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Seminars in Neurology Jun 2024This review delves into updates in management of large hemispheric infarction (LHI), a condition affecting up to 10% of patients with supratentorial strokes. While... (Review)
Review
This review delves into updates in management of large hemispheric infarction (LHI), a condition affecting up to 10% of patients with supratentorial strokes. While traditional management paradigms have endured, recent strides in research have revolutionized the approach to acute therapies, monitoring, and treatment. Notably, advancements in triage methodologies and the application of both pharmacological and mechanical abortive procedures have reshaped the acute care trajectory for patients with LHI. Moreover, ongoing endeavors have sought to refine strategies for the optimal surveillance and mitigation of complications, notably space-occupying mass effect, which can ensue in the aftermath of LHI. By amalgamating contemporary guidelines with cutting-edge clinical trial findings, this review offers a comprehensive exploration of the current landscape of acute and ongoing patient care for LHI, illuminating the evolving strategies that underpin effective management in this critical clinical domain.
Topics: Humans; Cerebral Infarction; Disease Management
PubMed: 38759959
DOI: 10.1055/s-0044-1787046 -
Leukemia May 2024The emergence of next generation sequencing and widespread use of mutational profiling in acute myeloid leukemia (AML) has broadened our understanding of the... (Review)
Review
The emergence of next generation sequencing and widespread use of mutational profiling in acute myeloid leukemia (AML) has broadened our understanding of the heterogeneous molecular basis of the disease. Since genetic sequencing has become a standard practice, several driver mutations have been identified. Accordingly, novel targeted therapeutic agents have been developed and are now approved for the treatment of subsets of patients that carry mutations in FLT3, IDH1, and IDH2 [1, 2]. The emergence of these novel agents in AML offers patients a new modality of therapy, and shifts treatment paradigms toward individualized medicine. In this review, we outline the role of IDH mutations in malignant transformation, focus in on a novel group of targeted therapeutic agents directed toward IDH1- and IDH2-mutant AML, and explore their impact on prognosis in patients with AML.
Topics: Isocitrate Dehydrogenase; Humans; Leukemia, Myeloid, Acute; Mutation; Prognosis; Disease Management; Molecular Targeted Therapy
PubMed: 38600315
DOI: 10.1038/s41375-024-02246-2 -
Frontiers in Immunology 2024Multiple Sclerosis (MS) management in individuals aged 55 and above presents unique challenges due to the complex interaction between aging, comorbidities,... (Review)
Review
Multiple Sclerosis (MS) management in individuals aged 55 and above presents unique challenges due to the complex interaction between aging, comorbidities, immunosenescence, and MS pathophysiology. This comprehensive review explores the evolving landscape of MS in older adults, including the increased incidence and prevalence of MS in this age group, the shift in disease phenotypes from relapsing-remitting to progressive forms, and the presence of multimorbidity and polypharmacy. We aim to provide an updated review of the available evidence of disease-modifying treatments (DMTs) in older patients, including the efficacy and safety of existing therapies, emerging treatments such as Bruton tyrosine kinase (BTKs) inhibitors and those targeting remyelination and neuroprotection, and the critical decisions surrounding the initiation, de-escalation, and discontinuation of DMTs. Non-pharmacologic approaches, including physical therapy, neuromodulation therapies, cognitive rehabilitation, and psychotherapy, are also examined for their role in holistic care. The importance of MS Care Units and advance care planning are explored as a cornerstone in providing patient-centric care, ensuring alignment with patient preferences in the disease trajectory. Finally, the review emphasizes the need for personalized management and continuous monitoring of MS patients, alongside advocating for inclusive study designs in clinical research to improve the management of this growing patient demographic.
Topics: Humans; Multiple Sclerosis; Aged; Middle Aged; Disease Management; Comorbidity; Aged, 80 and over; Age Factors; Aging
PubMed: 38646534
DOI: 10.3389/fimmu.2024.1379538 -
Drug Discovery Today Oct 2023Effective portfolio management is crucial for innovation and sustaining revenue in pharmaceutical companies. This article holistically reviews trends, challenges, and... (Review)
Review
Effective portfolio management is crucial for innovation and sustaining revenue in pharmaceutical companies. This article holistically reviews trends, challenges, and approaches to pharmaceutical portfolio management and focuses, in particular, on cognitive biases in portfolio decision-making. Portfolio managers strongly rely on external innovation and face increasing competitive pressure and portfolio complexity. The ability to address biases and make robust decisions remains a challenge. Portfolio management practitioners most commonly face confirmation bias, champion bias, or misaligned incentives, which they seek to mitigate through expert input, team diversity, and rewarding truth-seeking. Ultimately, highest-quality portfolio management decision-making could be enabled by three factors: high-quality data, structured review processes, and comprehensive mitigating measures against biases in decision-making.
