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У статті подані методичні рекомендації з лікування дисбіозу кишечника. Приділено увагу використанню пробіотика-біоентеросептика Ентерожерміна в комплексному лікуванні даної категорії пацієнтів.

Aim: The study was done to determine malaria prevention and treatment practices among care-givers of under-fives in urban slums South-East Nigeria. Methods: A community-based cross-sectional study involving 145 care-givers of under-fives recruited via multistage sampling method using a semi-structured questionnaire in selected urban slums of Enugu north LGA of Enugu state. Results: The prevalence of Malaria prevention and treatment practice was 19.3% and 17% respectively. Association between the age group of the under-five and the malaria prevention practice was (p=0.034) while the associations between the age of care-givers’ spouse, educational level of caregivers’ spouse and malaria treatment practice in under five was also statistically significant with p-values of 0.003 and 0.047 respectively. Conclusion: Malaria prevention and treatment practice among care-givers of the under-fives was low. Hence, the need for the government, non-governmental organizations and health care workers to collaborate so as to improve malaria outcome in the Nigeria society.

Background Ankle sprains are common musculoskeletal injuries. Until the 1990s, ankle ligament injuries were often treated operatively. The aim of this registry study was to determine how the change in treatment practice has affected the number of acute and elective ankle ligament surgeries in Finland. Material The data of ankle ligament injury patients operated between 1 January 1986 and 31 December 2018 was collected from the Finnish National Hospital Discharge Register. Results A total of 33,770 ankle ligament injuries were repaired. The incidence of acute ankle ligament injury repair surgery has decreased nearly 80% over the last three decades. No increase in the number of late-stage ankle ligament injury repairs was found. Conclusion The number of acute and elective ankle ligament surgeries has remained low in the 2000s. This suggests that the occurrence of clinical instability after ankle sprains has not increased, even though acute-phase treatment has become conservative.

Background: The oral presentation of studies at conferences may impact treatment practice even before the publication or regulatory approval. Methodological aspects and reporting patterns are evolving, and an assessment of these features may help understand the current landscape and the way forward. Methods: We analyzed the characteristics of primary analyses of phase 3 trials from oral sessions presented at ASCO, ESMO and SABCS 2017-19 and the timing of their subsequent publications. We excluded non-inferiority trials and duplicate presentations within the period. Results: Of 36 unique trials, 19/10/7 had a first author from Europe/United States/Asia or elsewhere, and 21/15 were in the (neo)adjuvant/palliative settings. All but one trial had 2 arms. The number of patients enrolled ranged from 226 to 4884 (median, 646). All but 2 trials were on systemic therapy, with 16 dedicated exclusively to hormone-receptor+, 8 to HER2+ and 6 to triple-negative disease. According to the authors, 23 (63.9%, 95% CI, 46.2 to 79.2%) trials were positive, and 13 were negative. For only 2 of the negative trials was the conclusion not entirely consistent with results. When sponsor information was available, 18/21 industry vs 4/14 academic trials were positive (P=0.002). Paradoxically, negative trials were larger than positive trials (medians of 2639 and 585 patients; P=0.002), perhaps because all but one of 13 negative trials were in the (neo)adjuvant setting, vs 9/23 among positive trials (P=0.004). The time to publication was significantly shorter for positive than negative trials (medians of 215 vs 785 days; HR=0.32; P=0.013). Of 30 trials with time-to-event endpoints, the ratio between observed:expected HR could be computed for 24: the mean was 0.88 for 15 positive and 1.43 for 9 negative trials (P=0.004; 1.09 overall). Conclusion: In recent phase 3 trials in breast cancer, positive trials are more likely than negative trials to be industry-sponsored, to assess the metastatic setting, and to be published earlier. These results also suggest that the treatment effect has been underestimated in positive trials. Research is ongoing to elucidate potential determinants of the latter hypothesis. Citation Format: Gustavo Oliveira Bretas, José Bines, Everardo Delforge Saad. Current landscape in phase 3 trials in breast cancer at major oncology conferences [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS11-23.

Introduction/objectives Multiple modes of administration are available for systemic lupus erythematosus (SLE) treatments. This study examined patient and physician characteristics associated with the choice of weekly subcutaneous (SC) injection or monthly intravenous (IV) infusion for an unspecified SLE treatment. Methods This was a cross-sectional, US web-based survey using a direct elicitation, stated-preference methodology (HO-16-16706). Two hundred patients and 200 physicians were asked to choose between IV or SC administration in a hypothetical scenario. Pairwise and multivariate analyses estimated the odds ratio (OR) for the likelihood of choosing SC over IV for respondent characteristics. Results Among patients, taking non-steroidal anti-inflammatory drugs increased the likelihood of choosing SC injection (OR 3.884), whilst having SLE-related skin problems, a fear of needles or self-injection, and never needing help around the house decreased the likelihood (OR 0.28, 0.13, 0.12, respectively; all p ≤ 0.05). Among physicians, > 95% recommended SC injection for patients who live or work far from an infusion center, prefer SC administration, and never or rarely miss medication doses. Physician characteristics including age and treatment practice also influenced choice. Conclusions Patient and physician characteristics influence choice of SC versus IV therapy for SLE. These findings might inform shared decision-making, which could lead to improved patient outcomes. Key Points• Data regarding patient and physician preference for different modes of administration of SLE therapy are sparse.• This cross-sectional, US web-based study showed that patient and physician characteristics influence choice of SC versus IV therapy for SLE.• A degree of disconnect exists between how factors influence patients’ choice and how those characteristics influence physicians’ choice of SLE treatment mode of administration.• The findings from this study might inform shared decision-making, which could improve alignment between treatment choice and patient preferences, treatment satisfaction, adherence, and improved patient outcomes.

