Recommendations regarding dose adaptations in situations such as sport-activities, dental-procedures, or coughing are highly variable. This first national audit reveals great heterogeneity among German centers and could improve patients’ care in SAI, for example, by initiating new trials and developing clinical practice guidelines.
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Roberts, Melinda A. "A Way of Looking at the Dalla Corte Case." Journal of Law, Medicine & Ethics 22, no. 4 (1994): 339–42. http://dx.doi.org/10.1111/j.1748-720x.1994.tb01315.x.
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When her baby was born last June, Rossana Dalla Corte, age sixty-two, was thought to be the oldest woman ever to have given birth. Her pregnancy was achieved at a private fertility clinic in Italy, the same clinic that treated “Jennifer F.,” a London woman who, on Christmas day, 1993, at the age of fifty-nine, gave birth to twins. The reproductive procedure, likely to become more common during the next few years, has received intense scrutiny from health officials in Great Britain, France, and Italy. Moral questions concerning that procedure already have been taken up by the popular press in the United States. Such questions can be expected to take on a new urgency as the United States considers reshaping its health care system and, specifically, the circumstances under which coverage for infertility treatment will be provided.
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Yuliartanto, Purnaresa, Adian Fatchur Rochim, and Ike Pertiwi Windasari. "Pengembangan Sistem Informasi Rekam Medis untuk Dinas Kabupaten Grobogan." Jurnal Teknologi dan Sistem Komputer 2, no. 3 (August 31, 2014): 203–8. http://dx.doi.org/10.14710/jtsiskom.2.3.2014.203-208.
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Abstract - Health services include the recording of the patient's medical record . Medical records were used to aid the treatment process. The number of medical records continues to grow proportional to the number of patients. Tens of thousands of sheets of paper used to record medical record requires effort , time and place great . The amount of effort will continue to grow each day. Search one sheet of medical records among a set of storage shelves requires considerable time and risk data is not found. The risk of error in the search and storing will increase every day. The development of technology allows the implementation of technology in the process of record-keeping. Changes in the form of digital medical records will reduce the need of a previous process. Labor, time and place required by the help of information systems will be reduced significantly . Storage process data stored in the cloud will provide more value for the system as a patient's medical records from a health center can be accessed from other health centers. The development of this system will reduce the risk of inappropriate storage and retrieval of medical records. Grobogan Health Department that oversees health center in Grobogan are office that are ready to migrate business processes into the digital age. Development of medical record information system for the health center expected to improve the quality of service of health centers , especially in health care.
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Marshall, S., A. Ondhia, C. Mearns, and T. Kandiah. "Improving pain management for children having dental extractions under general anaesthesia." Annals of The Royal College of Surgeons of England 102, no. 9 (November 2020): 733–36. http://dx.doi.org/10.1308/rcsann.2020.0172.
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Children provided with general anaesthesia for dental extractions at East Surrey Hospital were audited to determine the percentage of children who were prescribed adequate pain management in accordance with guidance published by the Association of Paediatric Anaesthetists of Great Britain and Ireland. Three audit cycles were completed. Data were collected retrospectively through case note review. The results from the first cycle showed that only 47% of children were prescribed with a recommended analgesic regimen. Implementation of change included the development of a protocol for analgesic delivery, which was disseminated to the anaesthetic and dental teams. Full compliance with the audit standards was then demonstrated in the second and third cycles. This audit demonstrates the importance of multidisciplinary collaboration in order to provide high standards of care for children undergoing dental extractions under general anaesthesia. The protocol developed could be applied to other surgical day case procedures for children to improve the patient experience.
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Pham, Dem Van, Hai Hoang Do, Anh Viet Nguyen, Nam Thanh Nguyen, Ngoc Van Hoang, and Ngoc-Anh Hoang. "The first newborn patient with SARS-CoV-2 variant B.1.1.7 identified in Viet Nam: treatment and care practices." Western Pacific Surveillance and Response Journal 12, no. 3 (September 30, 2021): 77–81. http://dx.doi.org/10.5365/wpsar.2021.12.2.008.
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SARS-CoV-2 variant B.1.1.7, first detected in September 2020 in the United Kingdom of Great Britain and Northern Ireland, has spread quickly to many countries around the world. While some publications have described the clinical features of adult patients with the B.1.1.7 variant, little information is available on newborn patients. We report the clinical characteristics, treatment and care practices for a 21-day-old newborn patient who was confirmed to be infected with SARS-CoV-2 variant B.1.1.7 in Viet Nam during contact tracing after her father was confirmed to be infected with SARS-CoV-2. The patient displayed no symptoms of COVID-19 on admission but 3 days later developed diarrhoea, vomiting, a runny nose and a productive cough. These symptoms lasted for 3 days before becoming milder for 1 day and then stopping until discharge. During treatment, the patient received Vietnamese traditional herbal peppermint extracts for cough and digestive probiotics for diarrhoeal symptoms. A saltwater solution (Sterimar 0.9%) was used to clean the patient’s sinuses. The patient was cared for and fed breastmilk by her mother, who was provided with personal protective equipment, including sterilized infant equipment, medical masks and hand sanitizer, during hospitalization. The patient’s mother tested negative for SARS-CoV-2 throughout hospitalization. In conclusion, we found no severely abnormal clinical symptoms in a newborn infected with SARS-CoV-2 variant B.1.1.7 during treatment. Our case suggests that newborn patients with the B.1.1.7 variant can receive exclusive breastmilk feeding if sufficient preventive measures are provided for both mother and child.
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Witt, Claudia M., and Christine Holmberg. "Changing Academic Medicine: Strategies Used by Academic Leaders of Integrative Medicine—A Qualitative Study." Evidence-Based Complementary and Alternative Medicine 2012 (2012): 1–7. http://dx.doi.org/10.1155/2012/652546.
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In Western countries, complementary and alternative medicine (CAM) is more and more provided by practitioners and family doctors. To base this reality of health care provision on an evidence-base, academic medicine needs to be included in the development. In the study we aimed to gain information on a structured approach to include CAM in academic health centers. We conducted a semistructured interview study with leading experts of integrative medicine to analyze strategies of existing academic institutions of integrative medicine. The study sample consisted of a purposive sample of ten leaders that have successfully integrated CAM into medical schools in the USA, Great Britain, and Germany and the Director of the National Center for Alternative and Complementary Medicine. Analysis was based on content analysis. The prerequisite to foster change in academic medicine was a strong educational and professional background in academic medicine and research methodologies. With such a skill set, the interviewees identified a series of strategies to align themselves with colleagues from conventional medicine, such as creating common goals, networking, and establishing well-functioning research teams. In addition, there must be a vision of what should be needed to be at the center of all efforts in order to implement successful change.
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Smith, John T. "The Priest and the Elementary School in the Second Half of the Nineteenth Century." Recusant History 25, no. 3 (May 2001): 530–42. http://dx.doi.org/10.1017/s003419320003034x.
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The Report of a Select Committee in 1835 gave the total of Catholic day schools in England as only 86, with the total for Scotland being 20. Catholic children had few opportunities for day school education. HMI Baptist Noel reported in 1840: ‘very few Protestant Dissenters and scarcely any Roman Catholics send their children to these [National] schools; which is little to be wondered at, since they conscientiously object to the repetition of the Church catechism, which is usually enforced upon all the scholars. Multitudes of Roman Catholic children, for whom some provision should be made, are consequently left in almost complete neglect, a prey to all the evils which follow profound ignorance and the want of early discipline.’ With the establishment of the lay dominated Catholic Institute of Great Britain in 1838 numbers rose to 236 in the following five years, although the number of children without Catholic schooling was still estimated to be 101,930. Lay control of Catholic schools diminished in the 1840s. In 1844, for example, Bishop George Brown of the Lancashire District in a Pastoral letter abolished all existing fund-raising for churches and schools and created his own district board which did not have a single lay member. The Catholic Poor School Committee was founded in 1847, with two laymen and eight clerics and the bishops requested that the Catholic Institute hand over all its educational monies to this new body and called for all future collections at parish level to be sent to it. Government grants were secured for Catholic schools for the first time in 1847. The great influx of Irish immigrants during the years of the potato famine (1845–8) increased the Catholic population and church leaders soon noted the great leakage among the poor. The only way to counteract this leakage was to educate the young under the care of the Church.
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Zimenkovsky, А. B., and T. G. Gutor. "Medical standard as a historical component on the way of clinical audit." Acta Medica Leopoliensia 26, no. 4 (2020): 108–15. http://dx.doi.org/10.25040/aml2020.04.108.
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Aim - the search, analysis and systematization of historical facts concerning the formation and evo-lution of the world medical standartization; severance of its certain long-standing models for the optimization of settling and introduction of the existing, and future analogs, particularly, in the clinical audit format. Material and Methods. In order to study the medical standard as a historical component the fol-lowing methods were used: bibliographic, historical, analytical and methods of systematization and comparison. Results and Discussion. As a result of the conducted research the main historical events in the world development of the medical standartization starting from 1500 up till nowadays were col-lected. In order to study the evolution of the medical standartization, the analysis of the normative documents that have regulated the process of standartization, especially the Doctor's statute(s) in Russia, Minimal standard of the medical equipment and works of the American college of surgeons, was carried out. The scientific works that initiated the introduction of the clinical audit in the Health Care system in Ukraine, Turkey, the USA and Great Britain were throroughly analyzed. Conclusions. The improvement of quality as to rendering the medical aid is a job priority in the health care systems in many countries. For that reason, the search for its optimization was and is still retrieved for many centuries. The territorial formation of medical standartization is associated with England, Russia and the USA, but the occurrence of clinical audit is connected with Ukraine, Turkey, the USA and Great Britain. The foundations of the medical standardization was lauched in 1500 year, while the clinical audit - in 1854 year. The medical standartization is a reflection of the history of development of the organization of health care system, that's why the expertness (knowl-edge) of historical stages concerning the setting and the introduction of medical standartization may give a new impulse in its improvement and development under present-day conditions of reforma-tion in the medical sphere in Ukraine. The earlier beginning of implementation of the medical stan-dartization in the health care system in different countries makes it possible to actualize its introduc-tion into the clinical audit format, that, in its turn, allows to improve the quality of rendering the medical aid. Key words: medical standartization, clinical audit, quality of medical aid
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L., J. F. "THIS FEDERAL HEALTH PLAN WORKED TOO WELL." Pediatrics 93, no. 2 (February 1, 1994): A46. http://dx.doi.org/10.1542/peds.93.2.a46.
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Before okaying any plan that attempts to increase access to health care while harnessing costs, congress ought to re-examine the government-funded End-State Renal Disease program. It shows that per-treatment costs can be controlled by setting limits on what providers are paid, but controlling the volume is vastly more complex... A program that initially served 11,000 people today serves 165,000 and is expected to soon have 300 000 beneficiaries... First year costs were $229 million and reached $1 billion by 1977. In 1991, the program cost $6.6 billion. Even so, efforts by Medicare, which administers the program, to control perpatient costs have been a great success. Administrators capped the reimbursement rate early and steadfastly refused to raise it—not even to compensate for inflation. Twice the rate was lowered. Thus, the cost in constant dollars of a dialysis treatment has fallen 61%—$54 from $138... Today dialysis patients are older and sicker, and people over age 65 form the fastest growing group of new users. Among the aged beneficiaries are people in a persistent vegetative state and nursing-home residents who go to dialysis centers on stretchers... In Britian it is rare for anyone over age 55 to go on dialysis, largely because the British health-care system contains an implicit bias against providing dialysis for any kidney patient with multiple serious disorders, which elderly patients almost always have. As a result, for every million people in Britain, 154 are on dialysis; in the U.S., 539 people out of every million are on dialysis.
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Puzanovа, Olha. "Evidence Based Medical Prevention: International Experience." Family Medicine, no. 6 (December 30, 2016): 34–37. http://dx.doi.org/10.30841/2307-5112.6.2016.249037.
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The objective: was to study the international experience of evidence based preventive medicine development as well as to estimate its perspectives in Ukraine.
Patients and methods. Main principles and methods of scientific knowledge and research have been used including universal ones, methods of systemic approach, quantitative and qualitative information analysis, classification and systematization of theoretical and empirical data, hystorical and logical methods, health statistics as well). In total 529 scientific information sources have been studied, particularly a number of evidence based medicine (EBM) computer databases, special task forces recommendations and Cochrane reviews on prevention, Register of medical and technological documents for health care standards in Ukraine et al.
