123 research outputs found
Journey from the Land of No: A Jewish Girl Caught in Revolutionary Iran
Get PDFRoya Hakakian, Documentary filmmaker, poet, and award-winning author of Journey from the Land of No.https://digitalcommons.fairfield.edu/bennettcenter-posters/1261/thumbnail.jp
Diagnosis and management of cerebral venous thrombosis
Get PDFCerebral venous thrombosis (CVT) is rare and accounts for 0.5% of all strokes. Its clinical presentation is variable and diagnosis requires a high index of clinical suspicion in conjunction with neuroradiological diagnostic support. Treatment options are limited and are mostly based on consensus. Therefore, familiarity with international guidelines is important. Outcome is often good and most patients make a full recovery, although a small proportion suffers death or disability. Here, we describe the clinical features, risk factors, acute imaging features, management and complications of CVT.</p
The Effects of GCSF Primary Prophylaxis on Survival Outcomes and Toxicity in Patients with Advanced Non-Small Cell Lung Cancer on First-Line Chemoimmunotherapy: A Sub-Analysis of the Spinnaker Study
Get PDFGCSF prophylaxis is recommended in patients on chemotherapy with a >20% risk of febrile neutropenia and is to be considered if there is an intermediate risk of 10–20%. GCSF has been suggested as a possible adjunct to immunotherapy due to increased peripheral neutrophil recruitment and PD-L1 expression on neutrophils with GCSF use and greater tumour volume decrease with higher tumour GCSF expression. However, its potential to increase neutrophil counts and, thus, NLR values, could subsequently confer poorer prognoses on patients with advanced NSCLC. This analysis follows on from the retrospective multicentre observational cohort Spinnaker study on advanced NSCLC patients. The primary endpoints were OS and PFS. The secondary endpoints were the frequency and severity of AEs and irAEs. Patient information, including GCSF use and NLR values, was collected. A secondary comparison with matched follow-up duration was also undertaken. Three hundred and eight patients were included. Median OS was 13.4 months in patients given GCSF and 12.6 months in those not (p = 0.948). Median PFS was 7.3 months in patients given GCSF and 8.4 months in those not (p = 0.369). A total of 56% of patients receiving GCSF had Grade 1–2 AEs compared to 35% who did not receive GCSF (p = 0.004). Following an assessment with matched follow-up, 41% of patients given GCSF experienced Grade 1–2 irAEs compared to 23% of those not given GCSF (p = 0.023). GCSF prophylaxis use did not significantly affect overall or progression-free survival. Patients given GCSF prophylaxis were more likely to experience Grade 1–2 adverse effects and Grade 1–2 immunotherapy-related adverse effects
Immunotherapy-related adverse events in real-world patients with advanced non-small cell lung cancer on chemoimmunotherapy: a Spinnaker study sub-analysis
Get PDFBackgroundThe Spinnaker study evaluated survival outcomes and prognostic factors in patients with advanced non-small-cell lung cancer receiving first-line chemoimmunotherapy in the real world. This sub-analysis assessed the immunotherapy-related adverse effects (irAEs) seen in this cohort, their impact on overall survival (OS) and progression-free survival (PFS), and related clinical factors.MethodsThe Spinnaker study was a retrospective multicentre observational cohort study of patients treated with first-line pembrolizumab plus platinum-based chemotherapy in six United Kingdom and one Swiss oncology centres. Data were collected on patient characteristics, survival outcomes, frequency and severity of irAEs, and peripheral immune-inflammatory blood markers, including the neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII).ResultsA total of 308 patients were included; 132 (43%) experienced any grade irAE, 100 (32%) Grade 1–2, and 49 (16%) Grade 3–4 irAEs. The median OS in patients with any grade irAES was significantly longer (17.5 months [95% CI, 13.4–21.6 months]) than those without (10.1 months [95% CI, 8.3–12.0 months]) (p<0.001), either if Grade 1–2 (p=0.003) or Grade 3–4 irAEs (p=0.042). The median PFS in patients with any grade irAEs was significantly longer (10.1 months [95% CI, 9.0–11.2 months]) than those without (6.1 months [95% CI, 5.2–7.1 months]) (p<0.001), either if Grade 1–2 (p=0.011) or Grade 3–4 irAEs (p=0.036). A higher rate of irAEs of any grade and specifically Grade 1–2 irAEs correlated with NLR <4 (p=0.013 and p=0.018), SII <1,440 (p=0.029 ad p=0.039), response to treatment (p=0.001 and p=0.034), a higher rate of treatment discontinuation (p<0.00001 and p=0.041), and the NHS-Lung prognostic classes (p=0.002 and p=0.008).ConclusionsThese results confirm survival outcome benefits in patients with irAEs and suggest a higher likelihood of Grade 1–2 irAEs in patients with lower NLR or SII values or according to the NHS-Lung score
Medication Safety Group clinician updates:a novel teaching programme to bridge the gap between the prescriber and the trust
