scholarly journals Treatment of AML in Older Patients

2021 ◽  
Author(s):  
Jacobien Hilberink ◽  
Gerwin Huls
Keyword(s):  
Treatment Option ◽  
Older Patients ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Patient Characteristics ◽  
Clinical Decision ◽  
New Drugs ◽  
Advanced Stages ◽  
Allogeneic Haematopoietic Cell Transplantation ◽  
Treatment Tolerance

Acute myeloid leukaemia (AML) is a disease mostly diagnosed in older adults. Treatment of older patients with AML remains challenging with higher rates of intrinsic chemotherapeutic resistance and decreased treatment tolerance. Indeed AML in older patients has different clinical and biologic characteristics compared to younger patients. Several treatment options are available for treatment of AML in older patients, namely conventional intensive chemotherapy (‘3 + 7’), low-dose cytarabine, and hypomethylating agents. Combinations with new drugs have been recently approved or are in advanced stages of clinical testing, namely venetoclax, midostaurin, glasdegib. Clinical decision making should take into account disease characteristics (e.g. cytogenetic and molecular abnormalities, white blood cell count), patient characteristics (e.g. performance, comorbidities, geriatric assessment) and patients’ preference when considering which treatment option is most suitable for the older patient. Allogeneic haematopoietic cell transplantation (HCT) as post-remission strategy should also be considered for older patients with AML. Allogeneic HCT following reduced-intensity conditioning or non-myeloablative conditioning has made this treatment option more suitable for older patients with a reduction in treatment-related mortality.

Management of thoracic aortic lesions - the future is endovascular

VASA ◽  
2012 ◽  
Vol 41 (3) ◽  
pp. 163-176 ◽  
Author(s):  
Weidenhagen ◽  
Bombien ◽  
Meimarakis ◽  
Geisler ◽  
A. Koeppel
Keyword(s):  
Thoracic Aorta ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Clinical Decision ◽  
Clinical Results ◽  
Treatment Modalities ◽  
Traumatic Rupture ◽  
Descending Thoracic Aorta ◽  
New Treatment ◽  
Aneurysm Dissection

Open surgical repair of lesions of the descending thoracic aorta, such as aneurysm, dissection and traumatic rupture, has been the “state-of-the-art” treatment for many decades. However, in specialized cardiovascular centers, thoracic endovascular aortic repair and hybrid aortic procedures have been implemented as novel treatment options. The current clinical results show that these procedures can be performed with low morbidity and mortality rates. However, due to a lack of randomized trials, the level of reliability of these new treatment modalities remains a matter of discussion. Clinical decision-making is generally based on the experience of the vascular center as well as on individual factors, such as life expectancy, comorbidity, aneurysm aetiology, aortic diameter and morphology. This article will review and discuss recent publications of open surgical, hybrid thoracic aortic (in case of aortic arch involvement) and endovascular repair in complex pathologies of the descending thoracic aorta.

Exploring hospital nurses’ transitional medication management for older patients with multi-morbidity: An ethnographic study

2021 ◽  
pp. 205715852110617
Author(s):  
Mette Geil Kollerup ◽  
Birgitte Schantz Laursen
Keyword(s):  
Older Patients ◽  
Communication Systems ◽  
Clinical Decision Making ◽  
Medication Management ◽  
Clinical Decision ◽  
Ethnographic Study ◽  
University Hospital ◽  
Hospital Nurses ◽  
Assessment Skills ◽  
Field Notes

Transitional medication management, in which individual needs are balanced against organizational priorities, is crucial for safe discharge processes. The aim of this study was to explore hospital nurses’ transitional medication management in the discharge of older patients with multi-morbidity. Using an ethnographic approach the data were collected through participant observations at a mixed medical ward at a Danish university hospital for two weeks. The participants were five registered nurses, responsible for nursing care of 23 patients with multi-morbidity and planned for discharge. The data comprised field notes that were analysed using iterative processes of domain, taxonomic and component analysis. The reporting adhered to the COREQ checklist. Hospital nurses’ transitional medication management was characterized by unpredictability and inconsistency in patient situations, fragmentation and discontinuity in working processes and complexity in communication systems. Special attention to nurses’ needs assessment skills and clinical decision making in caring for patients with multi-morbidity in a single focused healthcare system is required.