Topics: Bias; Cognition; Pharmaceutical Preparations; Decision Making
PubMed: 37572999
DOI: 10.1016/j.drudis.2023.103734 -
Canadian Family Physician Medecin de... Feb 2024To outline an approach to the assessment and initial management of patients with burns in the rural emergency department setting. Three mnemonics are presented that can... (Review)
Review
OBJECTIVE
To outline an approach to the assessment and initial management of patients with burns in the rural emergency department setting. Three mnemonics are presented that can be used for both the assessment and the initial management of patients with burns in rural settings.
QUALITY OF EVIDENCE
Current and local guidelines compiled by a plastic surgeon were reviewed to develop a systematic approach to the treatment of patients with burns. PubMed and other databases were also searched for current literature on emergency care of patients with burns.
MAIN MESSAGE
Burn injuries are a common reason for presentation to the emergency department. However, the care of patients with these injuries can vary substantially depending on geographic location, provider training, and hospital resources. Classification of burns, fluid resuscitation guidelines, dressings and wound care, indications for referral, and pain management are discussed.
CONCLUSION
Using a systematic approach may help improve burn injury outcomes for patients and provide practitioners with a step-by-step framework for the management of patients with burns in rural settings.
Topics: Humans; Burns; Emergency Service, Hospital; Emergency Medical Services; Pain Management; Fluid Therapy
PubMed: 38383016
DOI: 10.46747/cfp.700295 -
Expert Opinion on Pharmacotherapy 2023Benign prostatic hyperplasia (BPH) represents the histological entity of prostate cell proliferation, which inflicts a gradually increasing obstruction of the bladder... (Review)
Review
INTRODUCTION
Benign prostatic hyperplasia (BPH) represents the histological entity of prostate cell proliferation, which inflicts a gradually increasing obstruction of the bladder outlet and is accompanied by a progressing manifestation of lower urinary tract symptoms (LUTS). BPH management algorithm includes conservative measures, pharmaceutical agents, and surgical procedures.
AREAS COVERED
A comprehensive literature review was performed using PubMed, Scopus, and Google Scholar databases to identify publications written in English, analyzing BPH pharmaceutical treatment. The search was conducted from January 2000 to January 2023. Six main drug classes can be administered, either as monotherapy or in combination. Furthermore, the authors provide current direction of research on future medications, which focuses on a more etiological interference to the BPH pathophysiological mechanism.
EXPERT OPINION
The available medications represent an effective first-line step of BPH/LUTS therapy. Currently, the administration of BPH medications is tailored to patient/disease characteristics and entails long-time adherence to therapy. The emergence of new surgical modalities, which combine significantly lower morbidity compared to standard procedures and more durable effects than the available medications, seems to challenge the current treatment algorithm. More direct comparisons and the increasing experience with these surgical modalities will delineate the switch points between various therapy levels along the BPH management sequence.
Topics: Male; Humans; Prostatic Hyperplasia; Drug Therapy, Combination; Lower Urinary Tract Symptoms; Pharmaceutical Preparations
PubMed: 37448198
DOI: 10.1080/14656566.2023.2237406 -
The American Journal of Nursing Dec 2023Medication preparation and administration are complex tasks that nurses must perform daily within today's complicated health care environment. Despite more than two...
BACKGROUND
Medication preparation and administration are complex tasks that nurses must perform daily within today's complicated health care environment. Despite more than two decades of efforts to reduce medication errors, it's well known that such errors remain prevalent. Obtaining insight from direct care nurses may clarify where opportunities for improvement exist and guide future efforts to do so.
PURPOSE
The study purpose was to explore direct care nurses' perspectives on and experiences with medication safety practices and errors.
METHODS
A qualitative descriptive study was conducted among direct care nurses employed across a large health care system. Data were collected using semistructured interview questions with participants in focus groups and one-on-one meetings and were analyzed using qualitative direct content analysis.