No full textAims: This project aimed to develop, implement and evaluate a novel medication safety teaching programme focused on updating foundation doctors about local medication-related patient safety issues and engaging them in trust-wide medication safety initiatives.Methods: The Medication Safety Group (MSG) is a multidisciplinary panel responsible for comprehensively assessing and managing all medication-related factors associated with patient safety risks within our major acute hospital trust. Historically, dissemination of information from the MSG has been via ad hoc trust-wide emails or intranet alerts, and a significant disconnect existed between the MSG and prescribers; particularly junior doctors. Over 6 months, a novel medication safety teaching programme entitled the ‘MSG clinician updates' has been developed to formally disseminate key areas of concern identified by the MSG directly to foundation doctors. Sessions have been delivered by two junior clinical MSG representatives in bimonthly 1-hour lectures as part of the compulsory foundation teaching programme. Sessions were delivered in parallel with bimonthly MSG meetings to ensure timely communication of hospital incident report trends, lessons learnt from medication related serious untoward incidents, national safety alerts and changes to trust medication policies.Results: Evaluation of written feedback revealed high levels of satisfaction with MSG clinician updates. When asked to rate each session from 1–10 (10 = excellent, 1 = poor) for relevance, information provision and use of clinical examples, doctors gave mean scores of 8.7, 9.3 and 9.5, respectively (n=53). Case-based discussions were reported to be of significant benefit and review of the trust's medication guidelines improved trainees' knowledge of local resources. Some doctors felt feedback regarding prescribing errors often did not reach rotating doctors and these sessions helped close the feedback loop. Where specific local medication safety trends were identified, for example missed doses, doctors were encouraged to discuss and reflect upon how their practice could be improved, thus promoting real-time engagement in wider trust strategies to address medication related patient safety risks.Conclusion: MSG clinician updates is a novel teaching programme that is improving dissemination of medication safety issues to foundation doctors by forming a direct link between prescribers and the MSG. The sessions have also provided a valuable forum for trainees to relay concerns back to the MSG. This has generated prescriber-led initiatives that were addressed by the MSG and actively engaged clinicians in medication safety improvements within the trust. This project is being expanded to widen access to all grades of clinician through incorporation into the unscheduled care directorate departmental teaching programme
A New Evidence-Based Information Leaflet for Systemic Lupus Erythematosus Patients Providing Guidance about the Use of Medications During Pregnancy and Breastfeeding
No full textEmotion Regulation Mediates the Associations of Loneliness and Empathy with Death Anxiety in the Elderly
No full textIntroduction: In old age, diseases and frailty can be minimized through proper care and understanding, paving the way for healthy and normative aging. The present study aimed to investigate the mediating role of emotion regulation in the relationship between loneliness and empathy with death anxiety in the elderly.
Methods: This study utilized structural equation modeling. The statistical population included all elderly residents of Ahvaz, Iran, in 2023. Convenient sampling was employed to select 108 elderly individuals. The research instruments included the Death Anxiety Scale, UCLA Loneliness Scale, Interpersonal Reactivity Index, and Cognitive Emotion Regulation Questionnaire. Pearson correlation coefficient and structural equation modeling were adopted for data analysis.
Results: There was a direct relationship between loneliness and adaptive emotion regulation and maladaptive emotion regulation in the elderly. Additionally, there was a direct relationship between empathy and death anxiety, adaptive emotion regulation, and maladaptive emotion regulation. Moreover, a positive relationship was observed between maladaptive emotion regulation and death anxiety, while a negative relationship existed between adaptive emotion regulation and death anxiety in the elderly (p < 0.001). The results revealed an indirect relationship between loneliness and death anxiety mediated by emotion regulation. There was also an indirect relationship between empathy and death anxiety mediated by emotion regulation (p < 0.001).
Conclusion: The proposed model exhibited a good fit. Therefore, raising awareness and implementing measures to empower the elderly in emotion regulation concerning the relationship between loneliness and empathy can play a key role in reducing their death anxiety.