Results. The contribution of foreign scientific schools in the development of EBM has been determined, as well as the crucial role of scientific works carried out in the US and Great Britain in 1930–80s as to the development of evidence based preventive medicine. The international experience of the development and functioning of evidence based practice centers’ and special task forces on prevention has been summarized, as the experience of the development and implementation of recommendations on prevention in primary health care (PHC) in high income countries acceptable for Ukraine. The concept of evidence based prevention has been first proposed. It is revealed, that EBM implementation in Europe has been prioritized in both the field of infectious diseases prevention and PHC, while there are both the development of differentiated evidence based prevention and early evidence based diagnosis in PHC in the US.
Conclusion. The results proved importance of taking into consideration of international experience while evidence based PHC is being developed as a priority in Ukraine.
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Kodama, Yuko, Tomoyoshi Oikawa, Kaoru Hayashi, Michiko Takano, Mayumi Nagano, Katsuko Onoda, Toshiharu Yoshida, et al. "Impact of Natural Disaster Combined with Nuclear Power Plant Accidents on Local Medical Services: a Case Study of Minamisoma Municipal General Hospital after the Great East Japan Earthquake." Disaster Medicine and Public Health Preparedness 8, no. 6 (November 27, 2014): 471–76. http://dx.doi.org/10.1017/dmp.2014.112.
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ABSTRACTObjectiveTo elucidate the impacts of nuclear plant accidents on neighboring medical centers, we investigated the operations of our hospital within the first 10 days of the Great East Japan Earthquake followed by the Fukushima Daiichi nuclear power plant accident.MethodsData were extracted from medical records and hospital administrative records covering 11 to 20 March 2011. Factual information on the disaster was obtained from public access media.ResultsA total of 622 outpatients and 241 inpatients were treated. Outpatients included 43 injured, 6 with cardiopulmonary arrest, and 573 with chronic diseases. Among the 241 inpatients, 5 died, 137 were discharged, and the other 99 were transferred to other hospitals. No communication methods or medical or food supplies were available for 4 days after the earthquake. Hospital directors allowed employees to leave the hospital on day 4. All 39 temporary workers were evacuated immediately, and 71 of 239 full-time employees remained. These employees handled extra tasks besides patient care and patient transfer to other hospitals. Committed effective doses indicating the magnitude of health risks due to an intake of radioactive cesium into the human body were found to be minimal according to internal radiation exposure screening carried out from July to August 2011.ConclusionsAfter the disaster, hospitals located within the evacuation zone of a 30-km radius of the nuclear power plant were isolated. Maintenance of the health care system in such an event becomes difficult. (Disaster Med Public Health Preparedness. 2014;8:471-476)
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Barker, Hannah, and Sarah Green. "Taking Money from Strangers: Traders’ Responses to Banknotes and the Risks of Forgery in Late Georgian London." Journal of British Studies 60, no. 3 (May 17, 2021): 585–608. http://dx.doi.org/10.1017/jbr.2021.55.
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AbstractSelling to strangers was a significant occupational hazard for retailers in late Georgian Britain, one that was hard to avoid. The dangers were especially great in larger towns and cities, where shopkeepers were dependent on a steady stream of passing trade composed of a large number of customers that they did not know. Though traders risked financial loss and even possible prosecution by accepting counterfeit banknotes, refusal to accept them meant losing vital custom. In areas of growing urban populations, tradesmen and women thus faced an increasingly tricky dilemma in their day-to-day business as they dealt with more strangers whose trustworthiness and personal credit were extremely hard to gauge, at a time when banknote forgery was on the rise. The decisions that retailers made about both banknotes and the individuals who presented them for payment illustrate some of the ways that town dwellers sought to navigate the rising anonymity of urban society in the late eighteenth and early nineteenth centuries. This article suggests that traders relied on a series of techniques that in previous experience usually worked: examining banknotes and those strangers who presented them with care, relying on the expertise of neighbors and members of their household, and dealing by preference with individuals who appeared to be linked to their local community. These behaviors demonstrate that “modernity” might have affected the lives and outlooks of ordinary Londoners in unexpected and contradictory ways, some strongly linked to older forms of society.
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Makarenko, M. V., D. A. Govseev, I. V. Sokol, V. O. Berestovoy, and R. N. Vorona. "Пологовий центр – нова ланка акушерської допомоги в Україні." HEALTH OF WOMAN, no. 7(133) (September 30, 2018): 17–21. http://dx.doi.org/10.15574/hw.2018.133.17.
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In this article, data on the analysis of literature on the perinatal and maternal aspects of the domestic labor and delivery in maternity wards are conducted. For most women in developed countries, the choice of place of birth is maternity cultural norm. However, to give birth in a maternity room is a relatively recent phenomenon. In many countries, the change in birthplace has changed during the twentieth century. For example, in the UK, 80% of women were born in the 1920s, and in 2011, only 2.3%. The United States had a similar shift from 50% of births at home in 1938, to 1% in 1955. In developed countries such as Great Britain, Germany, the Netherlands, France, Italy, Israel, Canada, New Zealand, Australia, and in our geographical neighbors Latvia, Hungary and Poland have long been working on a three-step system of providing maternity care. This system includes: 1) Maternity Hospital – for women of high and moderate risk; 2) maternity centers in or near the hospitals, in which only the midwives receive births, and, if necessary, the woman and the child are quickly delivered to the hospital, where they will be in urgent assistance within a few minutes; 3) home births – for women from a low-risk group, accompanied by experienced certified midwives. The creation of a new obstetric link in Ukraine, the maternity center, is a promising direction for the development of all obstetrics. On the basis of Kyiv City Maternity Hospital № 5 a separate maternity center was created, which is an autonomous maternity ward office. The department has separate medical staff and maternity rooms as close as possible to home conditions. Emergency care for a mother and child takes several minutes. Key words: home birth, maternity center, perinatal aspects, maternal aspects.
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Cristino, Joseir Saturnino, Guilherme Maciel Salazar, Vinícius Azevedo Machado, Eduardo Honorato, Altair Seabra Farias, João Ricardo Nickenig Vissoci, Alexandre Vilhena Silva Neto, et al. "A painful journey to antivenom: The therapeutic itinerary of snakebite patients in the Brazilian Amazon (The QUALISnake Study)." PLOS Neglected Tropical Diseases 15, no. 3 (March 4, 2021): e0009245. http://dx.doi.org/10.1371/journal.pntd.0009245.
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Access to antivenoms is not guarranteed for vulnerable populations that inhabit remote areas in the Amazon. The study of therapeutic itineraries (TI) for treatment of snakebites would support strategies to provide timely access to users. A TI is the set of processes by which individuals adhere to certain forms of treatment, and includes the path traveled in the search for healthcare, and practices to solve their health problems. This study aims to describe TIs of snakebite patients in the Brazilian Amazon. This study was carried out at the Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, in Manaus, state of Amazonas, Brazil. The itinerary from the moment of the bite to the patient’s admission to the reference unit was analyzed. Sample size was defined by saturation. After an exploratory survey to collect epidemiological variables, in-depth interviews were conducted following a semi-structured guide. Patients originated from rural areas of 11 different municipalities, including ones located >500 kilometers from Manaus. A great fragmentation was observed in the itineraries, marked by several changes of means of transport along the route. Four themes emerged from the analysis: exposure to snakebite during day-to-day activities, use of traditional therapeutic practices, and personal perception of the severity, as well as the route taken and its contingencies. Access to healthcare requires considerable effort on the part of snakebite patients. Major barriers were identified, such as the low number of hospitals that offer antivenom treatment, poor access to healthcare due to long distances and geographic barriers, low acceptability of healthcare offered in countryside, lack of use of personal protective equipment, common use of ineffective or deleterious self-care practices, late recognition of serious clinical signs and resistance to seeking medical assistance. Health education, promotion of immediate transport to health centers and decentralization of antivenom from reference hospitals to community healthcare centers in the Brazilian Amazon are more effective strategies that would to maximize access to antivenom treatment.
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Schlickeiser, Reinhard, and Martin Kröger. "Forecast of Omicron Wave Time Evolution." COVID 2, no. 3 (February 24, 2022): 216–29. http://dx.doi.org/10.3390/covid2030017.
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The temporal evolution of the omicron wave in different countries is predicted, upon adopting an early doubling time of three days for the rate of new infections with this mutant. The forecast is based on the susceptible–infectious–recovered/removed (SIR) epidemic compartment model with a constant stationary ratio k=μ(t)/a(t) between the infection (a(t)) and recovery (μ(t)) rates. The assumed fixed early doubling time then uniquely relates the initial infection rate a0 to the ratio k; this way the full temporal evolution of the omicron wave is determined here. Three scenarios (optimistic, pessimistic, intermediate) and the resulting pandemic parameters are considered for 12 different countries. Parameters include the total number of infected persons, the maximum rate of new infections, the peak time and the maximum 7-day incidence per 100,000 persons. The monitored data from Great Britain underwent a clear maximum SDI of 1865 on 7 January 2022. This maximum is a factor 5.0 smaller than our predicted value in the optimistic case and may indicate a dark number of omicron infections of 5.0 in Great Britain. For Germany we predict peak times of the omicron wave ranging from 32 to 38 and 45 days after the start of the omicron wave in the optimistic, intermediate and pessimistic scenario, respectively, with corresponding maximum SDI values of 7090, 13,263 and 28,911. Adopting 1 January 2022 as the starting date our predictions imply the maximum of the omicron wave to be reached between 1 February and 15 February 2022. Rather similar values are predicted for Switzerland. Due to an order of magnitude smaller omicron hospitalization rate, in concert with a high percentage of vaccinated and boosted population, the German health system can cope with a maximum omicron SDI value of 2800 which is about a factor 2.5 smaller than the corresponding value 7090 for the optimistic case. By either reducing the duration of intensive care during peak time, and/or by making use of the nonuniform spread of the omicron wave across Germany, it seems that the German health system can barely cope with the omicron wave and thus avoid triage decisions. The reduced omicron hospitalization rate also causes significantly smaller mortality rates compared to the earlier mutants in Germany. Within the optimistic scenario, we predict 7445 fatalities and a maximum number of 418 deaths/day due to omicron. These numbers range in order of magnitude below the ones known from the beta mutant.
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De la Torre Rubio, N., J. Campos Esteban, M. Pavía Pascual, P. Navarro Palomo, M. Machattou, O. Rusinovich, M. Fernandez Castro, et al. "POS1548-HPR USEFULNESS OF AN ELECTRONIC CONSULTATION SYSTEM BETWEEN PRIMARY CARE HEALTH CENTERS AND RHEUMATOLOGY DEPARTMENT OF A TERTIARY HOSPITAL." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 1118.2–1119. http://dx.doi.org/10.1136/annrheumdis-2022-eular.1717.