scholarly journals Necrotizing fasciitis: presentation, microbiology and outcomes in a community hospital

2020 ◽  
Vol 7 (8) ◽  
pp. 2471
Author(s):  
Mercy N. Jimenez ◽  
Emily S. Seltzer ◽  
Bhavana Devanabanda ◽  
Martine Louis ◽  
Nageswara Mandava
Keyword(s):  
New York ◽  
Necrotizing Fasciitis ◽  
Clinical Decision Making ◽  
Community Hospital ◽  
Average Length ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Clinical Decision ◽  
Blood Cultures ◽  
Average Length Of Stay

Background: Necrotizing fasciitis (NF) is an aggressive and often fatal, soft tissue infection. Delayed surgical therapy leads to worsened outcomes. This study evaluates the mortality, outcomes, and characteristics of patients with NF in a diverse New York City Community Hospital Network.Methods: Retrospective chart review from 2012 to 2019 using ICD-9 and ICD-10 codes of gas gangrene, Fournier’s gangrene, and necrotizing fasciitis was done. Of the 297 patients reviewed 28 met inclusion criteria of imaging findings, operative reports, and clinical diagnosis of NF by an attending surgeon.Results: On average patients in ER were seen by the surgical team within less than 12 hours. Most patients were debrided within 10 hours of surgical consultation and on average received 2.2 procedures. Of the wound cultures obtained 65.38% were polymicrobial in nature. The average length of stay was 17.4 days and 32% of patients required ICU admission. The surgical mortality rate was 7.61%.Conclusions: Necrotizing fasciitis is a rare entity and increasing provider knowledge on patient characteristics as well as the complexity of these patients and the types and number of procedures they require may help guide clinical decision making. We identified that while most of our patients had negative blood cultures on admission, those that had positive blood cultures had multiple organisms growing. Knowing that these patients are complex and likely require multiple procedures, prompt operative intervention is key.

Aortoiliac Reconstruction

2017 ◽  
Author(s):  
Mark K. Eskandari ◽  
Michael J Nooromid
Keyword(s):  
Clinical Decision Making ◽  
Preoperative Evaluation ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Clinical Decision ◽  
Occlusive Disease ◽  
Aortobifemoral Bypass ◽  
Aortoiliac Occlusive Disease ◽  
Atherosclerotic Occlusive Disease ◽  
Aortoiliac Reconstruction

This review outlines the preoperative evaluation, clinical decision making, and surgical treatment options for patients with aortoiliac occlusive disease. It also details the open surgical techniques for the treatment of aortoiliac occlusive disease and reviews endovascular treatment options. The discussion of treatment options includes the potential complications and expected outcomes, as well as steps that can be taken to optimize surgical results. Key words: aortobifemoral bypass, aortoiliac reconstruction, atherosclerotic occlusive disease, endovascular reconstruction, femoral endarterectomy, iliac angioplasty, iliac stenting, peripheral vascular disease 

scholarly journals Concordance Rate between Clinicians and Watson for Oncology among Patients with Advanced Gastric Cancer: Early, Real-World Experience in Korea

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Youn I Choi ◽  
Jun-won Chung ◽  
Kyoung Oh Kim ◽  
Kwang An Kwon ◽  
Yoon Jae Kim ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Treatment Option ◽  
Clinical Decision Making ◽  
Medical Information ◽  
Medical Center ◽  
Treatment Options ◽  
Concordance Rate ◽  
Cancer Center ◽  
Recommended Level

