Medical research archives最新文献

{"title":"Neoadjuvant and Adjuvant Therapy; Calculating Costs","authors":"H. Guirgis","doi":"10.18103/mra.v11i8.4313","DOIUrl":"https://doi.org/10.18103/mra.v11i8.4313","url":null,"abstract":"Background: Neoadjuvant Nivolumab plus chemotherapy improved event-free survival in early resectable lung cancer. The target therapy Osimertinib is used as neoadjuvant, adjuvant and in advanced advanced/metastatic non-small lung cancer (a/m- NSCLC). The current clinical practice in a/m- NSCLC is to continue Osimertinib, if effective and safe. The estimated 3-year cost was $745,116, necessitating placement of $500,000 cap. The median immune check point inhibitors (ICI) 3-year cost of $404,388 was below the cap (Guirgis, ESMED, 2023). We aimed to quantify and compare ICI-and Osimertinib costs in earlier vs advanced stages in multiple solid tumors. Methods: Annual 2019-2020 costs of Osimertinib were calculated ad monthly optimal dose x 12. The ICI were calculated as dose x mg/m2 or per 80 kg x price x number of cycles. Results: The, 2-year Osimertinib cost in 1 st and 2 nd -line metastatic disease was $496,744, adjuvant 1-year $248,372 and neoadjuvant $31,046.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84639731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Global Emergency: Identifying Priorities for Reforming International Emergency Medical Systems","authors":"S. Thygerson, Gregory Memmott, Robbie Chaney","doi":"10.18103/mra.v11i5.3922","DOIUrl":"https://doi.org/10.18103/mra.v11i5.3922","url":null,"abstract":"Emergency Medical Systems differ around the world and perform at varying levels of effectiveness. This study analyzed how well countries met the emergency response requirements for emergency medical teams set by the World Health Organization and professional literature recommendations in the three levels of country classifications set by the United Nations. This was conducted through a stratified random sample of ten countries in the categories: developed, economies in transition, and developing, for a total of thirty countries. Each country was qualitatively analyzed for emergency response times, types of public-to-provider communication, insurance/financial coverage, certification level of emergency care provider, and level of emergency hospital care. These areas were compared to the WHO recommendations and the higher standards of care recommended by the professional literature. It was found that 90% of developing countries did not meet the WHO recommendation compared to 50% of transitioning economies, and 10% of developed countries. There was a strong positive correlation between Gross Domestic Product and overall effectiveness of an EMS system. Moving forward, it is recommended that the underlying problems be identified, risk factors evaluated, possible interventions created, and implementing interventions in developing countries to improve communication from public to provider in pre-hospital care, and hospital emergency care","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"R-30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84754353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical Factors of Food Influencing the Postprandial Blood or Plasma Glucose Level: A Narrative Review","authors":"R. Bipat, I. Magali, R. Soekhoe, J. Toelsie","doi":"10.18103/mra.v11i4.3739","DOIUrl":"https://doi.org/10.18103/mra.v11i4.3739","url":null,"abstract":"Emerging evidence suggests that a high postprandial glucose level in plasma or blood is an important factor for the etiology of non-communicable disorders like the metabolic syndrome, diabetes, obesity and cardiovascular disease. A high sugar content of the food naturally increases the postprandial glucose level. However, quite a few studies provided proof in the past that the physical properties like viscosity, temperature, and water content of the food we consume also may influence the level of this parameter. The aim of this study is to give a narrative review of present findings that showed the physical properties of consumed food influenced the postprandial glucose level. The online databases Medline, Pubmed, Google Scholar and Hinari have been searched for publications on “plasma glucose” and “temperature” or “viscosity” or “solubility” or “water content”. All articles dealing with the influence on the postprandial glucose level in the blood have been included. Articles written in a language we could not understand or without a proper translation into English have been excluded. In general, most available studies showed that the physical properties temperature, viscosity, and water content of consumed food influenced the postprandial glucose. An increased temperature, increased viscosity and decreased water content of the food is generally associated with a higher postprandial glucose level in blood or plasma after consumption. Further detailed studies in both preclinical as well as clinical trials should be considered to obtain more detailed results regarding this.