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BackgroundThe EPISER study is the first Spanish epidemiological study that has confirmed the great burden of rheumatic diseases in the general population: they consume a large quantity of health resources (doctor visits, medical products) and imply a high social impact in terms of work absenteeism. Rheumatic diseases represent almost 30% of Primary Care medical consultations in Spain1,2. Electronic consultation could be an alternative response to the increase of this demand, both to make an early diagnosis and derivation and to improve communication with Primary Care physicians3,4.ObjectivesTo analyze the demand of Primary Care and its resolution through the electronic consultation system of the Rheumatology Department of a tertiary hospital.MethodsRetrospective descriptive study of the data collected in the request and information system (Sistema de Peticiones Electrónicas, SIPE) that supports electronic consultation between primary care physicians of the health area and the Rheumatology Department of a tertiary hospital, between July 2020 and May 2021.The following variables were collected: age, sex, reason for consultation, response time in days and destination (primary care/outpatient follow-up). Descriptive statistics were used to present the results.ResultsThe last 500 consecutive electronic consultations registered in the system, referring to 496 patients, were collected. Mean age was 59.5±17.7 years; 74.2% women. Mean response time was 2 days, median response time 1 day and range 0-45. The reasons for consultation (see Graph 1) were: osteoporosis assessment 55 (11%), treatment adjustment 50 (10%), appointment request 49 (9.8%), loss to follow-up 43 (8.6%), local-regional pathology assessment 39 (7.8%), infiltration request 28 (5, 6%), suspected rheumatoid arthritis 19 (3.8%), flare 18 (3.6%), suspected polymyalgia rheumatica or giant cell arteritis 16 (3.2%), COVID vaccine consultation 14 (2.8%), Raynaud’s phenomenon 13 (2.6%), monoarthritis assessment 12 (2.4%), assessment of polyarthritis 11 (2.2%), adverse effects of treatment 11 (2.2%), suspected spondyloarthritis 11 (2.2%), suspected psoriatic arthritis 8 (1, 6%), generalized pain 7 (1.4%), suspected Sjögren’s syndrome 5 (1%), suspected systemic lupus erythematosus 1 (0.2%), suspected other systemic autoimmune diseases 9 (1.8%), others 81 (16.2%). Fifty-seven and four % (287) of the patients required an appointment at the Rheumatology outpatient clinic and in 42.6% of the patients (213) the electronic consultation was successful, so it was not necessary to refer the patient to the hospital.ConclusionForty-two and six percent of the queries were resolved thanks to the electronic consultation system in an average of two days, otherwise that patients would have been referred to specialized care. The main reasons for consultation were osteoporosis assessment and clarification of doubts about the treatment of patients who were already being followed up by the Rheumatology Department.References[1]Carmona L, Ballina J, Gabriel R, Laffon A. The burden of musculoskeletal diseases in the general population of Spain: results from a national survey. Ann Rheum Dis 2001 -11;60(11):1040-1045.[2]Seoane-Mato D, Martínez Dubois C, Moreno Martínez MJ, Sánchez-Piedra C, Bustabad-Reyes S. Frequency of medical visits due to osteoarticular problems of the adult general population in Spain. EPISER2016 Study. Gac Sanit 2020 Sep - Oct;34(5):514-517.[3]Tejera Segura B, Bustabad S. A New Form of Communication Between Rheumatology and Primary Care: The Virtual Consultation. Reumatol Clin 2016 /01/01;12(1):11-14.[4]Pego-Reigosa JM, Peña-Gil C, Rodríguez-Lorenzo D, Altabás-González I, Pérez-Gómez N, Guzmán-Castro JH, et al. Analysis of the implementation of an innovative IT solution to improve waiting times, communication with primary care and efficiency in Rheumatology. BMC Health Serv Res 2022 -01-12;22(1):60.Disclosure of InterestsNone declared
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Zakurdaeva, Kristina, Olga A. Gavrilina, Anastasia N. Vasileva, Sergei Dubov, Vitaly S. Dubov, Lev S. Butaev, Alena M. Sukhareva, et al. "COVID-19 and hematologic diseases: Risk factors and long-term follow-up of CHRONOS19 Registry." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e18715-e18715. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e18715.
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e18715 Background: Pts with hem diseases are at high risk of COVID-19 severe course and mortality. Emerging data on risk factors and outcomes in this patient population is of great value for developing strategies of medical care. Methods: CHRONOS19 is an ongoing nationwide observational cohort study of adult (≥18 y) pts with hem disease (both malignant and non-malignant) and lab-confirmed or suspected (clinical symptoms and/or CT) COVID-19. Primary objective was to evaluate treatment outcomes. Primary endpoint was 30-day all-cause mortality. Long-term follow-up was performed at 90 and 180 days. Data from 14 centers was collected on a web platform and managed in a deidentified manner. Results: As of data cutoff on January 27, 2021, 575 pts were included in the registry, 486 of them eligible for primary endpoint assessment, n(%): M/F 243(50%)/243(50%), median age 56 [18-90], malignant disease in 452(93%) pts, induction phase/R/R/remission 160(33%)/120(25%)/206(42%). MTA in 93(19%) pts, 158(33%) were transfusion dependent, comorbidities in 278(57%) pts. Complications in 335(69%) pts: pneumonia (67%), CRS (8%), ARDS (7%), sepsis (6%). One-third of pts had severe COVID-19, 25% were admitted to ICU, 20% required mechanical ventilation. All-cause mortality at 30 days – 17%; 80% due to COVID-19 complications. At 90 days, there were 14 new deaths: 6 (43%) due to hem disease progression. Risk factors significantly associated with OS are listed in Tab 1. In multivariate analysis – ICU+mechanical ventilation, HR, 53.3 (29.1-97.8). Acute leukemias were associated with higher risk of death, HR, 2.40 (1.28-4.51), less aggressive diseases (CML, CLL, MM, non-malignant) – with lower risk of death, HR, 0.54 (0.37-0.80). No association between time of COVID-19 diagnosis (Apr-Aug vs. Sep-Jan) and risk of death. COVID-19 affected treatment of hem disease in 65% of pts, 58% experienced treatment delay for a median of 4[1-10] weeks. Relapse rate on Day 30 and 90 – 4%, disease progression on Day 90 detected in 13(7%) pts; 180-day data was not mature at the time of analysis. Several cases of COVID-19 re-infection were described. Conclusions: Thirty-day all-cause mortality in pts with hem disease was higher than in general population with COVID-19. Longer-term follow-up (180 days) for hem disease outcomes and OS will be presented. [Table: see text]
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Juan, Juan, and Huixia Yang. "Prevalence, Prevention, and Lifestyle Intervention of Gestational Diabetes Mellitus in China." International Journal of Environmental Research and Public Health 17, no. 24 (December 18, 2020): 9517. http://dx.doi.org/10.3390/ijerph17249517.
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Gestational diabetes mellitus (GDM) has become an epidemic and has caused a tremendous healthy and economic burden in China, especially after the “two-child policy” put into effect on October 2015. The prevalence of GDM has continued to increase during the past few decades and is likely to see a further rise in the future. The public health impact of GDM is becoming more apparent in China and it might lead to the development of chronic non-communicable diseases in the long-term for both mothers and their children. Early identification of high-risk individuals could help to take preventive and intervention measures to reduce the risk of GDM and adverse perinatal outcomes. Therefore, a focus on prevention and intervention of GDM in China is of great importance. Lifestyle interventions, including dietary and physical exercise intervention, are effective and first-line preventive strategies for GDM prevention and intervention. The GDM One-day Care Clinic established in 2011, which educates GDM patients on the basic knowledge of GDM, dietary intervention, physical exercise, weight management, and blood glucose self-monitoring methods, sets a good model for group management of GDM and has been implemented throughout the hospitals as well as maternal and child health centers in China. The current review focus on the prevalence, risk factors, as well as prevention and lifestyle intervention of GDM in China for better understanding of the latest epidemiology of GDM in China and help to improve maternal and neonatal pregnancy outcomes and promote long-term health for women with GDM.
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Baghirova, Irada. "Academic Historiography in Azerbaijan at the Crossroads of Time (1989-1991)." Balkanistic Forum 30, no. 1 (January 5, 2021): 7–20. http://dx.doi.org/10.37708/bf.swu.v30i1.1.
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The scientific development in the USSR has come a long way. Despite all the obstacles posed during its formation and development, it has reached a reasonably high level by the mid-1980s. This achievement was mainly in the natural and technical sciences. The progress was determined by the USSR’s desire to keep the palm in space exploration, nuclear physics, petrochemistry, and other sciences of strategic importance for the country’s development. In these areas, contacts were established with world scientific centers and exchange of scientific achievements took place. As a result, Soviet scientists became winners of prestigious international awards, including the Nobel Prizes. As for the humanities and especially the social sciences, the dominance of Marxist-Leninist ideology and the corresponding interpretation of historical events significantly affected the development of Soviet sciences and reaching the world level quality. Until the mid-1990s, political history as an area of science of history, practically, did not exist. The “History of the CPSU” and the “History of the Communist Party of Azerbaijan” virtually monopolized the multifaceted nature of political themes, reducing it to the apologetics of the party history. Everything changed with the beginning of ‘Perestroika’ and ‘Glasnost’ (the officially announced publicity policy). As a result, the previously unknown pages of the past of the country and national republics became public. Almost every day, there were sensational publications of various authors published by popular magazines and newspapers, which also printed previously classified documents from historical archives. Traditional historical researchers and academicians were in shock. It was not easy for historians to abandon the 70-year-old account of history tied to ideological dogmas; the crisis associated with the loss of orientation was overcome with great difficulty and mainly by young historians. In the late 1980s, foreign historians, who studied the history of Azerbaijan, began visiting the country. Until that time, their existence was known only to a narrow circle of historians, who worked with foreign literature in specialized repositories of local and central libraries. For the first time, Azerbaijani historians left the USSR in 1990, when a conference was held at the University of London on the history of the South Caucasus. The event was attended by historians from Azerbaijan, Armenia, and Georgia, as well as the so-called Sovietologists - scientists from Great Britain, the USA, and France. It is symbolic that in the same year in Moscow the last all-Union conference on political history was held. The event was attended by scientists from the Soviet republics, which declared independence the following year.
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Abraham, Georgi, Vishnu Kumar, Karopadi Shivanand Nayak, Rajan Ravichandran, Geetha Srinivasan, Magesh Krishnamurthy, Arun K. Prasath, et al. "Predictors of Long-Term Survival on Peritoneal Dialysis in South India: A Multicenter Study." Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 30, no. 1 (January 2010): 29–34. http://dx.doi.org/10.3747/pdi.2008.00028.
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BackgroundLittle is known about survival on peritoneal dialysis (PD) in Indian patients since the initiation of continuous ambulatory PD (CAPD) in India in 1991. Survival data from single centers with small numbers have been published.ObjectiveA retrospective 4-center analysis for predictors of survival >3 years in south Indian chronic PD patients.MethodsA total of 309 patients were trained during the observation period (from 1999 to 2004) and were analyzed in a multicenter study (4 centers), including 150 patients (male:female 109:41) that survived ≥ 3 years and 59 patients that did not survive ≥ 3 years (nonsurvivors; male: female 43:16) that were taken as controls. The patients were on chronic PD, predominantly CAPD, using double-bag disconnect systems. They were supervised by 4 nephrologists. Mean age in the nonsurvival group was 56.6 ± 10.6 years. In the survival group, mean age was 50.9 ± 14.9 years; there were 92 (62%) nondiabetics and 58 (38%) diabetics; the majority were nonvegetarians; 148 patients were doing 6 – 8 L exchanges and 2 were doing >8 L exchanges daily; 93 of 102 patients were average transporters based on peritoneal equilibration testing. At the beginning, mean combined Kt/V was 2.31 and weekly creatinine clearance was 73 L. Patients making one lifetime payment were 46% and 21% belonged to the full reimbursement group.ResultsBody mass index (BMI) was normal in 114 patients (76%). Ultrafiltration volume was 1377 ± 452 at the start and 1400 ± 461 mL/day after 3 years. Anuric patients at the start were 12% and after 3 years 44%; urine output decreased from 527 ± 26 to 253 ± 14 mL/day from the start to after 3 years. Peritonitis rate was 1 episode/75 patient-months at the beginning and after 3 years it was 1 episode/30 patient-months. Exit-site care was done daily by 88% and 3 times weekly by 12%. Nonsmokers were 92% and smokers were 8%. Those that lived in the city were 62% and rural areas were 38%. Mean blood pressure was 143 ± 16/88 ± 10 and 136 ± 18/85 ± 9 mmHg, calcium × phosphorus product 44.6 ± 15.6 and 45.9 ± 15.7 mg2/dL2, albumin 3.33 ± 0.5 and 3.25 ± 0.4 g/dL, hemoglobin 9.18 ± 2 and 9.48 ± 1.8 g/dL at the beginning and after 3 years, respectively. Statistical analysis showed a significant fall in both systolic ( p ≤ 0.001) and diastolic blood pressure ( p ≤ 0.05), an increase in BMI ( p ≤ 0.01), and a decrease in blood urea ( p ≤ 0.001) in the survival group. Those with Hb ≥ 11 g/dL survived longer ( p ≤ 0.001), those with serum albumin ≥ 3 g/dL had better survival ( p = 0.001), and anuric patients survived longer ( p = 0.001).ConclusionThis multicenter cohort study of prevalent continuous PD patients in south India showed nondiabetics, average transporters, nonsmokers with reasonable nutritional status, with Hb 11 g/dL, with low peritonitis rate, with over 1 L ultrafiltration volume per day, the great majority that joined the once per lifetime payment scheme, and the reimbursement group survived for 3 years or longer.
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Konrad, Franz-Michael. "Early Childhood Education." History of Education Quarterly 49, no. 2 (May 2009): 238–40. http://dx.doi.org/10.1111/j.1748-5959.2009.00200.x.