Corresponding Author: Roya Ahmadimad
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State of the art in treatment of small cell lung cancer
No full textSmall cell lung cancer (SCLC) is an aggressive cancer, with most cases diagnosed as extensive-stage (ES-SCLC). Platinum and etoposide chemotherapy is the mainstay of first-line treatment, achieving high initial response rates. However, treatment resistance develops quickly, leading to poor overall survival and limited efficacy of subsequent therapies, especially for platinum-resistant disease. The addition of immune checkpoint inhibitors (ICIs) to first-line chemotherapy for ES-SCLC has resulted in modest improvements in survival. For limited-stage SCLC (LS-SCLC) treated with radical chemo-radiotherapy, the ICI durvalumab is now approved as a consolidation therapy to reduce relapse risk. Further trials are investigating ICIs concurrently with chemo-radiotherapy and/or as consolidation or maintenance therapy. For relapsed SCLC, treatment options include chemotherapies such as topotecan or lurbinectedin and carboplatin/etoposide rechallenge. The delta-like ligand 3-targeting bispecific T-cell engager (BiTE), tarlatamab, has been approved by the FDA for ES-SCLC with disease progression on or after platinum-based chemotherapy and is being evaluated in earlier lines of treatment. Other BiTEs are also in early-phase development, with promising early activity. Several antibody-drug conjugates, including sacituzumab govitecan, are being tested in clinical trials and have demonstrated encouraging efficacy. Novel targeted therapies aimed at overcoming resistance to chemotherapy and immunotherapy are also in preclinical development. Despite these advancements, progress remains hindered by the absence of validated biomarkers for predicting treatment outcomes. The identification of SCLC transcriptional subtypes with distinct therapeutic vulnerabilities offers hope for better treatment stratification. The SCLC-I transcriptional subtype, tumour mutational burden and tumour immune cell signatures are promising biomarkers for longer-term survival benefit from ICIs. Circulating tumour DNA and circulating tumour cells have demonstrated potential for prognostication, molecular subtyping and tumour monitoring. Further research remains essential to support treatment stratification, prolong treatment responses, overcome resistance and ultimately improve outcomes for this devastating disease.</p
Higher dose corticosteroids in patients admitted to hospital with COVID-19 who are hypoxic but not requiring ventilatory support (RECOVERY): a randomised, controlled, open-label, platform trial.
No full textBackground: Low-dose corticosteroids have been shown to reduce mortality for patients with COVID-19 requiring oxygen or ventilatory support (non-invasive mechanical ventilation, invasive mechanical ventilation, or extracorporeal membrane oxygenation). We evaluated the use of a higher dose of corticosteroids in this patient group. Methods: This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing multiple possible treatments in patients hospitalised for COVID-19. Eligible and consenting adult patients with clinical evidence of hypoxia (ie, receiving oxygen or with oxygen saturation <92% on room air) were randomly allocated (1:1) to either usual care with higher dose corticosteroids (dexamethasone 20 mg once daily for 5 days followed by 10 mg dexamethasone once daily for 5 days or until discharge if sooner) or usual standard of care alone (which included dexamethasone 6 mg once daily for 10 days or until discharge if sooner). The primary outcome was 28-day mortality among all randomised participants. On May 11, 2022, the independent data monitoring committee recommended stopping recruitment of patients receiving no oxygen or simple oxygen only due to safety concerns. We report the results for these participants only. Recruitment of patients receiving ventilatory support is ongoing. The RECOVERY trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). Findings: Between May 25, 2021, and May 13, 2022, 1272 patients with COVID-19 and hypoxia receiving no oxygen (eight [1%]) or simple oxygen only (1264 [99%]) were randomly allocated to receive usual care plus higher dose corticosteroids (659 patients) versus usual care alone (613 patients, of whom 87% received low-dose corticosteroids during the follow-up period). Of those randomly assigned, 745 (59%) were in Asia, 512 (40%) in the UK, and 15 (1%) in Africa. 248 (19%) had diabetes and 769 (60%) were male. Overall, 123 (19%) of 659 patients allocated to higher dose corticosteroids versus 75 (12%) of 613 patients allocated to usual care died within 28 days (rate ratio 1·59 [95% CI 1·20–2·10]; p=0·0012). There was also an excess of pneumonia reported to be due to non-COVID infection (64 cases [10%] vs 37 cases [6%]; absolute difference 3·7% [95% CI 0·7–6·6]) and an increase in hyperglycaemia requiring increased insulin dose (142 [22%] vs 87 [14%]; absolute difference 7·4% [95% CI 3·2–11·5]). Interpretation: In patients hospitalised for COVID-19 with clinical hypoxia who required either no oxygen or simple oxygen only, higher dose corticosteroids significantly increased the risk of death compared with usual care, which included low-dose corticosteroids. The RECOVERY trial continues to assess the effects of higher dose corticosteroids in patients hospitalised with COVID-19 who require non-invasive ventilation, invasive mechanical ventilation, or extracorporeal membrane oxygenation. Funding: UK Research and Innovation (Medical Research Council), National Institute of Health and Care Research, and Wellcome Trust.</p
Experimental and computational study of microfluidic flow-focusing generation of gelatin methacrylate hydrogel droplets
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