This study investigated treatment characteristics of Guillain-Barré syndrome (GBS) in a real-world setting between 2000 and 2019. We analyzed clinical improvement between nadir and last follow-up in patients with severe GBS (defined as having a GBS disability scale > 2 at nadir) and aimed to detect clinical factors associated with multiple treatments. We included 121 patients (74 male; median age 48 [IQR 35–60]) with sensorimotor (63%), pure motor (15%), pure sensory (10%) and localized GBS (6%) as well as Miller Fisher syndrome (6%). 44% of patients were severely affected. All but one patient received at least one immunomodulatory treatment with initially either intravenous immunoglobulins (88%), plasma exchange (10%) or corticosteroids (1%), and 25% of patients received more than one treatment. Severe GBS but not age, sex, GBS subtype or date of diagnosis was associated with higher odds to receive more than one treatment (OR 4.22; 95%CI 1.36–13.10; p = 0.01). Receiving multiple treatments had no adjusted effect (OR 1.30, 95%CI 0.31–5.40, p = 0.72) on clinical improvement between nadir and last follow-up in patients with severe GBS. This treatment practice did not change over the last 20 years.

Recent regulatory approval of midostaurin, a FLT3 targeting small molecular inhibitor, will likely lead to increased use of midostaurin in combination with intensive chemotherapy for patients with FLT3-mutant AML. Translation of clinical trial results into everyday practice has its challenges. This study compared the relevance of the trial population and practices studied in the midostaurin registration study (RATIFY) with real-world practice in terms of patient factors, chemotherapy, mutation-specific frequencies and clinical outcomes among patients with FLT3-mutant AML in the pre-midostaurin era (2010-2015) in Australia. We observed substantial diversity of chemotherapy regimens used in the community and limitations of the generalizability of eligibility criteria used in RATIFY (such as age and hyperleukocytosis). This study provides real-world historical data that may be used for comparison with future trial cohorts incorporating FLT3 inhibitors into the management of FLT3-mutant AML and highlights the inherent difficulties in translating clinical trial data into routine practice.

The article discusses main issues relating to abnormal taste and smell, which may an oncologist come across in the treatment practice. It also describes mechanisms of dysgeusia and disosmia development, as well as their relationship with nutritional deficiency. Authors review approaches to assess sensory disorders before treatment, at all the stages and after radiation therapy and chemotherapy. They present the world experience in managing patients with the abnormalities and their possible correction.

The integrated Model of health care for patients with inflammatory bowel disease (IBD) is based on the creation of specialized centers where multidisciplinary teams provide patient-centered care. Recent studies showed that the introduction of such approach into the IBD treatment practice led to faster diagnosis, an increase in the proportion of patients with mild forms of IBD and, as a result, the reduction of medical costs. The present study aims to assess the economic consequences of the proposed IBD healthcare optimization in the Republic of Tatarstan. Materials and methods. A budget impact model was created to compare two scenarios: the basic case when IBD patients are treated according to the current practice based on the existing network of clinics versus the simulated scenario when IBD patients receive medical care within a specialized IBD center, organised in accordance with the integrated multidisciplinary approach. The study hypothesis implies that the proportion of patients with severe IBD is gradually decreasing due to the change in the treatment model and the improved diagnostic procedure. The direct medical costs included the cost of visits to doctors, ambulance calls, diagnostic tests, outpatient medications, and the day-time and 24-hour in-patient care. One-way sensitivity analysis of all model inputs was performed. Results. As a result of the modified practice in the Republic of Tatarstan, the cost of medical care for IBD patients will decrease by 120 million rubles over 5 years. The sensitivity analysis shows the results are robust and not sensitive to fluctuations in the variables. However, the results are shown to be most sensitive to fluctuations in the distribution of patients by IBD severity. Conclusion. The introduction of the integrated healthcare for patients with IBD will result in lower costs of this service.

Background: Community Acquired Methicillin Resistant Staphylococcus aureus (CA-MRSA) rates have been increasing worldwide and contribute to a growing “global health security threat” as reported by the WHO. Our group previously reported an overall rate of 7% in CA-MRSA upper extremity infections between 2004–2009 at the Auckland Regional Hand Unit. This fell below the Center for Disease Control (CDC) recommendation for empiric antimicrobial cover once local rates exceed 10–15%. We examined prevalence and characteristics of CA-MRSA upper extremity infections in our region over a subsequent 5-year period. Methods: One thousand two hundred and fifty-two patients with upper extremity infections requiring operative management between 2011 and 2015 inclusive were included in this study. Associated clinical characteristics were recorded including ethnicity, cultured organisms, antibiotic sensitivities, infection rate, and treatment practice. Results: One hundred and fifty (12%) of patients had culture positive CA-MRSA upper extremity infections. There was an increasing annual trend. Of note, rates of CA-MRSA in the Maori and Pacific Island ethnic subpopulations exceeded 15% in 2014 and 2015. Susceptibilities, associated factors and patient demographics are reported. Conclusions: Our unit enjoys significantly lower rates of CA-MRSA upper extremity infections than has been reported internationally. However, trends are increasing relative to our prior 6-year report, and the threshold for empiric treatment has been met within the Maori and Pacific Island ethnic subpopulations. This evolving threat is also highlighted by increasing cases of multi-drug resistant CA-MRSA. Evolving regional guidelines for empiric coverage of CA-MRSA among high-risk ethnic subpopulations identified by this study are underway.