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As a historian of early childhood education in German-speaking Europe, I am struck by the outstanding role that Friedrich Froebel, or rather his ideas, played in all the countries described in the six essays. This is not really new since even the first historiographic articles in German-speaking countries already pointed out Froebel's role internationally. The worldwide spread of Froebel's educational teachings remains the subject of German research to this day. And yet it is still so remarkable to see how Froebel's philosophy of education—which had its origins in the spirit of romanticism and which seems strange even to German audiences—has succeeded in establishing itself in different cultures and for different reasons. Just think of Italy in the second half of the nineteenth century (James C. Albisetti), of post-revolutionary Russia ruled by the Bolsheviks (Yordanka Valkanova), of Great Britain, France, and the United States. Even in Asian countries we can find evidence of Froebel's influence, for example, in Korea and in Japan (on Japan, Kathleen Uno). In spite of the differences between these countries and their cultures, Froebel's pedagogy has succeeded in playing an influential role in all of them. Extant institutions for the care and education of preschool children developed into modern kindergartens under the influence of Froebel's teachings. In the end it was always about making it possible for young children to learn and, at the same time, taking into account the very special way learning occurs in these early years as an active, action-based and almost effortless kind of learning. Froebel found an answer to this problem. With his gifts he gave the answer in a simple and yet brilliant manner which was, despite its origins in German idealism, apparently unrelated to culture.
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O’Sullivan, Jane, Jack Collins, David Cooper, Ana Magdalina, Frances Meehan, Lachmann Kumar, John Quinlan, Donal O’Connor, and Gerry Fitzpatrick. "Optimisation of perioperative investigations among elective orthopaedic patients in a Dublin-based teaching hospital." Journal of Perioperative Practice 29, no. 9 (December 19, 2018): 291–99. http://dx.doi.org/10.1177/1750458918813254.
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Background The current National Institute for Health and Care Excellence guidelines, in accordance with the Association of Anaesthetists of Great Britain and Ireland guidelines, recommend the following haematological investigations for all patients undergoing major elective surgery: full blood count, renal profile and coagulation screen if clinically indicated. However, the guidelines fail to specify a time-interval for which normal blood results remain valid. Currently all patients in Ireland undergoing substantial elective surgery requiring general or regional anaesthetic have a preoperative assessment prior to the surgery. Patients have phlebotomy performed as part of this assessment. Patients admitted for elective surgery often have these bloods repeated on the morning of surgery. Objectives To determine if blood investigations taken over a one-year period prior to surgery can be used as a baseline for clinically stable patients undergoing elective surgery. Study design and methods All consecutive day of surgery admission patients >18 years of age undergoing elective orthopaedic surgery in Tallaght Hospital between 1 December 2014 and 1 December 2015 were identified using hospital records. Their blood results in the one-year period prior to surgery were compared to the blood results on the morning of surgery, using a McNemar’s test. A further clinical analysis was performed. Results There was no statistically significant change between blood results from three months prior to the surgery and the morning of surgery (P < 0.05). Furthermore, the blood results remained largely unchanged in the one year prior to surgery. No patient had the operation deferred due to aberrant blood results, following previously normal results prior to surgery. The potential cost-saving of omitting bloods is enormous. Conclusions There appears to be neither a statistical nor clinical benefit to repeating blood tests on the morning of surgery, following normal bloods <3 months in a clinically stable individual.
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Mogasala, Nagendra, Sumana Devata, Anthony Perissinotti, and Dale Bixby. "Clinical Availability of All-Trans Retinoic Acid (ATRA) for Patients with Suspected Acute Promyelocytic Leukemia – Why National Guidelines May Not be Followed." Blood 124, no. 21 (December 6, 2014): 2297. http://dx.doi.org/10.1182/blood.v124.21.2297.2297.
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Abstract Background: All-Trans Retinoic Acid (ATRA, Tretinoin, Vesinoid, Teva Pharmaceuticals Industries, North Wales, PA) serves as a uniform backbone in the care and management of patients with acute promyelocytic leukemia (APL). While first investigated as a salvage therapy for patients with relapsed or refractory disease, current National Comprehensive Cancer Network (NCCN) and European LeukemiaNet (ELN) guidelines call for its early use in patients suspected of having APL even prior to the genetic confirmation of the disease. Because ATRA can significantly mitigate disseminated intravascular coagulopathy (DIC), one of the early complications of APL, the NCCN and ELN guidelines support the prescription of ATRA as soon as there is a clinical suspicion of the diagnosis. As a regional referral center for the care of patients with advanced myeloid malignancies, we receive numerous requests for the transfer of care for patients suspected of having APL. Yet many of the referring centers have not instituted treatment with ATRA, typically due to a lack of access to the medication in the referring hospital’s formulary. Therefore, we conducted an exploratory analysis of the clinical availability of ATRA for patients with a suspected diagnosis of APL and also to explore the potential hurdles limiting the availability of this drug. Methods: We divided the United States into six geographical regions: Northwest, Southwest, Central, Southeast, Northeast, and the Great Lakes. A state from each of these regions was selected (Washington, Arizona, Missouri, Georgia, Massachusetts, and Michigan). To select the 120 hospitals, an online hospital directory – American Hospital Directory (ahd.com) was utilized. We went to each state’s specific hospital list page and assigned a number to all hospitals with a bed capacity of greater than 100. We then entered these numbers into a random number generator and selected the first 20 hospitals to be generated (excluding repeats). We then asked the following set of questions to the inpatient pharmacist of the hospital: 1. Does your hospital treat Acute Leukemia or do they refer to other hospitals; 2. Do you have All Trans Retinoic Acid (oral) – 10 mg tablets on the formulary or available in stock as a non-formulary request; 3. If no, why not. Results: Based upon the responses we received, ATRA was available in less than half of the hospitals queried (46%) (Table 1). There were no identifiable differences in the percentages based upon hospital size (inpatient beds) or academic versus non-academic status of the hospital. Interestingly, of the hospitals that refer to other institutions for the care of their leukemia patients, only 19% (8/43) had ATRA on their formulary or available in stock as a non-formulary request that could act as a bridge prior to the transfer. The analysis identified three common barriers to the availability of ATRA in these hospitals including: a) that it has not been recently requested by a physician and therefore was not available, b) the inpatient pharmacist had never heard of the drug, and c) that the hospital relied on associated hospitals or cancer centers to provide the drug to the patient. Table 1 Clinical Availability of All-Trans Retinoic Acid in Participating Hospitals Region State Percentage of Hospitals Possessing ATRA Northwest Washington 65% Southwest Arizona 45% Midwest Missouri 35% Great Lakes Michigan 58% Southeast Georgia 35% Northeast Massachusetts 40% Conclusion: While national guidelines support the rapid introduction of ATRA as soon as there is a morphologic consideration for APL, the majority of hospitals caring for these patients can not rapidly institute therapy due to a lack of availability of the medication. Moreover, only 19% (8/43) of hospitals that we studied that refer patients to tertiary care centers can provide ATRA as a bridge prior to their transfer. While much has been written about the early 30-day mortality seen in patients with APL, we can not specifically comment on the impact of these findings on the rates of mortality of APL patients treated in hospitals without ready access to ATRA versus those with the medication available on formulary. However, we propose that these findings should spur an investigation of this possibility together with a call by hematologists nationwide to their formulary committees to ensure that this lifesaving medication is available to patients in as timely a manner as possible. Disclosures Off Label Use: All Trans Retinoic Acid (ATRA) is indicated for the use in patients with acute promyelocytic leukemia (APL) who are refractory to, or who have relapsed from, anthracycline chemotherapy, or for whom anthracycline based chemotherapy is contraindicated. We will be discussing the availability of ATRA for the use in patients with newly diagnosed APL..
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Aquino, S. L. "Hiking Is a Great Way to Enjoy Having a Healthy Lifestyle. This Campaign Was Created to Raise Prostate Cancer Awareness." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 181s. http://dx.doi.org/10.1200/jgo.18.78300.
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Amount raised: $1500.00 Background and context: Evidence for the role of physical activity in cancer incidence is well known and increases cancer survivorship. Cancer survivors as well as new patients would like to have a more active role in their health care, including what diet and lifestyle changes they should make. Since physical exercise has attracted increasing interest in our country we decided to do and experience the first hiking activity suggested by the Honduran Urology Society as an excellent way to raise awareness about prostate cancer and how to prevent it. Aim: The key aim was to raise awareness among men and their families and therefore organize the Prostate Cancer Association for Patients since there is none in Honduras. Strategy/Tactics: We started an alliance with the doctors from Honduran National Society of Urology so they could be the official spokesman for this activity. We contacted radio stations and TV health programs in order for the physicians to educate and publicized the event. Networking the activity on social media and decided on a Sunday as the day of the event since most people were off from work and school. November was chosen as it commemorates Prostate Cancer Awareness Month. A public facility was the place chosen since it had been shortly renovated and would be an attraction for men and their families. Program process: Since prostate cancer is the most common type of cancer among men, we felt the need to get involved in this activity. We contacted town officials to find out if a permit was needed. We also requested local businesses to donate T-shirts, drinks and food for the participants. We asked businesses to place campaign publicity on visible areas of shopping centers. We contacted a fitness instructor to donate an hour of his time for this cause. Once the T-shirt donation arrived we had printed a logo as a symbol for our campaign. Costs and returns: Since the very beginning we decided to get the most from this campaign by getting almost everything donated and the outcome was surprisingly a positive reaction. Donated kits with a T-shirt and a water bottle were given in exchange of a registration fee of $10, there was no fee from the hiking park. What was learned: With proper tools, educating patients for early detection may be the key to successful treatment. We all can better understand the facts about prostate cancer, who it affects and what you can do about it. We learned that we made such a great team working together as one and looking forward to our 2nd hiking event for 2018.
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Grayvoronskiy, Vladimir V. "Монголоведение в Институте востоковедения РАН: современное состояние и перспективы." Oriental Studies 13, no. 4 (December 25, 2020): 927–40. http://dx.doi.org/10.22162/2619-0990-2020-50-4-927-940.
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Introduction. The paper briefly reviews the current state and prospects of Mongolian studies at the Institute of Oriental Studies (RAS) that celebrated its 200th anniversary in 2018. The Institute maintains and strengthens its positions as a leading national and global research center for Oriental studies. Goals. The study attempts at summarizing the Institute’s 2010–2020 experiences in developing Mongolian studies as a traditional branch of Russia’s Oriental studies, characterizing the present state and development prospects with due regard of actual achievements, challenges, and problems. Materials and Methods. The work analyzes scholarly publications authored by associates of the Mongolian Studies Unit (Department of Korean and Mongolian Studies) and other departments of the Institute in 2010–2020, including operating archives ― through the use of historical, chronological, descriptive, analytical and other methods. Results. The study shows that despite a number of objective and subjective difficulties, associates of the Institute keep developing Mongolian studies exploring some topical and understudied issues of ancient, medieval, modern, and contemporary Mongolia; providing comprehensive insights into present-day political, socioeconomic, and cultural frameworks of Mongolia proper and Russia-Mongolia relations. Still, the Institute ― and specifically the Mongolian Studies Unit ― experiences a critical shortage of qualified young Mongolists, and if the problem remains unsolved respective research perspectives should encourage no optimism. The number of highly experienced Mongolists and Orientalists that conduct research activities on a range of Mongolia-related issues (history, historiography, source studies, discoveries and publications of new sources, written monuments and archives, philology, etc.) affiliated thereto is small enough. The former publish their scholarly works and actively cooperate with colleagues from similar scientific and educational organizations of Moscow, St. Petersburg, Irkutsk, Ulan-Ude, Elista, Kyzyl, Vladivostok and other Russian cities; establish relations with foreign humanities research centers of Mongolia, China, Japan, the United States, Great Britain, Germany, France, etc. Chronologically, the review covers the period between 2010 and 2020, and characterizes key changes in staff composition; shows fundamental research trends; summarizes outcomes of scholarly, organizational and publishing activities; mentions main joint and individual monographs authored (published) by associates of the Department of Korean and Mongolian Studies in 2010–2020. The paper specifies basic development problems faced by Mongolian studies in the context of Oriental studies as such, provides conclusions and prognoses for further evolution of this research line at the Institute of Oriental Studies (RAS).
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Schonland, Stefan O., Ute Hegenbart, Simona Iacobelli, Jennifer Hoek, M. Rovira, Guustaaf van Imhoff, G. Bandini, et al. "Center Experience and Calendar Year Of Transplantation Strongly Influence Short Term Survival After Autologous Peripheral Blood Transplantation In 1315 Patients With Light Chain Amyloidosis: An EBMT Analysis." Blood 122, no. 21 (November 15, 2013): 417. http://dx.doi.org/10.1182/blood.v122.21.417.417.