Backgrounds/Aims. Watson for Oncology (WFO) is a cognitive technology that processes medical information by analyzing the latest evidence and guidelines. However, studies of the concordance rate between WFO and clinicians for advanced gastric cancer (AGC) are lacking.Methods. We retrospectively reviewed 65 patients with AGC who consulted WFO and the Gachon Gil Medical Center multidisciplinary team (GMDT) in 2016 and 2017. The recommendations of WFO were compared with the opinions of the GMDT. WFO provided three treatment options: recommended (first treatment option), for consideration (second treatment option), and not recommended.Results. In total, 65 patients (mean age 61.0 years; 44 males and 21 females) were included in the study. The concordance rate between WFO and the GMDT was 41.5% (27/65) at the recommended level and 87.7% (57/65) at the for consideration level. The main causes of discordance between WFO and the GMDT were as follows. First, WFO did not consider the medical history. Second, WFO recommended the use of agents that are considered outdated in Korea. Third, some patients wanted to be involved in a clinical trial. Fourth, some patients refused to use the biologic agents recommended by WFO for financial reasons as they were not covered by medical insurance.Conclusions. The concordance rate at the recommended level was relatively low but was higher at the for consideration level. Discordances arose mainly from the different medical circumstances at the Gachon Gil Medical Center (GMC) and the Memorial Sloan Kettering Cancer Center (MSKCC), the main WFO consulting center. The utility of WFO as a tool for supporting clinical decision making could be further improved by incorporating regional guidelines.

Using the Outcome Prioritization Tool (OPT) to assess the preferences of older patients in clinical decision-making: A review

Maturitas ◽  
2019 ◽  
Vol 128 ◽  
pp. 49-52 ◽  
Author(s):  
Mariken E. Stegmann ◽  
Suzanne Festen ◽  
Daan Brandenbarg ◽  
Jan Schuling ◽  
Barbara van Leeuwen ◽  
...  
Keyword(s):  
Decision Making ◽  
Older Patients ◽  
Clinical Decision Making ◽  
Clinical Decision

Neuralgic amyotrophy: a paradigm shift in diagnosis and treatment

2020 ◽  
Vol 91 (8) ◽  
pp. 879-888 ◽  
Author(s):  
Clemens Gstoettner ◽  
Johannes A Mayer ◽  
Stephanie Rassam ◽  
Laura A Hruby ◽  
Stefan Salminger ◽  
...  
Keyword(s):  
High Resolution ◽  
Peripheral Nerve ◽  
Clinical Decision Making ◽  
Current Knowledge ◽  
Treatment Options ◽  
Treatment Algorithm ◽  
Clinical Decision ◽  
Neuralgic Amyotrophy ◽  
Positive Effects ◽  
Nerve Surgery

Neuralgic amyotrophy (NA), also known as Parsonage-Turner syndrome, is characterised by sudden pain attacks, followed by patchy muscle paresis in the upper extremity. Recent reports have shown that incidence is much higher than previously assumed and that the majority of patients never achieve full recovery. Traditionally, the diagnosis was mainly based on clinical observations and treatment options were confined to application of corticosteroids and symptomatic management, without proven positive effects on long-term outcomes. These views, however, have been challenged in the last years. Improved imaging methods in MRI and high-resolution ultrasound have led to the identification of structural peripheral nerve pathologies in NA, most notably hourglass-like constrictions. These pathognomonic findings have paved the way for more accurate diagnosis through high-resolution imaging. Furthermore, surgery has shown to improve clinical outcomes in such cases, indicating the viability of peripheral nerve surgery as a valuable treatment option in NA. In this review, we present an update on the current knowledge on this disease, including pathophysiology and clinical presentation, moving on to diagnostic and treatment paradigms with a focus on recent radiological findings and surgical reports. Finally, we present a surgical treatment algorithm to support clinical decision making, with the aim to encourage translation into day-to-day practice.

scholarly journals Real-time utilisation of administrative data in the ED to identify older patients at risk: development and validation of the Dynamic Silver Code

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e033374 ◽  
Author(s):  
Daniela Balzi ◽  
Giulia Carreras ◽  
Francesco Tonarelli ◽  
Luca Degli Esposti ◽  
Paola Michelozzi ◽  
...  
Keyword(s):  
At Risk ◽  
Cohort Study ◽  
Real Time ◽  
Administrative Data ◽  
Older Patients ◽  
Clinical Decision Making ◽  
External Validation ◽  
Clinical Decision ◽  
Patients At Risk ◽  
Ed Visits