Background There are numerous non-biologic and biologic disease-modifying anti-rheumatic drugs (bDMARDs) for rheumatoid arthritis (RA). Typical sequences of bDMARDs are not clear. Future treatment policies and trials should be informed by quantitative estimates of current treatment practice. Methods We used data from Corrona, a large real-world RA registry, to develop a method for quantifying sequential patterns in treatment with bDMARDs. As a proof of concept, we study patients who eventually use tocilizumab monotherapy (TCZm), an IL-6 antagonist with similar benefits used as monotherapy or in combination. Patients starting a bDMARD were included and were followed using a discrete-state Markov model, observing changes in treatments every 6 months and determining whether they used TCZm. A supervised machine learning algorithm was then employed to determine longitudinal patient factors associated with TCZm use. Results 7300 patients starting a bDMARD were followed for up to 5 years. Their median age was 58 years, 78% were female, median disease duration was 5 years, and 57% were seropositive. During follow-up, 287 (3.9%) reported use of TCZm with median time until use of 25.6 (11.5, 56.0) months. Eighty-two percent of TCZm use began within 3 years of starting any bDMARD. Ninety-three percent of TCZm users switched from TCZ combination, a TNF inhibitor, or another bDMARD. Very few patients are given TCZm as their first DMARD (0.6%). Variables associated with the use of TCZm included prior use of TCZ combination therapy, older age, longer disease duration, seronegative, higher disease activity, and no prior use of a TNF inhibitor. Conclusions Improved understanding of treatment sequences in RA may help personalize care. These methods may help optimize treatment decisions using large-scale real-world data.

Background. Due to the Coronavirus disease 2019 (COVID-19) pandemic, non-emergency services like botulinum toxin A (BoNT) injections were temporarily discontinued. Objective. We aimed to create standard practices that optimize the management of patients needing BoNT injections while ensuring both patients' and healthcare professionals' safety. Methods. We evaluated published guidelines and best practices to determine their applicability for BoNT injection during this pandemic. We then devised a decision tree algorithm for use in our hospital. Results. A decision tree algorithm has been formulated based on patient evaluation and risk stratification, triaging, the urgency of the procedure, and proper precautions on personal protective wear as appropriate for the procedure’s risk stratification. Conclusion. The algorithm is in place to ensure the safety of both the patient and healthcare professional. It can be adopted and revised by other centers to suit their clinic needs.

Background: Recent studies cast doubt on the net effect of antipsychotics for delirium. Aim: To investigate the influence of these studies and other factors on clinicians’ delirium treatment practice and practice change in palliative care and other specialties using the Theoretical Domains Framework. Design: Australia-wide online survey of relevant clinicians. Setting/participants: Registered nurses (72%), doctors (16%), nurse practitioners (6%) and pharmacists (5%) who cared for patients with delirium in diverse settings, recruited through health professionals’ organisations. Results: Most of the sample ( n = 475): worked in geriatrics/aged (31%) or palliative care (30%); in hospitals (64%); and saw a new patient with delirium at least weekly (61%). More (59%) reported delirium practice change since 2016, mostly by increased non-pharmacological interventions (53%). Fifty-five percent reported current antipsychotic use for delirium, primarily for patient distress (79%) and unsafe behaviour (67%). Common Theoretical Domains Framework categories of influences on respondents’ delirium practice were: emotion (54%); knowledge (53%) and physical (43%) and social (21%) opportunities. Palliative care respondents more often reported: awareness of any named key study of antipsychotics for delirium (73% vs 39%, p Conclusion: Clinicians’ use of antipsychotic during delirium remains common and is primarily motivated by distress and safety concerns for the patient and others nearby. Supporting clinicians to achieve evidence-based delirium practice requires further work.

Since their discovery, relevant efforts have been made to optimize the detection approaches to EGFR mutations as well as the clinical management of EGFR-mutated NSCLC. The recent shift from single gene testing to novel comprehensive detection platforms along with the development of new generation tyrosine kinase inhibitors, targeting both common and uncommon EGFR-mutations, is leading to a progressive increase in the number of patients who may benefit from targeted approaches, with subsequent impact on their long-term survival and quality of life. However, a prompt and adequate implementation of the most recent diagnostic and treatment advances in the routine practice often remains critical to be specifically addressed. In this review we provide a complete and updated overview of the different detection platforms and therapeutic options currently available for the clinical management of advanced EGFR-positive NSCLC, summarizing scientific evidence and describing molecular testing as well as treatment practice in the real-word scenario.

In the original publication, under section, BRVO treatment practice pattern, the sentence in p. 369 was published as.

Prostate cancer (PCa) is a heterogeneous disease. PCa is stratified into risk groups based on clinical factors such as T-stage, Gleason score, and baseline prostate-specific antigen. Treatments are selected based on these risk groups. However, we hypothesize that non-clinical factors such as the radiation therapy (RT) center may also impact treatment selection, and we investigate the impact of these factors on treatment selection practice and their adherence to recommended guidelines from the national comprehensive cancer network (NCCN). A total of 552 patients with intermediate or high-risk localized PCa related data was collected from 34 radiation therapy centers of the Veterans Health Administration (VHA), who were treated with definitive RT and with or without Androgen Deprivation Therapy (ADT) between 2010 and 2017. Patients’ clinical information is extracted by manually reviewing their medical charts. We also extracted treatment intended and treatment administered information from consult and end-of-treatment notes, respectively. The random forest classification algorithm was used to identify the impact of clinical and non-clinical factors in treatment selection, their adherence to the treatment guidelines, and treatment alteration (i.e., change in intended and administered treatments). We created models for predicting treatment intended as well as treatment administered. Our results demonstrated that non-clinical (i.e., treatment center) factors, along with clinical factors, are significant for predicting the adherence of treatment intended to the NCCN guidelines. Furthermore, the center served as an important factor for prescribing ADT; however, it is not associated with the duration of ADT and is weakly associated with treatment alterations. This presence of center-bias in treatment selection warrants further investigation on details of center-specific barriers for NCCN guideline adherence, and as well as the impact of center-bias on oncological outcomes.