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"76 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88576573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congenital Heart Diseases in the Cleft Lip Palate Patients and its Perioperative Implications: An Observational Study In Rural Central Maharashtra, India","authors":"Monal Karkar, Abhinav Lambe","doi":"10.18103/mra.v11i7.2.4167","DOIUrl":"https://doi.org/10.18103/mra.v11i7.2.4167","url":null,"abstract":"Introduction: Congenital heart disease (CHD) is a common birth defect that occurs in approximately 1% of live births worldwide. Cleft lip and palate (CLP), another common birth defect, affecting approximately 1 in 600- 800 live births in India. Several studies have reported an association between CHD and CLP, however, there is limited data on the prevalence and types of CHD in patients with CLP in rural areas of developing countries, including India. This study aimed to investigate the prevalence and types of CHD in patients with CLP at a rural hospital in central Maharashtra, India. Methods: This retrospective study included medical records of patients with isolated Cleft lip, isolated cleft palate and patients with cleft lip and palate, between January 2018 and December 2020. The study was conducted at a rural hospital in central Maharashtra, India. The patients’ records were examined for any heart disease. Patients who had a diagnosis of CHD were identified through medical records and echocardiography reports. The prevalence and types of CHD were compared between the two groups using descriptive statistics and chi-square tests. Results: A total of 291 patients were included in our study. 169 were males and 122 were females. Congenital heart diseases were found in 12.37% (n=36) patients.5 Cleft lip (13%), 12 Cleft lip and palate (48%), 19 Isolated cleft palate (39%) were diagnosed with Congenital heart diseases. The types of Congenital Heart Diseases reported in our study were atrial septal defect, Ventricular septal defect, Patent ductus arteriosus, Pulmonic Stenosis and Tetralogy of Fallot. Conclusion: The most common types of CHD in both groups were ASD and VSD, but the prevalence of these defects was significantly higher in the CLP group. These findings have important implications for the multidisciplinary Perioperative management of patients with CLP, as they may require close monitoring for CHD and appropriate intervention if necessary, especially in resource-limited settings.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88801093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Malpractice Payments and Adverse Actions against Pharmacists in the United States between 1990-2022","authors":"Mhay S., S. S., Kapadia U., Nair N., Nalliah RP.","doi":"10.18103/mra.v11i7.1.4043","DOIUrl":"https://doi.org/10.18103/mra.v11i7.1.4043","url":null,"abstract":"Background: We evaluated malpractice payments and adverse actions against pharmacists in the United States. Malpractice is defined as professional negligence by act or omission. Adverse actions are actions administered by the board of registration in a health profession against a provider. The purpose of the study is to analyze the trends in malpractice payments and adverse actions for pharmacists during the period 1990-2022. Methods: This is a retrospective study that utilizes the National Practitioner Data Bank (NPDB) data analysis tool for the period 1990-2022. This information was exported to a data visualization tool and trends were studied. Results: During the period of the study there were 2480 malpractice payments and 44,204 adverse action reports made against pharmacists. In the current study we found that there has been a 19.56% decline in the number of malpractice payments against pharmacists in the last 5 years from 46 in 2018 to 37 in 2022. Similarly, adverse action reports also show a downward trend from 2016 to 2022. Conclusion: Pharmacy profession implements multiple processes to protect patients from medication errors. As the volume of prescriptions increases in the US, there is an increased risk of error and subsequent litigation against pharmacists. Even though malpractice payments and adverse actions against pharmacists have continued to decline, the probability of an adverse action remains high for practicing pharmacists. As the role of pharmacist continues to evolve there is a need to keep up with the changes in the healthcare market.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89355256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding Attitudes and Practices of Low-Income Caregivers Toward Sugar-Sweetened Beverage Consumption in Preschool-Aged Children","authors":"C. Cooper, Angela Northrup, Michelle Iannacchino","doi":"10.18103/mra.v11i3.3459","DOIUrl":"https://doi.org/10.18103/mra.v11i3.3459","url":null,"abstract":"Sugar-sweetened beverage (SSB) consumption during early childhood has been linked to adverse health outcomes across the lifespan. Caregivers of young children are often unaware of the potential health harms of SSB and may lack knowledge, skills and environmental supports to limit SSB. The objectives of this study were to determine study caregivers’ attitudes and practices with regard to SSB and to identify themes that may inform future policies and interventions to limit these beverages. Guided by the Social Ecological Model (SEM), the research team interviewed low-income caregivers of children ages two to five at a health clinic in urban New York State. Interviews were recorded, transcribed, and coded for