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Abstract Introduction High-dose chemotherapy and autologous stem cell transplantation (ASCT) is a treatment option for eligible patients with systemic light chain (AL) amyloidosis. Compared to patients with multiple myeloma (MM), the risk for complications and transplant-related mortality is increased. However, in this fragile patient group it is often not possible to distinguish between treatment- and amyloidosis-related deaths in the post-transplant period. The CIBMTR reported a one year survival (1-yr OS) of 66% of patients transplanted between 1995 and 2001. Another multicenter analysis from Great Britain reported a one year survival of 75% (Goodman et al., BJH, 2006); interestingly, they could show a significant reduction of day 100 all-cause mortality from 32% to 13% after 1998. In recent single center studies 1-yr OS was better ranging from 80% to 90% (reviewed by Schönland et al., BMT, 2011). The amyloidosis groups of Mayo Clinic and Boston Medical School could also show a survival improvement over time (Tsai et al., Blood, 2012 and Gertz et al., BMT, 2010). Specific Aim The aim of this retrospective study was to analyze the 1-yr OS after ASCT for patients with AL amyloidosis in Europe. Of special interest were calendar year of transplants and center experience. Methodology Patient-, disease-, and transplant-related variables were collected according to the data entries in the EBMT database. Inclusion criteria were as follows: first autologous transplant with peripheral blood stem cells performed between 1997 and 2010. Center experience was measured for each patient by the number of previous MM ASCT done in the center until the year of AL transplant. Results 1315 patients from 259 centers fulfilled the entry criteria and were included in the analysis (for patient characteristics see table). The conditioning regimen was high-dose melphalan in most cases. Median follow up was 47 months. 1-yr OS after ASCT was 80.7% (CI 78.5 – 82.9). In univariate analysis age, gender, time from diagnosis to ASCT had no influence on 1-yr OS. Bad performance status (57% (50-65) vs. 90% (87-92); p<0.001) and progression/relapse as status at conditioning (61% (53-69) vs. 85% (83-87); p<0.001) significantly reduced 1-yr OS. A strong and significant influence of the transplant period (see figure 1, log-rank test, p<0.001) and higher center experience (see figure 2; log-rank test, p<0.001) could also be demonstrated. Interestingly, the proportion of patients with bad performance status decreased from 28% to 13% in most recent years (p=0.001). These results hold in multivariate analysis. Bad performance status (HR 4.3; p<0.001), progression/relapse as status at conditioning (HR 1.96; p<0.001) and earlier transplant period (HR 1.1; p<0.001) retained their highly significant negative influence on 1-yr OS. In an alternative multivariate model replacing transplant period with center experience, the latter has also a beneficial effect (HR 0.99 for 10 additional previous MM transplants; p=0.015) and all other prognostic factors retained the estimated effects. Conclusion This is the first report from the EBMT about the results of ASCT in AL amyloidosis from 259 European centers and the largest retrospective analysis for this rare entity. It clearly shows that short term survival has been improved over time probably due to better patient selection and increase of center experience. Of note, in the most recent cohort (2009 to 2010) the 1-yr OS was 91% (CI 87-96) supporting the further use of ASCT in eligible AL amyloidosis patients. Disclosures: Leblond: Roche : Consultancy, Honoraria, Membership on an entity’s Board of Directors or advisory committees, Speakers Bureau; Janssen: Honoraria, Membership on an entity’s Board of Directors or advisory committees; Mundipharma: Honoraria, Membership on an entity’s Board of Directors or advisory committees, Speakers Bureau.
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Cusatis, Rachel, Irena Tan, Claire Piehowski, Idayat Akinola, Emma Crawford, Juliana Craig, Aline Thiengmany, et al. "Worsening Financial Toxicity Among Patients Receiving Chimeric Antigen Receptor t-Cell (CAR-T) Therapy: A Mixed Methods Longitudinal Study." Blood 138, Supplement 1 (November 5, 2021): 567. http://dx.doi.org/10.1182/blood-2021-146032.
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Abstract Introduction: CAR-T cell therapy is associated with extra-ordinary costs with estimates of as much as $1.5 million in some patients, including the high list-price for the CAR-T product, additional costs of inpatient stay, toxicity management and outpatient follow-up. As a result, CAR-T therapy may be associated with financial toxicity for patients due to high costs, as well as the financial strain of travel and/or temporary relocation. To date, there are no published studies assessing financial toxicity among CAR-T patients. Methods: Adult patients with hematologic malignancies receiving CAR-T therapy (commercial and clinical trial products) were prospectively recruited from two academic centers to this longitudinal, mixed methods study evaluating financial toxicity in CAR-T recipients. Patients completed questionnaires and telephone interviews prior to CAR-T, 28 days (questionnaire only), 90 days, and 180 days after treatment. The questionnaire included the Comprehensive Score for Financial Toxicity (COST-FACIT), a validated questionnaire with 12 questions on financial stressors of cancer care. Eleven of the 12 items are used to create a summary score ranging from 0 to 44, with higher scores indicating better financial well-being. Validation studies have established clinically meaningful grades of financial toxicity: scores 26+ = grade 0; 14-25 = grade 1; < 14 = grade 2; 0 = grade 3. Semi-structured interviews included questions on financial concerns, impacts on lifestyle, and other medical costs, including questions like "Has the financial cost of your cancer treatments up until this point affected your lifestyle?" Quantitative analysis included COST-FACIT scores summarized as means, ranges, and standard deviations at each timepoint, including longitudinal change from baseline. Qualitative analysis included recording interviews, professional transcription, team-based codebook development, and systematic thematic analysis. Results: We report on 28 patients enrolled from August 2020 to June 2021. For questionnaires, 26 completed baseline, 23 completed day 28 (1 patient died and 2 have not reached this timepoint), 12 completed day 90 (11 have not reached this timepoint), and 8 completed day 180 (16 have not reached this timepoint). For qualitative interviews, 16 completed baseline telephone interviews, 6 completed day 90 (10 have not reach this timepoint), and 4 completed day 180 (12 have not reached this timepoint). Median age was 57.7 years, 52% were male, 21% Hispanic/Latinx, 75% white, 8% Asian, and 4% Hawaiian/Pacific Islander. A majority of patients were (76%) married. COST-FACIT scores were highest at baseline indicating higher financial well-being (mean 29), and also represented the largest range (range 8-44) suggesting patients come into CAR-T at different levels of financial toxicity, ranging from grade 0 to grade 2 (Figure 1). Average financial toxicity at Baseline and Day 28 corresponded to grade 0 toxicity. Financial well-being declined thereafter, elevating to grade 1 toxicity with the average score 25.2 at day 90 and 23.6 at day 180. At Baseline, Day 28, and Day 90 there are patients experience grades 0, 1, and 2 financial toxicity. Qualitative themes include: Insurance, Lodging/Relocation, Work/Income, Nontraditional sources of funding, Discussion with Providers (Table 1). Preliminary assessment of thematic patterns over time supports the quantitative results, with patients expressing little to no financial concerns at baseline, often citing "great insurance", with changes at day 90 recognizing the additional costs not covered by insurance, and uncertainty of insurance coverage. Conclusions: Our results using both quantitative and qualitative methods indicate the financial impact of CAR-T therapy extends beyond the cost of treatment. Patients undergoing CAR-T therapy experience financial toxicity, with its impact worsening with time as the stressors and payments cumulate. These data are important for understanding the full patient experience with CAR-T therapy and emphasize that durable support and resources are needed to help patients with financial toxicity. Concern for financial toxicity may limit access to this therapy and future research should focus on access to therapy based on personal financial concerns and referral patterns. Figure 1 Figure 1. Disclosures Frank: Allogene Therapeutics: Research Funding; Kite-Gilead: Membership on an entity's Board of Directors or advisory committees; Adaptive Biotechnologies: Research Funding. Miklos: Pharmacyclics, Amgen, Kite, a Gilead Company, Novartis, Roche, Genentech, Becton Dickinson, Isoplexis, Miltenyi, Juno-Celgene-Bristol Myers Squibb, Allogene, Precision Biosciences, Adicet, Adaptive Biotechnologies: Research Funding; Adaptive Biotechnologies, Novartis, Juno/Celgene-BMS, Kite, a Gilead Company, Pharmacyclics-AbbVie, Janssen, Pharmacyclics, AlloGene, Precision Bioscience, Miltenyi Biotech, Adicet, Takeda: Membership on an entity's Board of Directors or advisory committees; Pharmacyclics: Patents & Royalties; Kite, a Gilead Company, Amgen, Atara, Wugen, Celgene, Novartis, Juno-Celgene-Bristol Myers Squibb, Allogene, Precision Bioscience, Adicet, Pharmacyclics, Janssen, Takeda, Adaptive Biotechnologies and Miltenyi Biotechnologies: Consultancy. Shah: Umoja: Consultancy; Miltenyi Biotec: Consultancy, Honoraria, Research Funding; Lily: Consultancy, Honoraria, Research Funding; Incyte: Consultancy; Kite: Consultancy; Legend: Consultancy; Epizyme: Consultancy. D'Souza: Imbrium, Pfizer, BMS: Membership on an entity's Board of Directors or advisory committees; Sanofi, Takeda, Teneobio, CAELUM, Prothena: Research Funding; Janssen, Prothena: Consultancy. Muffly: Pfizer, Amgen, Jazz, Medexus, Pfizer: Consultancy; Astellas, Jasper, Adaptive, Baxalta: Research Funding; Adaptive: Honoraria, Other: fees for non-CME/CE services: , Research Funding. Sidana: Allogene: Research Funding; Janssen: Consultancy, Research Funding; BMS: Consultancy; Magenta Therapeutics: Consultancy, Research Funding.
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Ramprakash, Stalin, Rajat Kumar Agarwal, C. P. Raghuram, Pallavi Mehta, Deepa Trivedi, Priya Marwah, Rajpreet Soni, Rakesh Dhanya, and Lawrence Faulkner. "Incidence, Risk Factors and Outcomes of Veno-Occlusive Disease / Sinusoidal Obstruction Syndrome (VOD/SOS) in Children with Severe Thalassemia (ST) Conditioned with Busulfan- Cyclophosphamide (Bu-Cy) Based Regimen." Blood 134, Supplement_1 (November 13, 2019): 4499. http://dx.doi.org/10.1182/blood-2019-130841.
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Introduction Sinusoidal obstruction syndrome / Veno-occlusive disease (VOD/SOS) is one of the major complication which increases morbidity and mortality following allogeneic stem cell transplant. Busulfan-cyclophosphamide (Bu-Cy) based conditioning regimen, use of busulfan and patients with thalassaemia are considered to be among the important risk factors for development of VOD/SOS (Barker et al. Bone Marrow Transplantation (2003) 32, 79-87, Dix et al Bone Marrow Transplantation 1996 Feb;17(2):225-30). We routinely use oral busulfan in our low and intermediate risk thalassemia transplant conditioning regimen. We summarize the incidence, risk factors, severity and outcomes of VOD/SOS in our patient population. Methods We studied the incidence of VOD/SOS defined by EBMT criteria (Corbacioglu et al. Bone marrow transplantation 2018 Feb;53(2):138-145) in 121 consecutive patients with ST (thalassemia syndrome with the inability to spontaneously maintain hemoglobin levels ≥ 7 g/dl) on a single uniform protocol across three collaborating centers from India - People Tree hospitals, Bangalore (PTH), Care Institute of Medical sciences, Ahmedabad (CIMS), South- East Asia Institute of Thalassaemia (SEAIT). Our conditioning regimen comprised of Fludarabine (150 mg/m2, days -17 to -13), anti-thymocyte globulin (ATG) (Genzyme 4 mg/kg, days -12 to -10, dose was increased to 7 mg/kg in case of splenomegaly and or sex mismatched transplants), busulfan (14 mg/kg oral, not adjusted to serum levels over days -9 to -6) and cyclophosphamide (200 mg/kg, days -5 to -2). G-CSF-primed bone marrow (5 μg/kg/dose twice daily for 5 days prior to harvest) was the source of hematopoietic stem cells in all cases. The majority of patients (111) were low - intermediate risk based on liver size < 2 cm from costal margin and age less than 15 years (median 6.9 years, range 1.1 to 14.5) while 10 patients might have been high-risk based on Pesaro classification due to liver >3 cm by palpation at transplant. In fact, liver biopsies were not performed. All matched related donors were HLA-compatible by high resolution typing. None of the patients received routine defibrotide prophylaxis and all patients have at least one year follow up. Results Out of the 121 patients studied, 18 developed VOD/SOS (14.9%). One patient developed massive intracranial haemorrhage (ICH) on day 9 and subsequently died on day 11, had some features of VOD/SOS which may have contributed to the ICH. Another patient needed admission in intensive care with respiratory distress was treated with defibrotide for 5 days and recovered. In all others VOD/SOS resolved spontaneously with supportive care only. There was a trend towards decreased overall (94% vs 97%) and disease-free survival (83% vs 89%) in the VOD/SOS group, both did not reach statistical significance (Fig 1 and 2). None of the previously known risk factors studied such as age at BMT (p =0.16), Ferritin level at BMT (p = 0.2), hepatitis C status (p = 0.28) and raised pre-transplant ALT levels (> 3 times normal upper limit) (p = 0.7) showed significant variation between VOD/SOS group and unaffected group. Factors which showed significant difference were Major ABO mismatch (p = 0.041), presence of splenomegaly at BMT (p = 0.0015) and duration of Hydroxyurea (HU) treatment pre-transplant for more than 12 months (p = 0.04). Longer duration of HU may be related to the prolonged down-staging process for poorly managed ST patient pre-transplant. As expected, the VOD/SOS group required increased blood product support (Table 1). Conclusion Our results suggest that even though about 15% of low/intermediate risk thalassaemia transplants using Bu-Cy may develop VOD/SOS, in the great majority of cases this complication is mild and resolves spontaneously with supportive care alone. Many of the known risk factors did not seem to be relevant in our patient population. The possible role of splenomegaly at BMT and major ABO mismatch as risk factors for VOD/SOS may warrant further studies. Disclosures No relevant conflicts of interest to declare.