Background and purposeDifferences in the treatment practice of female and male physicians have been shown in several medical subspecialties. It is currently not known whether this also applies to endovascular stroke treatment. The purpose of this study was to explore whether there are differences in endovascular treatment decisions made by female and male stroke physicians and neurointerventionalists.MethodsIn an international survey, stroke physicians and neurointerventionalists were randomly assigned 10 case scenarios and asked how they would treat the patient: (A) assuming there were no external constraints and (B) given their local working conditions. Descriptive statistics were used to describe baseline demographics, and the adjusted OR for physician gender as a predictor of endovascular treatment decision was calculated using logistic regression.Results607 physicians (97 women, 508 men, 2 who did not wish to declare) participated in this survey. Physician gender was neither a significant predictor for endovascular treatment decision under assumed ideal conditions (endovascular therapy was favored by 77.0% of female and 79.3% of male physicians, adjusted OR 1.03, P=0.806) nor under current local resources (endovascular therapy was favored by 69.1% of female and 76.9% of male physicians, adjusted OR 1.03, P=0.814).ConclusionEndovascular therapy decision making between male and female physicians did not differ under assumed ideal conditions or under current local resources.

Landfill leachate contains extremely diverse mixtures of pollutants and thus requires appropriate treatment before discharge. Co-treatment of landfill leachate with sewage in wastewater treatment plants is a common approach because of low cost and convenience. However, some recalcitrant organic compounds in leachate can escape biological treatment processes, lower the UV transmittance of waste streams due to their UV-quenching properties, and interfere with the associated disinfection efficacy. Thus, the leachate UV quenching substances (UVQS) must be removed or reduced to a level that UV disinfection is not strongly affected. UVQS consist of three major fractions, humic acids, fulvic acids and hydrophilics, each of which has distinct characteristics and behaviors during treatment. The purpose of this review is to provide a synthesis of the state of the science regarding UVQS and possible treatment approaches. In general, chemical, electrochemical, and physical treatments are more effective than biological treatments, but also costlier. Integration of multiple treatment methods to target the removal of different fractions of UVQS can aid in optimizing treatment. The importance of UVQS effects on wastewater treatment should be better recognized and understood with implemented regulations and improved research and treatment practice.

We are delighted to dedicate an edition of the Irish Journal of Psychological Medicine to the topic of attention-deficit hyperactivity disorder (ADHD). ADHD accounts for the majority of clinical presentations to Child and Adolescent Mental Health Services, both in terms of new assessments and ongoing attendances. Papers presented in this edition reflect on the evolving construct of ADHD, drawing from science, clinical practice and public opinion. Current and evidenced-based assessment and treatment practice guidelines are reviewed. International longitudinal studies allow us to understand the personal and societal cost, which can persist for many years post-diagnosis. Despite continuation to adulthood in many young people, follow on adult services are lacking. It is fitting that submissions, by way of personal reflections and opinion pieces, are also included from adult colleagues as they reflect on their experiences in this area. Given the recent development of a national clinical programme in ADHD in Ireland, coupled with a growing evidence for effective interventions, it is hoped that this special edition will highlight the need for appropriate and accessible ADHD treatments across the lifespan.

Despite the increasing use of ventricular assist devices (VADs), gender differences in indications, hemodynamics, and outcome are not well understood. We examined gender differences and gender-specific predictors for perioperative outcome in patients on ventricular support.Multicenter data of 966 patients (median age 55 years, 151 women) from the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) were analyzed. Median follow-up was 1.26 years.At the time of VAD implantation, women were more often in an unstable condition (Interagency Registry for Mechanically Assisted Circulatory Support [INTERMACS] profile 1 and 2) (51.7% vs 41.6% in men), experiencing significantly more often major bleeding (p = 0.0012), arrhythmias (p = 0.022), and right ventricular (RV) failure (p0.001) with need for additional RV support. The survival of women on isolated LVAD support was significantly worse (1-year survival 75.5% vs 83.2% in men). Age-adjusted Cox regression analyses showed significant associations with mortality for preoperative inotropic therapy, percutaneous mechanical support, INTERMACS profile 1 and 2, RV dysfunction, major bleeding, cerebral bleeding, ischemic stroke, and RV failure. In women, pump thrombosis was more strongly related with mortality compared to men, while the direction of the association of renal dysfunction with mortality was different for women and men (p-value interaction 0.028 and 0.023, respectively).Women and men differ in perioperative hemodynamics, adverse events, and mortality after VAD implantation. A gender-dependent association of pump thrombosis with mortality was seen. The impact on treatment practice needs to be shown.

Background & Aims Intestinal microbiota-host interactions play a major role in health and disease. This has been documented at the microbiota level ("dysbiosis" in chronic immune-mediated diseases) and through the study of specific bacteria-host interactions but rarely at the level of intestinal ecosystem dynamics. However, understanding the behavior of this ecosystem may be key to the successful treatment of disease. We recently postulated that health and disease represent alternative stable states of the intestinal ecosystem (different configurations that can exist under identical external conditions), which would require adapted strategies in disease treatment. Here, we examine if alternative stable states indeed exist in this ecosystem and if they could affect remission from ulcerative colitis (UC). Methods We analyzed data from a study on pediatric UC. The data reflect current treatment practice following the recruitment of treatment-naive patients with new-onset disease. Patients received personalized anti-inflammatory treatments over a period of 1 year. Stool samples at 0, 4, 12, and 52 weeks allowed an estimation of microbiota status (through 16S ribosomal RNA gene sequencing) and host inflammatory status (through the measurement of fecal calprotectin levels). Results We identify 4 microbiota states and 4 host states. Longitudinal data show that the improvement of inflammatory status is accompanied by an improvement of microbiota status. However, they also provide strong indications that both improvements are retarded or blocked by alternative states barriers. Conclusions Our observations strongly suggest that inflammation suppression should be combined with microbiota management where possible to improve the efficacy of UC treatment.