themes and further analyzed for determinants of behavior with regard to providing SSB. Five major themes emerged: Greater SSB knowledge led to healthier choices; confusion about the healthfulness of some SSB; SSB affordability, accessibility and cultural acceptability; children’s “pester power” to obtain SSBs; and, lack of SSB information from healthcare providers. Determinants such as perceived barriers to action, self-efficacy, cues to action, and perceived threat emerged from the themes. SSB are widely available, affordable and palatable. Healthcare providers seldom discuss children’s SSB intake specifically at well visits. SSB are frequently marketed and labeled as “healthy.” SSB are a significant source of empty calories and added sugars. Helping parents limit SSBs may reduce child overweight and obesity and minimize lifelong chronic disease risks. Heathcare providers, health campaigns and nutrition assistance programs may collaborate to help parents limit SSB intake in young children.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87260941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A COMPACT NEUTRON GENERATOR FOR THE NIORT® TREATMENT OF SEVERE SOLID CANCERS","authors":"M. Martellini","doi":"10.18103/mra.v11i3.3799","DOIUrl":"https://doi.org/10.18103/mra.v11i3.3799","url":null,"abstract":"In the last four years, TheranostiCentre S.r.l., Berkion Technology LLC and ENEA have patented and fabricated a first prototype of a Compact Neutron Generator (CNG) currently under testing in the ENEA laboratories. Besides the usual applications in the field of materials irradiation, this CNG - producing neutrons of 2.45 MeV energy by using the DD fusion reaction - was conceived for the neutron irradiation of the solid cancer’s tumour bed by means of the Intra-Operative Radiotherapy (IORT) technique, the so-called neutron-IORT (nIORT®). The CNG is self-shielded and light-weight (~120 kg) making possible its remote handling by a robotic arm. Accurate Monte Carlo simulations, modelling the CNG and the “open wound” biological tissues near its irradiation window, demonstrated that the apparatus - operated at 100 kV-10 mA - supplies a neutron flux ~108 cm-2 s-1 and can deliver equivalent dose rates ~2 Gy (RBE)/min. Hence, it can administer very high dose levels in limited treatment times. This article briefly summarizes the main findings of this collaborative research study, the clinical rationales underpinning the nIORT® idea and the potential performances of the CNG for the treatment of solid cancer pathologies. Indeed, the CNG can be installed in an operating room dedicated to nIORT® treatments, without posing any environmental and safety issues. Monte Carlo simulations have been carried out by envisioning the CNG equipped with an IORT applicator, that is an applicator pipe with a tuneable diameter to be inserted in the surgical cavity. By foreseeing the clinical endpoints of the standard IORT protocols, the irradiation performances for potential nIORT® treatments - obtained with an applicator pipe of 6 cm diameter - are here reported for different regimes: from 10 up to 75 Gy (RBE), that can be administered in a single session of about 4 to 30 minutes. Besides the dose peak in the centre of the tumour bed, the almost isotropic neutrons emission allows to irradiate the surroundings side-walls of the tumour bed – usually filled by potential quiescent cancer cells (QCCs) – and therefore reducing the chances of local recurrences by improving the local control of the tumour. The rapid decrease in tissues depth of the dose profile (in few centimetres) will spare the neighbouring organs at risk from harmful radiations. Thus, the CNG apparatus developed for nIORT® applications can potentially improve the resectability rate of a given neoadjuvant cancer treatment and, generally, could satisfy all five R’s criteria of radiotherapy. Furthermore, in comparing with the current IORT techniques with electrons or low-keV X-rays, the nIORT® exploiting a high-flux neutrons beam of 2.45 MeV energy could lead to some significant clinical advantages due to its larger Linear Energy Transfer (LET, ~ 40 keV/m as average) and significantly higher Relative Biological Effectiveness (RBE 16) than all other forms of ionizing radiation.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87401898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large Variation in Diagnosis and Treatment of Chyle Leak after Pancreatic Surgery: A Nationwide Insight","authors":"S. Rietveld, A. Latenstein, M. Besselink, J. Haverkamp, J. Haver","doi":"10.18103/mra.v11i7.1.4008","DOIUrl":"https://doi.org/10.18103/mra.v11i7.1.4008","url":null,"abstract":"Background: In the current literature different diagnosis and treatment strategies for chyle leak after pancreatic surgery are described. In 2017, the International Study Group for Pancreatic Surgery defined a consensus-based definition for diagnosis. However, consensus on the optimal treatment strategy is lacking. Aim: The aim of this multicenter study is to investigate the current treatment and diagnosis of chyle leak after pancreatic surgery in clinical practice in the Netherlands to gain insight into practical applications of chyle leak. Methods: A nationwide survey about the diagnosis and treatment of chyle leak was