RESULTS
A total of 21 direct care nurses participated. Four major themes emerged that impact the medication safety practices of and errors by nurses: the care environment, nurse competency, system influences, and the error paradigm. These themes were often interrelated. Most participants depicted chaotic environments, heavy nursing workloads, and distractions and interruptions as increasing the risk of medication errors. Many seemed unsure about what an error was or could be.
CONCLUSIONS
The complexity of medication safety practices makes it difficult to implement improvement strategies. Understanding the perspectives and experiences of direct care nurses is imperative to implementing such strategies effectively. Based on the study findings, potential solutions should include actively addressing environmental barriers to safe medication practices, ensuring more robust medication management education and training (including guidance regarding the definition of medication errors and the importance of reporting), and revising policies and procedures with input from direct care nurses.
Topics: Humans; Clinical Competence; Nurses; Medication Errors; Pharmaceutical Preparations; Nursing Care
PubMed: 37934872
DOI: 10.1097/01.NAJ.0000996552.02491.7d -
American Society of Clinical Oncology... Jun 2024The management of brain metastases, a potentially devastating complication of advanced cancers, has become increasingly complex with advancements in local and systemic... (Review)
Review
The management of brain metastases, a potentially devastating complication of advanced cancers, has become increasingly complex with advancements in local and systemic therapies. Improved outcomes and extended survival for patients with metastatic solid tumors have led to a surge in the prevalence and possibly incidence of brain metastases, affecting up to 40% of individuals with solid tumors. Enhanced imaging technologies contribute to more accurate and early detection, shaping the understanding of the intricate landscape of this condition. Traditionally, surgery and radiation stood as the mainstays of treatment because of the limited efficacy of systemic therapies within the brain. However, emerging clinical data, particularly in melanoma, lung, and breast cancers, reveal promising results with novel systemic treatments such as immunotherapy and targeted therapies. Despite the historical exclusion of patients with active brain metastases from clinical trials, a shift is occurring toward a more inclusive approach. This chapter delves into the multifaceted challenges associated with managing brain metastases, with a focus on the evolving landscape of systemic approaches as well as the intricacies of shared decision making, providing a comprehensive overview of the current state and future directions in navigating the complexities of brain metastases management.
Topics: Humans; Brain Neoplasms; Disease Management; Combined Modality Therapy
PubMed: 38781565
DOI: 10.1200/EDBK_433694 -
Diabetes & Metabolic Syndrome Mar 2024Diabetic gastroparesis (DGp) is a common and preventable complication of uncontrolled diabetes mellitus (D.M.) and significantly affects the Quality of Life of patients.... (Review)
Review
BACKGROUND AND AIMS
Diabetic gastroparesis (DGp) is a common and preventable complication of uncontrolled diabetes mellitus (D.M.) and significantly affects the Quality of Life of patients. Diagnosis and management present as a clinical challenge due to the disease's complexity and limited effective therapeutic options. This review aims to comprehensively outline the pathogenesis, diagnosis, and management of diabetic gastroparesis, evaluating evolving approaches to guide clinicians and provide future recommendations.
METHODS
A literature review was conducted on scholarly databases of PubMed, Google Scholar, Scopus and Web of Science encompassing published articles, gray literature and relevant clinical guidelines. Data were synthesized and analyzed to provide a comprehensive overview of diabetic gastroparesis, focusing on pathogenesis, diagnosis, and management.
RESULTS
The review intricately explores the pathogenesis contributing to diabetic gastroparesis, emphasizing autonomic neuropathy, oxidative stress, inflammation, hormonal dysregulation, microbiota alterations, and gastrointestinal neuropathy. Primary management strategies are underscored, including lifestyle modifications, symptom relief, and glycemic control. The discussion encompasses pharmacological and surgical options, highlighting the importance of a multidisciplinary approach involving various healthcare professionals for comprehensive patient care.
CONCLUSION
This review offers a thorough understanding of pathogenesis, diagnosis, and management of diabetic gastroparesis, underlining evolving approaches for clinicians. A multidisciplinary approach is crucial to address both the physical and mental health aspects of diabetes and its complications.
Topics: Humans; Gastroparesis; Diabetes Complications; Disease Management; Quality of Life; Prognosis
PubMed: 38579489
DOI: 10.1016/j.dsx.2024.102994 -
European Journal of Neurology Jun 2024
Topics: Humans; Neuromuscular Diseases; Rare Diseases; Patient Care Team; Disease Management
PubMed: 38425128
DOI: 10.1111/ene.16265