Introduction: Clinical availability of highly effective novel agents (including Bruton tyrosine kinase [BTK] and B-cell lymphoma 2 [BCL-2] inhibitors) is rapidly altering the therapeutic landscape of chronic lymphocytic leukemia (CLL) necessitating a review of treatment guidelines. However, there is limited real-world data to validate if the availability of these novel agents has translated to a true shift in treatment paradigm for patients treated in the community. As the majority of CLL patients are treated in non-academic community-based settings, we investigated the clinical adoption trends of commercially available FDA approved novel agents for treatment of CLL patients. In addition, given that the COVID-19 pandemic led to major alteration in clinical oncology practices, we further studied if this contributed to an alteration in the selection of therapeutic agents resulting in changes of CLL treatment patterns and the utilization of novel agents in the real-world setting. Thus, the objectives of this study were to examine the utilization pattern of various CLL therapies, as well as evaluate the pattern of adoption of novel agents for treatment and the impact of COVID. Methods: A retrospective observational study was conducted using the Flatiron Health database that comprised EHR-derived de-identified data. Adult patients (≥18 years) with newly diagnosed CLL from January 2014 to May 2021, with no prior treatment and who were continuously enrolled for at least 6 months before and 3 months after the index date, defined as the first date of CLL/SLL diagnosis were included. Treatment regimens were classified into seven mutually exclusive categories: bendamustine-based chemotherapy, other chemotherapy, anti-CD20-based therapy, ibrutinib, idelalisib, acalabrutinib and venetoclax. Further treatment categorization included chemotherapy vs. targeted therapy, and traditional IV vs. novel oral agents. The impact of the pandemic was examined by comparing the pre- and post-COVID cohorts (defined as 15 months pre- and post- of March 1, 2021). Descriptive analyses were conducted to examine the frequency of use of treatment regimens by quarter in each year, line of therapy and between different age, gender, US geographical region, insurance status, and race/ethnicity subgroups. Multivariable regression was conducted to examine factors associated with the likelihood of adoption of novel and oral agents. Statistical significance was determined at a p-value of less than 0.05. Results: A total of 3,037 newly diagnosed CLL patients (median age =73) were included in the study. Over half were male (62.3%), white (74.6%) and commercially-insured (54.1%). Patients were primarily treated in community practices (92%). Overall, a significant trend in adoption of novel agents was observed throughout the years following their approval (Figure 1A). Across the evaluation period, a significant decrease in chemotherapy use was observed from 61.3% (quarter 1, 2014) to 20% (quarter 2, 2021) in favor of targeted therapy as first-line therapy (Figure 1B). In contrast, the utilization of novel oral agents (vs. traditional IV agents) for first-line therapy increased from 9.5% to 70.9% for the same period (Figure 1C). Similar trends were observed for second-line and third-line therapies. Encouragingly, this change in treatment patterns was adopted comparably in all sociodemographic subgroups with no evidence of disparity. While there was no statistically significant difference between the pre- and post-COVID treatment landscape, the adoption of target and novel oral agents has been more pronounced with the COVID pandemic. Conclusions: Results from real-world data suggest that there is a clear shift towards the adoption of novel therapies with preference given to targeted agents and oral therapies in the US since 2014. Further research examining real-world outcomes associated with treatment regimens are needed to inform decision makers. Figure 1 Figure 1. Disclosures Chanan-Khan: Cellectar: Current equity holder in publicly-traded company; Alpha2 Pharmaceuticals, NonoDev, Starton: Current holder of stock options in a privately-held company; Ascentage: Research Funding; Alpha2 Pharmaceuticals: Patents & Royalties: Tabi; Ascentage, Starton, Cellectar, NonoDev, Alpha2 Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees; BeiGene, Jansen, Ascentage: Honoraria; BieGene, Jansen, Ascentage: Consultancy. Yang: BeiGene, Ltd.: Current Employment. Liu: BeiGene, Ltd.: Current Employment. Zimmerman: BeiGene, Ltd.: Current Employment. Tang: BeiGene, Ltd.: Current Employment. Ailawadhi: Karyopharm: Consultancy; AbbVie: Consultancy; Genentech: Consultancy; Takeda: Consultancy; GSK: Consultancy, Research Funding; Xencor: Research Funding; Cellectar: Research Funding; Medimmune: Research Funding; Ascentage: Research Funding; Pharmacyclics: Consultancy, Research Funding; Amgen: Consultancy, Research Funding; Janssen: Consultancy, Research Funding; Bristol Myers Squibb: Consultancy, Research Funding; BeiGene, Ltd.: Consultancy; Sanofi: Consultancy; Oncopeptides: Consultancy.

The article discusses the current prospects for herbal medicines in treatment practice, specifically, in the therapy of acute respiratory infections (ARI). The authors highlight the properties, characteristic features, principles and objectives of the phytotherapeutic method. Based on their own experience and analysis of a number of experimental and clinical reports, the use of Umckalor, the Pelargonium sidoides extract (Pelargonium sidoides EPs 7630), is substantiated in the treatment of ARI and its complications in children.