ObjectiveIdentification of older patients at risk, among those accessing the emergency department (ED), may support clinical decision-making. To this purpose, we developed and validated the Dynamic Silver Code (DSC), a score based on real-time linkage of administrative data.Design and settingThe ‘Silver Code National Project (SCNP)’, a non-concurrent cohort study, was used for retrospective development and internal validation of the DSC. External validation was obtained in the ‘Anziani in DEA (AIDEA)’ concurrent cohort study, where the DSC was generated by the software routinely used in the ED.ParticipantsThe SCNP contained 281 321 records of 180 079 residents aged 75+ years from Tuscany and Lazio, Italy, admitted via the ED to Internal Medicine or Geriatrics units. The AIDEA study enrolled 4425 subjects aged 75+ years (5217 records) accessing two EDs in the area of Florence, Italy.InterventionsNone.Outcome measuresPrimary outcome: 1-year mortality. Secondary outcomes: 7 and 30-day mortality and 1-year recurrent ED visits.ResultsAdvancing age, male gender, previous hospital admission, discharge diagnosis, time from discharge and polypharmacy predicted 1-year mortality and contributed to the DSC in the development subsample of the SCNP cohort. Based on score quartiles, participants were classified into low, medium, high and very high-risk classes. In the SCNP validation sample, mortality increased progressively from 144 to 367 per 1000 person-years, across DSC classes, with HR (95% CI) of 1.92 (1.85 to 1.99), 2.71 (2.61 to 2.81) and 5.40 (5.21 to 5.59) in class II, III and IV, respectively versus class I (p<0.001). Findings were similar in AIDEA, where the DSC predicted also recurrent ED visits in 1 year. In both databases, the DSC predicted 7 and 30-day mortality.ConclusionsThe DSC, based on administrative data available in real time, predicts prognosis of older patients and might improve their management in the ED.

A Multiscale Specimen-Specific Data Set to Enable Comprehensive Modeling and Simulation of the Tibiofemoral Joint

2013 ◽  
Author(s):  
Snehal Chokhandre ◽  
Ahmet Erdemir
Keyword(s):  
Clinical Decision Making ◽  
Mechanical Response ◽  
Multiple Scales ◽  
Treatment Options ◽  
Complex Structure ◽  
Clinical Decision ◽  
Fe Analysis ◽  
Data Set ◽  
Tibiofemoral Joint ◽  
Joint Biomechanics

The tibiofemoral joint is a complex structure and its overall mechanical response is dictated by its numerous substructures at both macro and micro levels. An in-depth understanding of the mechanics of the joint is necessary to develop preventative measures and treatment options for pathological conditions and common injuries. Finite element (FE) analysis is a widely used tool in joint biomechanics studies focused on understanding the underlying mechanical behavior at joint, tissue and cell levels [1]. Studies, regardless of their purpose (descriptive or predictive), when employing FE analysis, require anatomical and mechanical data at single or multiple scales. It is also critical that FE representations are validated and closely represent specifics of the joint of interest, anatomically and mechanically. This is an utmost need if these models are intended to be used to support clinical decision making (in surgery or for rehabilitation) and for the development of implants.

scholarly journals Orthodontic treatment time: can it be shortened?

2018 ◽  
Vol 23 (6) ◽  
pp. 90-105 ◽  
Author(s):  
Ricardo Moresca
Keyword(s):  
Orthodontic Treatment ◽  
Clinical Decision Making ◽  
Tooth Movement ◽  
Treatment Time ◽  
Treatment Options ◽  
Clinical Decision ◽  
Orthodontic Appliances ◽  
Factors Influencing ◽  
Determining Factors ◽  
Major Factors

Abstract Introduction: In the literature, no consensus has been reached about orthodontic treatment time. Similarly, the determining factors of the latter have not yet been completely elucidated. Objective: The aim of the present article was to deepen the discussion on the major factors influencing orthodontic treatment time, as well as to present some strategies that have proven effective in controlling and shortening it. Method: Based on evidences found in the literature, the method focussed in providing the basis for clinical decision-making. Conclusions: Treatment time varies according to the type of malocclusion and treatment options. Orthodontist’s influence, patient’s characteristics and compliance are all decisive in determining treatment time, while the effects provided by orthodontic appliances and methods used to speed tooth movement up seem little effective.

Sign in / Sign up

Export Citation Format

Share Document