sent to specialized dieticians and pancreatic surgeons from all 16 pancreatic centers collaborating in the Dutch Pancreatic Cancer Group. Data was quantitative processed according to thematic content analysis and by using descriptive analysis. Results: In total, 16 dieticians from 16 centers and 20 surgeons from 12 centers completed the questionnaire. Analysis showed that the International Study Group for Pancreatic Surgery-definition for chyle leak was used in clinical practice by 31% (n=11) of the respondents. The results show also large nationwide variation in treatment of chyle leak after pancreatic surgery, as well between as within centers. The most common treatment was a step-up approach of nutritional therapies (44% (n=16)), which starts with an enteral fat restricted diet enriched with medium chain fatty acids followed by total parenteral nutrition. Conclusion This study shows that the current diagnosis and treatment strategies for chyle leak after pancreatic surgery in clinical practice on a nationwide scale are different. More comparable studies are needed to define the optimal treatment strategy for chyle leak. There is need for an international multidisciplinary (sub)working group to reach consensus on the treatment strategy of chyle leak and to discuss implementation strategies for clinical practice.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80602790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards adaptive structuring of the lupologist’s consultation to transform the care pathway of systemic lupus erythematosus","authors":"","doi":"10.18103/mra.v11i3.3679","DOIUrl":"https://doi.org/10.18103/mra.v11i3.3679","url":null,"abstract":"Systemic lupus erythematosus (SLE) is a complex autoimmune disease, which can be clinically heterogeneous in the same patient over the disease process and has an unpredictable evolution. Although its prevalence is increasing, SLE remains a rare disease with frequent extra-articular manifestations managed by multiple specialists. Among these, the internist is a key player in the overall coordination of the care pathway. The dramatic improvement in the short-term prognosis of SLE observed over the past few decades has favoured the emergence of more chronic disease-associated morbidities, especially infectious, cardiovascular and/or related to sequelae, notably renal. Thus, every lupologist is confronted with the difficulty of having to address, in an educational, individualised but also systematic way, a certain number of key items on which the short-, medium- and long-term medical future of patients who develop SLE at a relatively young age depend. In recent years, in addition to the creation of a network of reference centres and the drafting of regularly updated national therapeutic guidelines and therapeutic education programs, international consensus about the factors to consider in SLE patients has been reached, including the definition of therapeutic objectives according to a treat-to-target (T2T) strategy. However, the translation of these new objectives/paradigms in real-life has encountered a number of difficulties. As part of a multidisciplinary team involving SLE patients, we developed practical tools in the form of CHECKLISTs addressing the problems of refractory SLE (D2T), the management of comorbidities and toxicities (BASICs), and, more recently, therapeutic de-escalation with a shared medical decision (T2U). It appears that there is an opportunity to transform the care pathway of SLE patients by allowing the implementation of these tools within adaptive structuring of the consultation, which has the advantage of defining a starting point within the care pathway as a common denominator for lupologists, regardless of their specialty or where they work.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"149 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86656723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring Social Determinant Access and Equity by Race in U.S. States","authors":"R. Hahn","doi":"10.18103/mra.v11i2.3643","DOIUrl":"https://doi.org/10.18103/mra.v11i2.3643","url":null,"abstract":"The effective design, implementation, monitoring, and evaluation of state programs to reduce racial health inequities requires measures of societal resource access (e.g., education, home ownership, voting) and access inequity by race in each state. This paper proposes criteria for the selection of social determinants to assess, and ways to combine data to assess overall access and overall access inequity in states. Access and equity can be compared across geographic regions assessed. Hypotheses regarding the determinants and consequences of access and equity can be examined. Means of validating metrics are proposed. An example of analysis of access and inequity for Blacks and Whites in U.S. states yields surprising results—social determinant access and access equity are generally greatest in southern states. These metrics can be used to target and measure the effects of interventions to advance health equity for racial minority populations. The condition of state access and equity by race indicates the culmination of structural racism.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86706362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}