Evidence-based guidelines, published in 2010, equate the efficacy of oral and intravenous antibiotics and recommend treatment duration of 2 weeks in early Lyme neuroborreliosis (LNB) without encephalitis or myelitis. Further, the Norwegian health authorities give a general advice to choose oral rather than intravenous administration when proven effective, due to lower costs, fewer risks, and reduced patient inconvenience. In this study we aimed to chart LNB treatment practice in Norway and compare it to these recommendations. Adult patients diagnosed with definite LNB between 2007 and 2013 in 11 different hospitals in the four health regions in Norway were invited to answer a questionnaire regarding duration and administration of antibiotic treatment. A total of 253 patients answered. Median age at diagnosis was 59 years (range 19-83), and 125 (49%) were women. Duration of treatment was 1 week in 7 (3%) patients, 2 weeks in 81 (32%), 3 weeks in 62 (25%), 4 weeks in 48 (19%), 5 weeks in 12 (5%), ≥6 weeks in 29 (12%), and unknown in 14 (6%). Treatment was given orally in 77 (30%) patients, intravenously in 110 (44%), both orally and intravenously in 65 (26%), and unknown in one. Treatment practices differed between the health regions (p = 0.002). During the study period, there were no significant time trend neither with respect to proportion of patients treated for only 2 weeks (OR 0.899, p = 0.109) nor with respect to proportion of patients treated exclusively with oral antibiotics (OR 1.131, p = 0.074). In conclusion, there seem to be a gap between evidence-based recommendations and treatment practice of LNB in Norway.

Alternative medicine it is a medicine that is not taught in traditional medicine. It is based on ancient historical foundations and different experiments in treatment without building it on the basis of scientific teacher. Alternative medicine is used in many peoples, especially non-developed peoples. Alternative medicine is used as primary medicine. The evidence of poor quality and knowledge about the awareness of using the natural drugs instead of using the chemical medication in the hospital. Little is known about the prevalence of natural medication in the Europe, especially in Cyprus. To determine the knowledge, community awareness, and to define the difference treatment practice between natural elements and chemical drugs. To identified the rate of the knowledge that students had and evaluate the results and measure it. Cross-sectional survey were performed by using SPSS and the Pearson Chi-Square test was done to determine the differences perform the questionnaire at near East University in Cyprus. We print our data as questionnaire paper and give it to 562 international students with different backgrounds. A total of 562 questionnaires were administered for this survey and the percentage respondents gender of students was 62.3% in males and 37,3% were females, also The Percentage of Respondents of students choose strongly disagree that were 47% and few of students shown 6.1% Percentage in strongly disagree. Furthermore, student’s percentage of that prefer use of natural elements that were 66.5% cheaper with strongly agree, 21.2% with agree, 2.8% with strongly disagree, and disagree that were 9.5%. Furthermore, students 38.0% Yoga with good scale, 35.2% Herbal with good scale and 34.6% Holy books with excellent scale. (Respectively, p

Psychische und Verhaltenssymptome bei Patienten mit Demenz und Delir sind mit wesentlichen Beeintrachtigungen der Lebensqualitat der Erkrankten und ihrer Angehorigen verbunden. Fur das medizinische Personal stellen sie eine enorme Herausforderung dar. Nach pharmakoepidemiologischen Untersuchungen geht die Anwendung von Psychopharmaka in der ambulanten und der stationaren Versorgung signifikant uber die Empfehlungen aktueller Leitlinien hinaus. Die Analyse dieser Diskrepanz steht im Fokus des vorliegenden Beitrags. Selektive Literaturubersicht unter besonderer Berucksichtigung deutsch- und englischsprachiger Behandlungsleitlinien. Die Empfehlungen fur den Einsatz von Psychopharmaka bei Demenzkranken sind in der deutschen S3-Leitlinie speziell fur Antipsychotika eng gefasst. Diese stellt daruber hinaus fest, dass fur bestimmte Storungsbilder evidenzbasierte Aussagen derzeit nicht moglich sind. Fur das Delir existieren verschiedene, teilweise auf unterschiedliche Kontexte bezogene Behandlungsempfehlungen. Wie in der S3-Leitlinie „Demenzen“ wird hier eine Priorisierung allgemeinmedizinischer und nichtmedikamentoser Masnahmen gefordert. Die Indikation zur Therapie mit Psychopharmaka bei deliranten Patienten wird z. T. enger, z. T. weiter gefasst. Aktuelle Leitlinien empfehlen, gut begrundet, eine zuruckhaltende Verordnung von Psychopharmaka bei Patienten mit Demenz und Delir. Dass die Verordnungsraten in der Versorgungspraxis deutlich daruber hinaus gehen, erklart sich neben dem Fehlen evidenzbasierter Empfehlungen fur bestimmte Storungsbilder v. a. auch durch eine mit erheblichen Risiken verbundene Uber- und Dauerbehandlung bei einem substanziellen Anteil der Betroffenen. Dieser nichtakzeptablen Situation sollte durch die konsequente Umsetzung etablierter Prinzipien guter altersmedizinischer Praxis entgegengewirkt werden.