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Pettingill, Bernard. "Why Orthopedic Surgery for Elderly Indicates that the Maryland Total Cost of Care Model should be Universally Adopted." Journal of Health Care and Research 2, no. 1 (April 26, 2021): 63–69. http://dx.doi.org/10.36502/2021/hcr.6190.
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Arthritis is the disease that kills the fewest but cripples the most. With the aging of the population in the United States and the antiquated DRG reimbursement system for hospital surgical intervention, it is inevitable that the Medicare assistant will bankrupt itself prior to the proposed bankruptcy date of 2026 if changes are not made. It may change would be to insist that the system in Maryland for reimbursement to hospitals for essential joint replacement surgery of the elderly be adapted nationwide. Medicaid expenditures are driven by a variety of factors, including the demand for care, the complexity of medical services provided, medical inflation, and life expectancy. The Medicare program has two separate trust funds – the Hospital Insurance (HI) Trust Fund and the Supplementary Medical Insurance (SMI) Trust Fund. Under the Hospital Insurance Trust, payroll taxes from workers and their employers go towards paying for the Part A benefits for today’s Medicare beneficiaries. In 2019, Medicare provided benefits to over 60 million elderly patients at an estimated cost of $796 billion [1]. While excluding the significant decrease in payroll taxes during the COVID-19 pandemic, the latest 2020 projections calculate Medicare Hospital Trust insolvency by 2026 [2]. The 2020 report declared that funds would be sufficient to pay for only 90 percent of Part A expenses at the time of this writing. Since inception, the Hospital Insurance Trust has never been insolvent, because there are no provisions in the Social Security Act that govern what would happen if insolvency were to occur. Ten of the last twelve years have witnessed expenditure outflows outpacing the Hospital Insurance Trust inflows, resulting in total Medicare spending obligations outpacing the increasing demands on the federal budget, as the number of elderly beneficiaries and the per capita health care costs continue to grow [2]. One of the principal goals of the following study is to determine how elderly patients, who often suffer from acute stages of arthritis and other orthopedic diseases, due in part to wear and tear, can continue to demand surgical intervention, in particular joint replacement surgery. Arthritis has been described as the disease that kills the fewest but cripples the most. With that in mind, the hospital systems ability to absorb the ever increasing number of elderly patients who demand joint replacement surgeries will continue to outstrip supply. The principal author of this study completed his PhD dissertation at the University of Manchester in 1977 by measuring the cost-benefit analysis of the treatment of chronic rheumatoid arthritis in Great Britain. Therefore, the author of this study aims to show the only reasonable method of payment for the imminent immeasurable demand for treatment for the elderly for age related diseases such as joint replacement surgery [3]. A recent Journal of Rheumatology article projects Medicare will finance approximately 2.67 million joint replacement surgeries by 2035, plus an additional 2.35 million joint replacement surgeries by the year 2040 [4]. The author believes that the current nationwide Diagnostic Related Groups (DRGs) system that helps determine how much Medicare pays the hospital for each “product” needs to be phased out as soon as possible. Our research shows that prior to Medicare implementing the DRGs payment system, Maryland proved that their total cost model of state-wide rewards and penalties compensated “efficient and effective” hospitals, providing care as defined by metrics set up by the Health Services Cost Review Commission (HSCRC). The Maryland legislature granted this independent government agency the broad powers to insulate the HSCRC from conflicts of interests, regulatory capture, and political meddling in the long term. In exchange, the HSCRC had the freedom to design a system that must deliver on three areas: cost reduction of hospital services, health improvement for all Maryland residents, and quality of life care improvements. Since inception of the HSCRC, all stakeholders are legally required to comply with robust auditing and data-submission requirements that allow the agency to collect data on the costs, patient volume, and financial condition of all inpatient, hospital-based outpatient, and emergency services in Maryland. This level of transparency allows the agency to set prices for hospital services, and hospitals must obey because it is Maryland law. Because of this methodology, HSCRC-approved average Maryland hospital markups ranged from 18 percent in 1980 to only 22 percent in 2008. During that same period, the average hospital markup nationally skyrocketed from 20 percent in 1980 to more than 187 percent in 2008 [5]. This strong evidence is the primary reason why the HSCRC has continued to receive a federal waiver from the Centers for Medicare and Medicaid Services, which requires both Medicare and Medicaid to pay the HSCRC-approved rates statewide. No discounts are given because of volume, nor any shifting of costs to other payers. There is a mandate: same price for the same service at the same hospital, no exceptions. Adjustments for uncompensated medical care are automatically bundled into the HSCRC-approved rates, as thus, this financial burden is shared by all hospitals in Maryland. This article explores the important milestones taken by the state of Maryland and how the lessons learned are responsible for the impressive results of their program today. This author believes that by applying the Maryland Total Cost of Care Model (Maryland TCOC Model) nationwide will yield financial savings of at least $227 billion by 2035, plus another $280 billion by 2040, exclusively from joint replacement surgeries reimbursed at HSCRC-approved rates and not any other method.
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Gavrilina, Olga A., Kristina A. Zakurdaeva, Anastasia N. Vasileva, Sergei Dubov, Vitaly S. Dubov, Vladimir I. Vorobyev, Lev S. Butaev, et al. "Final Results of CHRONOS19 Observational Study in Patients with Hematologic Disease and COVID-19 in Russia." Blood 138, Supplement 1 (November 5, 2021): 4994. http://dx.doi.org/10.1182/blood-2021-152735.
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Abstract Background: Research on the impact of COVID-19 on different patient populations has been of great value for the optimization of patient care since the start of the SARS-CoV-2 pandemic. Earlier, we reported the interim analysis of the immediate outcomes in patients (pts) with hematologic (hem) disease and COVID-19. Long-term results of the CHRONOS19 registry are now available. Methods: CHRONOS19 is an observational prospective cohort study among adult pts ((≥18 years) with hem diseases (malignant or non-malignant) and laboratory-confirmed or suspected (based on clinical symptoms and/or CT) COVID-19 in Russia. Data from 15 centers all over the country were collected on a web-based platform in a de-identified manner at 30, 90, and 180 days after COVID-19 was diagnosed. The primary endpoint was 30-day all-cause mortality. Secondary outcomes included COVID-19 complications, rate of ICU admission and mechanical ventilation, outcomes of hem disease in SARS-CoV-2 infected pts, overall survival, and risk factors for disease severity and mortality. Results: As of July 30, 2021, 666 pts were enrolled (females / males [n (%)]: 317 (48%) / 349 (52%); median [range] age: 56 [18-90] years. Disease types (malignant/non-malignant [n (%)]): 618 (93%) / 48 (7%), including AML 115 (17%), MM 113 (17%), NHL 106 (16%), CML / CMPD 92 (14%), ALL 52 (8%), CLL 50 (8%), MDS 25 (4%), HCL 23 (3%), HL 21 (3%), AA 16 (2%), APL 11 (2%), others 42 (6%); among them induction phase / remission / relapse or refractory / NA in 237 (35%) / 231 (35%) / 152 (23%) / 46 (7%) pts. Concomitant conditions were reported in 385 (58%) pts: cardiovascular 254 (66%), diabetes 76 (20%), obesity 57 (15%), pulmonary 41 (11%), chronic renal 44 (11%) or hepatic 33 (9%) disease, other 90 (23%). At a median follow-up of 7,5(1-19) months, 618 pts were evaluable for the primary outcome. Thirty-day all-cause mortality was 16% (100 pts died). Death due to COVID-19 complications occurred in 82 pts, 14 pts died due to progression of hem disease. Overall, 217 (33%) pts had severe disease, COVID-19 complications were detected in 458 (70%) pts, the most common were pneumonia in 425 (93%) pts, respiratory failure in 252 (55%) pts, multiple organ failure in 56 (12%) pts, cytokine storm in 52 (11%) pts, ARDS in 47 (10%) pts, and sepsis in 44 (10%) pts. The rate of ICU admission was 23% (145 pts) with high mortality in this group of pts (77%), 111 (17%) pts required mechanical ventilation, among them only 5 (4.5%) pts survived. Treatment of hem disease was changed, interrupted, or discontinued in 395 (60%) pts with a median delay of 4 weeks. At 30 days, the rate of relapse / progression of hem disease was 5% / 8% (24 / 40 of 517 evaluable pts). At the longer follow-up (90 and 180 days), relapse / progression occurred in another 9 / 23 pts. At the data cutoff, the median overall survival was not reached. Antibody detection was performed in 253 pts: 211 (84%) pts had IgG to SARS-CoV-2. In a univariate analysis, older age (> 60 years), myelotoxic agranulocytosis, transfusion dependence, diabetes among comorbidities, ARDS and other complications, except CRS, ICU and mechanical ventilation (Fig. 1) were associated with higher risks of mortality (p<0.05). The final results of the CHRONOS19 study will be presented. Conclusions: Patients with hem disease and COVID-19 have higher mortality than a general population with SARS-CoV-2 infection, predominantly due to COVID-19 complications. The longer-term follow-up did not reveal any concerns in terms of hem disease outcomes. Figure 1 Figure 1. Disclosures Vorobyev: Janssen, Roche, Sanofi, Takeda, Biocad, Abbvie: Other: Advisory Boards, Speakers Bureau; Astellas, Novartis, AstraZeneca: Speakers Bureau. Chelysheva: Pharmstandart: Speakers Bureau; Pfizer: Speakers Bureau; Bristol Myers Squibb: Speakers Bureau; Novartis Pharma: Speakers Bureau.
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Gomes, Brenno Cardoso, João Manoel Silva Júnior, and Felipe Francisco Tuon. "Evaluation of Urinary NGAL as a Diagnostic Tool for Acute Kidney Injury in Critically Ill Patients With Infection: An Original Study." Canadian Journal of Kidney Health and Disease 7 (January 2020): 205435812093421. http://dx.doi.org/10.1177/2054358120934215.