Introduction: Myelodysplastic syndromes (MDS) are a group of progressive clonal hematopoietic malignancies that primarily affect an elderly demographic. MDS is treated based on age, symptoms, disease severity, and prognostic scoring. There is limited evidence on the health economic burden and how transfusion dependency affects clinical outcomes of patients with MDS in Japan. This is the first retrospective database analysis study that was performed to elucidate the patient baseline characteristics, 1-year medical costs, and 3-year overall survival (OS) in patients treated for MDS using an administrative claims database of more than 150 hospitals in Japan. Methods: In this study, we used the Medical Data Vision (MDV) database to identify patients diagnosed with MDS (International Classification of Diseases, Tenth Revision, [ICD-10]: code D46.9) using a nationwide administrative database comprising anonymized data covering more than 25 million patients. Patients who received transfusions, erythropoiesis-stimulating agents (ESA) with or without transfusions, azacitidine (AZA) with or without transfusions, and other (e.g. chemotherapy such as doxorubicin, cytarabine) as the index treatment during the identification period from October 1, 2009 to June 30, 2018 were included if they had 1 year of lookback data before the index date and a follow-up period of ≥ 1 year. Results: Of the 5,981 patients with MDS who met the eligibility criteria for this study, 37.8% were female; the median age of patients was > 70 years. Patients receiving transfusion in their index line of therapy was the largest regimen group (n = 2,844, 47.6%), followed by AZA + transfusion (n = 703, 11.8%), ESA (n = 294, 4.9%), and AZA (n = 288, 4.8%). The AZA regimen had the youngest mean age of 70.2 years while the ESA + transfusion group had the oldest (77.8 years). AZA and AZA + transfusion groups recorded a median Charlson Comorbidity Index score of 1.9 and 2.0, respectively, whereas ESA and ESA + transfusion groups had a mean score of 3.2 and 2.6, respectively. Medical costs varied widely for these groups (Figure 1). Mean overall costs were highest for the AZA + transfusion regimen group (USD 63,226) and lowest for the ESA group (USD 15,931). Mean overall costs for regimen groups without transfusion were highest for AZA (USD 47,475), followed by ESA (USD 15,931; P < 0.0001), and the addition of the transfusion component was observed to incur higher overall costs, inpatient costs, and MDS-related treatment costs. Inpatient costs for the ESA groups ranged from USD 16,717 for ESA only to USD 30,347 for ESA + transfusion. The highest outpatient costs were observed for the AZA group (USD 20,011; P < 0.0001). MDS-related treatment costs were highest for the AZA + transfusion group (USD 32,123) and lowest for the ESA group (USD 2,518; P < 0.0001). Overall, there were 1,966 deaths (32.9%) recorded within 3 years of index treatment. The median OS for patients receiving AZA + transfusion was 957 days (Figure 2). Conclusions: In this study, mean overall costs, inpatient costs, and outpatient costs were highest for the AZA + transfusion regimen group. Consistent with the trend of MDS studies, the majority of patients with MDS received supportive transfusion-dependent therapy. Transfusion dependency led to considerable incremental cost and poorer clinical outcomes compared with other regimens. This study provides insights into the real-world disease burden for patients with MDS and the current treatment options available for MDS in Japan. Disclosures Tsutsué: Celgene KK, a Bristol-Myers Squibb Company: Current Employment. Suzuki:Bristol Myers Squibb: Honoraria; Nippon Shinyaku Co., Ltd: Honoraria; Kyowa Hakka Kirin Co., Ltd: Honoraria, Research Funding; Novartis Pharmaceuticals: Honoraria. Kim:Syneos Health: Current Employment. Kuan:Syneos Health Clinical K.K.: Current Employment. Crawford:Syneos Health: Current Employment.

To evaluate variations in treatment practice and compliance with national guidelines for the diagnostic evaluation of children with Kawasaki disease (KD).We used the Pediatric Hospital Information System database to analyze demographic, laboratory and treatment data from patients admitted with KD between January 1, 2006, and December 31, 2015.During the study period, 12,089 children with KD were diagnosed. Nearly all patients had a complete blood cell count, erythrocyte sedimentation rate, and C-reactive protein ordered. Fewer patients had alanine aminotransferase (48.6%) or a urinalysis (75.3%). A small percentage of children had abdominal imaging (11.5%), neck imaging (5.9%), and lumbar punctures (4.5%), and 36.0% of patients received antibiotic therapy. Obtaining echocardiograms pretreatment and the use of steroids and infliximab significantly increased over the study period (P0.001). For patients who failed initial intravenous immunoglobulin (IVIG) monotherapy, 82.0% received a second dose of IVIG, 7.7% received steroids, 6.5% received infliximab, and 3.9% received combination therapy. Patients receiving infliximab or steroids as second therapy had a higher response rate than those who received only a second IVIG dose (87.9% versus 83.0% versus 73.3%, P0.001).KD remains a challenging diagnosis. Opportunities exist for earlier use of echocardiograms in the evaluation of children with potential KD. Significant variations in practice exist surrounding second-line therapy. Our data suggest superiority of second-line therapy use of infliximab or steroids over IVIG in terms of reducing need for additional therapies. Prospective, controlled studies are needed to confirm this finding.

The incidence of chronic wounds has been increasing over the past 20 years. However, the standardized diagnosis and treatment practice of chronic refractory wounds have not been established. In addition, the properties of the wound are characterized by morphology and thus correct description of the wound in medical history collection plays a vital role, which directly affects the definitive diagnosis. To develop more accurate format of clinical history record which can correctly reflect a patient’s course and treatment progress, and to standardize the medical history record of chronic refractory wounds, at the national or regional level, we designed the WoundCareLog APP. It acts as a recording and communication tool for wound healing specialists at all levels of medical institutions in China. The WoundCareLog APP is fully compatible to meet the criteria and requirements of conventional medical records by embedding 9 modules. In addition, the demands for morphological description of wounds in wound healing diagnosis and treatment have been fulfilled by enroll of digital imaging technology to overcome the inadequacies of traditional medical history records. Keywords: Mobile applications, Wound healing, Chronic wound, Diagnosis and treatment