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Background: Acute kidney injury (AKI) is a common complication in critical care patients. The presence of AKI is a marker for poor outcomes such as longer hospitalization durations, more hospital readmissions, and especially, higher mortality rates. Sepsis is one of the major causes of AKI within the intensive care unit (ICU) population. Sepsis-related AKI occurs in approximately 20% of patients, reaching more than 50% in patients with septic shock. The diagnosis of AKI depends on urine output and/or serum creatinine measurements. Unfortunately, serum creatinine is a late and unreliable (insensitive and nonspecific) indicator of AKI. However, biomarkers of renal damage have great potential in facilitating early diagnosis of AKI. Several biomarkers, including urinary neutrophil gelatinase-associated lipocalin (uNGAL), have been used in the early detection of AKI. Objectives: The aim of this study was to evaluate uNGAL for the diagnosis and prognosis of AKI in critical ill patients with infections. Design: Original study (Cohort Prospective Observational). Setting: Study in 2 ICUs of different Brazilian hospitals, in the city of Curitiba: Hospital de Clínicas da Universidade Federal do Paraná and Hospital da Polícia Militar do Paraná, from November 12, 2016 to May 15, 2018. Participants: Critically ill patients with infections, sepsis, or septic shock were selected. The inclusion criteria were patients older than 18 years with infection. They were followed up for 30 days in the analysis of outcomes. We requested that consent forms be signed by all eligible patients or their caregivers. Measurements: The urinary neutrophil gelatinase-associated lipocalin (uNGAL) levels of the patients were measured on 4 consecutive days and was assayed using a chemiluminescent microparticle immunoassay system. The screening time occurred within 72 hours of admission to the ICU. The first urine sample was collected within the first 24 hours of the screening hours. Mortality and AKI were assessed during first 30 days. Methods: clinical and laboratory data, including daily uNGAL levels, were assessed. The AKI stage using the KDIGO criteria was evaluated. Sensitivity, specificity, and the area under the curve-receiver operating characteristic (AUC-ROC) values were calculated to determine the optimal uNGAL level for predicting AKI. Results: We had 38 patients who completed the study during the screening period. The incidence of AKI was 76.3%. The hospitalization period was longer in the group that developed AKI, with 21 days of median (interquartile range [IQR]: 13.5-25); non-AKI group had a median of 13 days (IQR 7-18; P = .019). We found a direct relationship between uNGAL levels and the progression to AKI. Increased values of the biomarker were associated with the worsening of AKI ( P < .05). The cutoff levels of uNGAL that identified patients who would progress to AKI were the following: (d1) >116 ng/mL, (d2) >100 ng/mL, and (d3) 284 ng/mL. The value of the fourth and last measurement was not predictive of patients who would progress to AKI. The median urinary uNGAL was also associated with mortality on Days 1, 3, and 4: d1, P = .039; d3, P = .005; d4, P = .005. The performance of uNGAL in detecting AKI patients (AUC-ROC = 0.881). There were no risk factors other than AKI that could be correlated with increased uNGAL levels on Day 1. Limitations: The study was carried out in 2 centers, having used only 1 biomarker, and our small number of patients were limitations. Conclusion: the uNGAL had an association in its values with the diagnosis and prognosis of patients with severe infections and AKI. We suggest that studies with a greater number of patients could better establish the cutoff values of uNGAL and/or serum NGAL in the identification of infected patients who are at a high risk of developing AKI.
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Ghalehsari, Nima, Pragnan Kancharla, Neil S. Nimkar, Anita Mazloom, Farah Ashraf, Angelica Singh, and Mendel Goldfinger. "An Institutional Retrospective Study on Recognizing the Delay in Multiple Myeloma Diagnosis." Blood 134, Supplement_1 (November 13, 2019): 3430. http://dx.doi.org/10.1182/blood-2019-127625.
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Background Multiple myeloma (MM) is the abnormal proliferation of plasma cells in the bone marrow often resulting in debilitating symptoms ranging from ostealgia to pathological fractures from bone destruction. According to American Cancer Society, MM accounts for 1-2% of cancers and approximately 17% of hematological malignancies in the United States each year (1). Fifty percent of patients with symptomatic MM have three or more primary care visits before they are referred to a specialist, which is greater than any other cancer (5). It has been shown that a delay in diagnosing multiple myeloma negatively impacts the clinical course of the disease and hence the outcome in patients (2). Patients with longer diagnostic intervals also experience shorter disease free survival and more complications from treatment (4). Herein, a retrospective analysis was performed to determine the average delay in diagnosis of MM. Methods This is a retrospective electronic chart review of all indexed newly diagnosed MM cases between 1/1/2014 through 12/31/2018 at New York-Presbyterian Brooklyn Methodist Hospital (NYP BHM). NYP BMH is a Weill Cornell Medical College-affiliated hospital in Brooklyn, NY whose patient population includes those with private insurance, uninsured and Medicare/Medicaid. Data abstraction from the electronic medical record (EMR) was uniform and involved baseline characteristics such as age, gender and race. International Classification of Diseases (ICD)-10-CM code (C90.00) was used for extraction of data which identified 492 patients. After excluding patients with MGUS or a prior diagnosis of multiple myeloma, 104 patients were included in the final study. We calculated the number of days between the date of first abnormal laboratory value seen on bloodwork for a myeloma related sign (at least 90 days prior to diagnosis) to the date of bone marrow biopsy that confirmed the diagnosis. The inclusion criteria were anemia defined as hemoglobin <12gm/dl, Hypercalcemia defined by corrected calcium >10, kidney dysfunction with a creatinine >1.5 and total protein >8. Results Of the 104 patients with newly diagnosed MM, 69 patients were diagnosed within 90 days of the first abnormal lab value recorded in our electronic medical record (EMR). Thirty-five patients (34%) had a delay in diagnosis at least 90 days with a mean delay of 38 months. Isolated anemia was the most common abnormal lab finding with 29/104 (28%) having documented anemia at least 90 days prior to diagnosis of myeloma. The mean delay in diagnosis for patients with anemia was 41 months. There were four patients with anemia and elevated creatinine with an average delay of 23 months. Five patients had anemia and elevated calcium with an average delay of 21 months. Nine patients had anemia and elevated total protein with an average delay of 38 months. Conclusion: In the current era where we have effective therapies for MM it is now more important than ever to avoid a delay in diagnosis. We demonstrate that 34% of patients receiving care at an Urban Teaching Hospital had at least a 90 day delay in their diagnosis of MM. Our cohort consisted of 64% African Americans, suggesting that minorities are more commonly affected by this. There is a need for more awareness amongst clinicians to consider the diagnosis of MM in the workup of anemia. References: 1. Kariyawasan, C. C., D. A. Hughes, M. M. Jayatillake, and A. B. Mehta. 2007. "Multiple Myeloma: Causes and Consequences of Delay in Diagnosis." QJM: Monthly Journal of the Association of Physicians 100 (10): 635-40. 2. Siegel, Rebecca L., Kimberly D. Miller, and Ahmedin Jemal. 2019. "Cancer Statistics, 2019." CA: A Cancer Journal for Clinicians. https://doi.org/10.3322/caac.21551. 3. Vélez R, Turesson I, Landgren O, Kristinsson SY, Cuzick J. Incidence of multiple myeloma in Great Britain, Sweden, and Malmö, Sweden: the impact of differences in case ascertainment on observed incidence trends. BMJ Open. 2016;6:e009584. 4. Kariyawasan CC, Hughes DA, Jayatillake MM, et al. Multiple myeloma: causes and consequences of delay in diagnosis. QJM 2007;100:635-40. 10.1093/qjmed/hcm077 5. Lyratzopoulos G, Neal RD, Barbiere JM, et al. Variation in number of general practitioner consultations before hospital referral for cancer: findings from the 2010 National Cancer Patient Experience Survey in England. Lancet Oncol 2012;13:353-65. 10.1016/S1470-2045(12)70041-4 Disclosures No relevant conflicts of interest to declare.
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Oudina, Fateh, Elhadj Benkhaled, Mohamed Mili, and Fatima Zohra Oudina. "Choosing the best site for a technical backfill center for urban solid waste using a multi-criteria evaluation technique based on geographic information systems. Case study of the city of M'sila." Technium Social Sciences Journal 36 (October 8, 2022): 592–606. http://dx.doi.org/10.47577/tssj.v36i1.7429.
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Many wastes arise from human daily activities, and solid household waste is one of the most impactful and heavy on human shoulders, as the management of solid household waste is one of the important issues that must be taken care of in order to preserve the health and safety of humans and the environment. Therefore, this study came to identify solid household waste and the methods and methods used to manage it through collection and transportation operations until its final disposal. Geographical information systems are used in the environmental planning process in order to better plan the location of containers and identify waste collection paths, and this requires collecting data and maps for the study area to be used in the process of analyzing spatial appropriateness using geographical information systems based on planning and environmental standards to reach the best results using current-day techniques from Huge software that contributes greatly to the planning process and helps in making decisions (Geographical Information Systems "GIS", Statistical Group for Social Sciences "SPSS"). The selection of sites for technical landfill centers is of great importance at the present time, as the latter is an important and necessary issue for the sanitary disposal of waste, given the complexity of waste management systems, the selection of the appropriate urban solid waste landfill site requires consideration of alternative solutions and multiple and rather complex evaluation criteria. Where this study aims to assess the spatial suitability of the Technical Backfill Center in the city of M’sila, through a spatial analytical methodology, where the significant increase in the population of 1,276721 people in 2019 led to an increase in the quantities of produced waste that exceeded 382,038 tons / year, and thus increased rates of environmental pollution and distortion of the urban landscape. for the city. The poor location of the embankment center caused the residents to annoy, and demanded that they expedite the closure of the center despite the fact that its lifespan had not expired, which made the authorities in an embarrassing position. This is what the study provides, as the best sites were chosen for the establishment of a landfill center for the city of M'sila, so that it is difficult to change it in the future, based on a set of criteria approved by the National Waste Agency and analyzed in the GIS environment, by applying the spatial analyzer and giving weights to the criteria affecting the The site of the backfill was selected according to the relative importance of each of them by the hierarchical analysis (Ahp) process using Excel, then the Raster calculator process was performed. In our study, we tried to find an alternative site to the current site that would be more suitable than the previous one, where a set of criteria (economic, social, and environmental) were defined and using the integration of geographic information system (GIS) and the analytical hierarchy method (AHP where the GIS program plays a role). It is important in contributing to superposition analysis for landfill site selection because it has a high capacity to manage large amounts of spatial data and considers many factors from a variety of sources ,as well as its high ability to deal with the necessary social, environmental and economic constraints. this study, it was relied on using a combination of GIS and AHP programs to choose the best and most appropriate urban solid waste burial site from among the many candidate sites that meet the largest possible number of environmental and scientific criteria so that it is difficult to change it in the future, which helps officials to take the appropriate decision to achieve this goal. .The processes of choosing a landfill site includes several steps that must be performed using GIS software are: (1): The study area is divided into categories to suit the requirements, and then an appropriate weight is given to each category (2): Determining the final map of the landfill sites using the special analysis tool in GIS "Map Algebra - Single Output Map Algebra". (3): Exclusion of unsuitable areas to simplify the process of selecting candidate sites for the urban solid waste landfill center in the city of M'sila. The results showed that the best areas are likely to be suitable for the establishment of a technical landfill center for waste in the southern side (Municipality of AWLAD MADI), in the southern eastern side (Municipality of AL-MATARFA), and in the western/south side (Municipality of AWLAD MANSOUR and the lines of Dam El Geer). The study showed the location outside the city due to the lack of real estate in the city and the lack of availability of areas that meet the necessary standards for the establishment of landfill centers, and this confirms the inadequacy of the current site and the need to find an alternative site quickly. We hope that our work will provide a methodology for siting and provide basic and logistical support to decision makers in assessing waste management problems in the city and help to choose the appropriate landfill site for the city.
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Sautter, Lilja Mareike. "FEMININITY AND COMMUNITY AT HOME AND AWAY: SHIPBOARD DIARIES BY SINGLE WOMEN EMIGRANTS TO NEW ZEALAND." Victorian Literature and Culture 43, no. 2 (February 25, 2015): 305–16. http://dx.doi.org/10.1017/s1060150314000564.
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New Zealand experienced a massive influx of European immigrants in the 1870s and early 1880s after the introduction of Julius Vogel's assisted immigration programme. Single women under the age of thirty-five were a significant target group of recruitment schemes. They were expected to contribute to the colony's labour force as domestic servants and balance New Zealand's surplus of male settlers by becoming wives and mothers. Many of these young women had never been away from home until they embarked on their hazardous journey halfway around the world. Elizabeth Fairbairn, a single woman emigrant herself, was the matron in charge of the young women travelling to New Zealand on board the Oamaru in 1877–78. She narrates in her shipboard diary that Christmas Day made many of the single women homesick: “A great many of the girls grew downhearted last night and had such a good cry, poor things I was sorry for them, for the heart does feel things at a time like this and it is the first time a good many of them have been from home” (25 Dec. 1877). Jane Finlayson was one of these homesick “girls” on the same ship a year earlier. On 22 September 1876 she writes in her diary: “After parting with our friends at Greenock and thinking that ‘Whatever be our earthly lot, Wherever we may roam, Still to our heart the brightest spot, Is round the hearth at home’ we came with the tug on board this ship.” Having left their old home, the women emigrants spent three months crammed into an uncomfortable steerage compartment, honing domestic skills such as sewing and knitting. The ship became a temporary home in which the emigrants prepared for their future life in New Zealand. Metropolitan notions of femininity which located women in the private, domestic sphere had to be questioned and modified on board. While the single women's compartment was supposed both to become a home away from home and to represent a domestic setting, the transitional and public nature of shipboard space complicated both of these projects. This ambiguity relates to an image of single women which was similarly contradictory. The single woman emigrant was a figure at the centre of discourses of femininity and community: on her centred hope but also anxiety. Like in other settler colonies, it was imagined in New Zealand that women would exert beneficial moral and religious influence upon male-dominated colonial society. Women were thus expected to act as creators of community, both ideologically through their moral influence and physically by bearing children. However, until they got married, single women also represented a threat: they were often held responsible for the increase in prostitution in New Zealand (Macdonald 180). This illustrates the danger women could embody: again, both ideologically, since prostitution was seen as contaminating the moral character of society, and physically, since deviant sexual activity was often seen as undermining the biological purity of the community. How did such notions of femininity and community travel from Britain to New Zealand? How were they constructed and redefined during the transitional period of the voyage? In order to explore these questions this essay discusses two texts that also travelled, and narrate travelling: the two shipboard diaries by Elizabeth Fairbairn and Jane Finlayson referenced above, which look at single women's experience of emigration from the slightly different perspectives of a matron and a young woman under the care of a matron. The figure of the matron is an ambiguous one within the notion of women as representing both hope and anxiety: she is not married but nevertheless in a position of relative authority compared to the other single women on board. Elizabeth Fairbairn's diary represents her efforts to create unity among the women under her charge by submitting all of them to the same ideology of femininity. However, her text also has to deal with her own complicated status within the social structure of the ship. Jane Finlayson's text aims to contain anxiety and ambiguity by framing subversive and frightening events within the generic conventions of a shipboard diary. It negotiates the position of the single women on board while simultaneously reaffirming this position.
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Paubelle, Etienne, Felipe Suarez, Florence Zylbersztejn, Celine Callens, Michael Dussiot, Marc Benhamou, Françoise Isnard, et al. "Association of Deferasirox and Vitamin D Promotes Cell Differentiation and Improves Overall Survival in Acute Myeloid Leukemia (AML) Elderly Patients After Demethylating Agents Failure: A Retrospective Case Control Study." Blood 120, no. 21 (November 16, 2012): 3622. http://dx.doi.org/10.1182/blood.v120.21.3622.3622.
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Abstract Abstract 3622 Background: AML is a group of heterogeneous malignant diseases characterized by uncontrolled cell growth and differentiation arrest. Following the success of differentiating therapies in APL, great hopes were placed in Vitamin D (VD) and its ability to promote differentiation of non-APL AML cells. However, results of clinical studies were disappointing and trials were interrupted due to the occurrence of life-threatening hypercalcemia. Our group has shown that iron chelators such as deferasirox (DFX) are able to promote monocytes differentiation in both normal hematopoietic progenitors and AML cells (Callens et al Jexp Med 2010). Moreover, iron deprivation synergized with VD to promote cell differentiation on leukemic cells. Most elderly patients diagnosed with AML suffer from secondary iron overload because of in some cases ineffective erythropoiesis and iterative red blood cell transfusions. Furthermore, in myelodysplastic syndromes, retrospective studies have suggested that iron chelators may increase life expectancy and decrease the risk of transformation into AML. In AML of the elderly, the use of demethylating agents such as 5-azacytidine or decitabine may induce hematological response and increase life expectancy. However, response is often of short duration. Since VD deficiency and iron overload prevalence is high in the elderly, the association of VD and DFX was given to a subgroup of patients following demethylating agents failure. Methods: A retrospective chart review of 17 elderly AML patients after demethylating agents failure was performed in three French centers. Patients treated by the combination of DFX/VD were matched to patients treated with best supportive care (BSC). Based on ferritin, and creatinin levels the dose of DFX was adapted in each case. DFX dose was up to 2000 mg a day and VD was used at 100,000 units orally weekly. The tolerance and the overall survival (OS) were analyzed. Pre-clinical studies were conducted in vitro on cell lines (HL60, U937, OCI-AML3, THP-1, MOLM 13) to evaluate cell differentiation induced by DFX and a new VDR agonist (Inecalcitol) by cell morphology and flow cytometry (expression of CD11b and CD14 markers). VDR activity and expression were evaluated by flow cytometry, immunoblotting, luciferase reporter assays and qPCR to detect VDR-targeted genes. Results: Median age of DFX/VD patients and BSC control group were 76 (range 63–84) and 71 (58–85) respectively. Most patients were diagnosed with AML with multilineage dysplasia (cases 70%, controls 76%). Prognosis groups were distributed homogeneously between the treated patients and controls. There were no significant differences in blast infiltration, leukocytosis, neutropenia, systemic iron and phosphocalcium parameters. All patients received 5-azacytidine (median of 8 courses for the cases and 7 for the controls).No renal insufficiency, hepatotoxicity or hypercalcemia were observed in DFX/VD patients. At 3 months, 4 treated patients (23.5%) had significant monocyte level increase an evidence of the enhanced monocyte differentiation efficacy. The treatment did not decrease the need of transfusion. Most interestingly median survival of treated patients was significantly increased (10.4 m vs 4 m, p=0.002). In vitro studies were conducted in parallel aiming to characterize new potential alternative therapeutic associations, which could improve patients' response. We show that the use of a new highly potent VDR agonist (Inecalcitol) potentiated the effect of DFX in promoting terminal monocyte differentiation of leukemic cell lines. It also increased VDR activity evaluated by VDR expression and phosphorylation and expression of VDR-targeted genes. In vivo studies in mice model of AML using combined DFX/inecalcitol therapy will be presented. Conclusions: The prognosis of elderly patients diagnosed with AML after demethylating agents remains poor. Here we show that the differentiating therapy by the association of Deferasirox and Vitamin D was able to improve overall survival with low toxicity. New generation of highly-potent VDR agonists (which are devoided of hypercalcemic properties) significantly enhanced VDR activation and terminal monocyte differentiation of AML cells and represent potential therapeutic alternatives in the near future. These encouraging results should be verified in a large randomized prospective multicenter study. Disclosures: No relevant conflicts of interest to declare.
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Pylypchuk, Oleh, Oleh Strelko, and Yuliia Berdnychenko. "PREFACE." History of science and technology 12, no. 2 (December 16, 2022): 194–96. http://dx.doi.org/10.32703/2415-7422-2022-12-2-194-196.
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The issue of the journal begins with an article on French sinology. French sinology takes a special place in the history of the sinological studies development. It was France that became the first country where the transformation of missionary sinology, which was common among a limited circle of researchers (mainly in a religious sphere), into the academic scientific discipline, which had already been taught and studied at a professional level in academic institutions, occurred. The Parisian type of sinology used to dominate the entire world for a long time, including such powerful centers of Chinese studies as Germany, Great Britain, the USA, and China itself. In order to form a complete picture of sinology development in France, the authors singled out and analyzed three historical periods covering the entire history of Chinese studies development, starting from its birth and flourishment to the process of stagnation. Modern scientific communication traditionally uses visual narratives, such as comics, for education, presentation of scientific achievements to a mass audience, and as an object of research. In the article by Oksana Hudoshnyk and Oleksandr P. Krupskyi, offers a three-level characterization of the interaction of comic culture and science in a diachronic aspect. Attention is focused not only on the chronological stages of these intersections, the expression of the specifics of the interaction is offered against the background of scientific and public discussions that accompany the comics–science dialogue to this day. Emphasis is placed on the unique phenomenon of the simultaneous concordance of various stages of the dialogue between comics and science, on the prolonged replication of successful inventions into modern experience, and the active testing of known narratives at new levels of a scientific presentation. The next paper assesses the topicality of Vernadsky's concept of the noosphere, coined over almost twenty years starting in the early 20th century. Emphasizing the uniqueness of Vernadsky's concept of the noosphere as the transformation of the biosphere by a man using reason, we concentrate on the assessment of the utopian or realistic nature of his vision of the future of humanity. Based on the philosophical case-studies analysis, it identifies the ideological roots of the noosphere concept, the development of views on the concept in time, the role of reason and scientific thinking, the opinions of its supporters and critics, and Moiseev's related concept of co-evolution. Lectures de Potentia Restitutiva or Of Spring: Explaining the Power of Springing Bodies (1678) is an important book for the history of science. This book is better known for Hooke’s presentation of the law that bears his name. In the article by Isadora Monteiro, seeks to study the Lectures de Potentia Restitutiva once again to better understand Hooke’s thoughts about the rule which bears his name and his conception of gravity, which the author considered a force. Here Hooke’s definitions of body and motion will be presented, as well as his actual objective when he formulated the so-called Hooke’s Law. As we will see, Hooke intended to create a “philosophical scale” to measure the gravitational attraction between bodies. By considering his previous publications, such as An attempt to prove the motion of the Earth from Observations or Micrographia: or some Physiological Descriptions of Minute Bodies, or even unpublished works such as On the inflection of a direct motion into a curve by supervening Attractive principle, it becomes clear that Hooke was already opening a path toward an understanding of gravity before Newton’s Principia (1687) were published. By taking into account the controversy between Isaac Newton and Robert Hooke, we also intend to strengthen the idea that Hooke was an indispensable contributor to the elaboration of a law of universal gravitation. In 1915, the first occupational therapy school was founded by Jane Addams at Hull House (Chicago, USA). In that process, Addams inspired the first generation of occupational therapists, especially Eleanor Clarke Slagle. Thus, in the article by Rodolfo Morrisonseeks to highlight the contribution of Jane Addams to the development of Occupational Therapy through an in-depth bibliographic review, from primary sources. The next article presents the results of a study of the features of biographical and prosopographic materials about famous mathematicians and natural scientists, published in one of the most authoritative journals “Bulletin of Experimental Physics and Elementary Mathematics”, which was published in Kyiv and Odesa during 1886–1917. In fact, the journal was an unofficial periodical printed branch of the Mathematical Department of the Novorossiysk Society of Naturalists. The aim of the next research is to study the policy efforts conducted by the Indonesian government since the beginning of independence in 1945 to present, in advancing science and technology and innovation. A content analysis approach is employed to identify each stipulated regulation in Indonesia in the form of Laws, Government Regulations, Presidential Regulations, Presidential Decrees, and Presidential Instructions. There are 78 regulations in the field of science and technology and innovation that are analyzed. The results of the analysis are described based on the emergence of regulations and institutional implications generated as part of the ecosystem. In the article by Ihor Annienkov, based on the problem-chronological, comparative-historical, historiographical, and source-research methods, as well as the method of actualization, identifies the extent of borrowing foreign design and technological solutions in the Ukrainian Soviet Socialist Republic for projecting electrical machines in the second half of the 1930s, as well as the reasons for the absence of unambiguous information in historiography regarding the existence of this phenomenon in the republic at this chronological stage. The publication provides a general assessment of the quality of scientific support for the processes of creating electrical machines, establishes the ways of fulfilling the scientific-technical borrowings that were studiedand the dynamics of their development, analyzes their role in the growth of the technical level of products of the Ukrainian electrical machine-building branch. In the article by Mykola Ruban and Andrii Fomin, attempts to investigate the historical circumstances of the mastering and development of the industrial production of rolling stock in Ukraine from 1991 to 2021. In the course of the scientific development of the proposed research, materials from mass-circulation newspapers, industry publications of railway transport, as well as technical studies of employees of manufacturing plants were used. The next discusses the conditions and prerequisites for choosing the location of the plant; considers the stage of the establishment (foundation) of the plant; examines the stage of plant construction and equipping it with technological facilities in detail; analyzes the development and establishment of the plant between 1897 and 1914. A brief analysis of locomotive designs produced by the Kharkiv Locomotive Plant from 1897 to 1914 has been made. The article shows the significance of Consultative Congresses of Traction Engineers for the development of railway machinery both at Kharkiv Locomotive Plant and for the entire railway industry. The purpose of next study is to highlight the peculiarities of the development of the Russian aviation industry during the First World War. The focus is on analyzing production programs and matching their quantitative and qualitative parameters to war requirements. Production plans of leading Russian aviation factories as well as qualitative and quantitative parameters of products have been analyzed in the article.