ObjectiveTo define the current treatment practice of Guillain-Barré syndrome (GBS).MethodsThe study was based on prospective observational data from the first 1,300 patients included in the International GBS Outcome Study. We described the treatment practice of GBS in general, and for (1) severe forms (unable to walk independently), (2) no recovery after initial treatment, (3) treatment-related fluctuations, (4) mild forms (able to walk independently), and (5) variant forms including Miller Fisher syndrome, taking patient characteristics and hospital type into account.ResultsWe excluded 88 (7%) patients because of missing data, protocol violation, or alternative diagnosis. Patients from Bangladesh (n = 189, 15%) were described separately because 83% were not treated. IV immunoglobulin (IVIg), plasma exchange (PE), or other immunotherapy was provided in 941 (92%) of the remaining 1,023 patients, including patients with severe GBS (724/743, 97%), mild GBS (126/168, 75%), Miller Fisher syndrome (53/70, 76%), and other variants (33/40, 83%). Of 235 (32%) patients who did not improve after their initial treatment, 82 (35%) received a second immune modulatory treatment. A treatment-related fluctuation was observed in 53 (5%) of 1,023 patients, of whom 36 (68%) were re-treated with IVIg or PE.ConclusionsIn current practice, patients with mild and variant forms of GBS, or with treatment-related fluctuations and treatment failures, are frequently treated, even in absence of trial data to support this choice. The variability in treatment practice can be explained in part by the lack of evidence and guidelines for effective treatment in these situations.

Introduction Numerous studies have compared treatment approaches of female and male physicians in different medical subspecialties, some of them revealed significant differences. To date, only few women are engaged in the neurointerventional field. Hence, it is unclear whether the treatment practice is influenced by physicians’ sex. We explored whether there are differences in treatment decisions made by female and male physicians. Materials and methods An international cross-sectional survey of both female and male stroke physicians and neurointerventionalists was conducted. Participants were randomly assigned 10 cases out of a pool of 22 case scenarios and asked how they would treat the patient A) assumed there were no economical or infrastructural constraints, and B) given their current working conditions. Subgroup analyses were performed for female and male physicians respectively. Results 607 physicians (97 women, 508 men, 2 who did not disclose their sex), of different specialties (326 neurologists, 173 interventional neuroradiologists, 81 interventional neurosurgeons, 2 geriatricians, 5 internists, 20 other) from 38 countries participated in this survey. 6070 responses were obtained. Neurologists constituted the largest group of both female (76.3%) and male (49.2%) physicians, with a more even distribution of specialties in male physicians. Assuming ideal conditions, no significant differences in EVT decision making was observed (EVT was favored by 77% of female and 79.3% of male physicians). Under their current working conditions, female physicians decided less frequently in favor of EVT (69.1%) as compared to their male colleagues (76.9%, p Conclusion Under the ideal conditions, EVT decision between male and female physicians did not differ. Current working conditions restricted female physicians’ endovascular treatment decision to a greater degree as compared to their male colleagues, resulting in a significantly lower decision rate in favor of EVT. Disclosures J. Ospel: None. N. Kashani: None. B. Campbell: None. M. Foss: None. F. Turjman: None. S. Yoshimura: None. A. Wilson: None. W. Kunz: None. M. Cherian: None. B. Kim: None. A. Rabinstein: None. U. Fischer: None. P. Sylaja: None. B. Baxter: None. J. Heo: None. B. Menon:None. G. Saposnik: None. M. Hill: None. M. Goyal: None. M. Almekhlafi: 1; C; unrestricted research grant by Stryker to University of Calgary.

Purpose To compare the cervical cancer treatment outcome and toxicities between two different institutions. Material and methods We analysed the clinical outcome of cervical cancer patients treated at two different centres from January 2015 to December 2016. Centre A treated 72 patients by external beam radiotherapy (EBRT) to a dose of 45 Gy in 25 fractions followed by intracavitary brachytherapy (ICBT) 6.5 Gy × 4 fractions and centre B treated 89 patients by EBRT to a dose of 50.4 Gy in 28 fractions followed by ICBT 9 Gy × 2 fractions. The local control, distant metastases and treatment toxicities were compared. Results The median follow-up in centre A was 12 months and in centre B was 18 months. The median overall treatment time in centre A was 52 days and in centre B was 61 days. The mean equieffective doses in 2 Gy (EQD2) for high risk target volume (CTVHR) and point A in centre A were 84.59 and 64.5 Gy, respectively. The mean EQD2 for point A in centre B was 78.5 Gy. One patient out of 72 (1.38%) had local recurrence in centre A and five patients out of 89 (5.6%) had local recurrence in centre B. Local control in centre A was 98.6% and in centre B was 94.3%. The local recurrence rate was higher in centre B but it was not statistically significant (p = 0.15). One patient developed brain metastasis in centre B. One patient developed grade 3 proctitis in centre A. Conclusions A high dose rate brachytherapy fractionation schedule of 6.5 Gy × 4 fractions over 2 days for CTVHR is associated with reduced overall treatment time, a slightly higher local control rate and lesser dose to OARs compared to 9 Gy × 2 fractions given one week apart to point A.

Brachytherapy (BT) for locally advanced cervical cancer is vital for optimal outcomes. There is heterogeneity in brachytherapy treatment practice for cervical cancer across India. In an attempt to standardize various processes involved in cervical cancer brachytherapy, the expert members of the Indian Brachytherapy Society (IBS) developed a document related to radiation therapy treatment of cervical cancer with special emphasis on brachytherapy. The guidelines are based on high quality clinical evidence, expert opinion and consensus wherever evidence was lacking. The document provides a guide for external beam radiation and details of all the processes involved in high-dose-rate (HDR) brachytherapy including patient selection, preparation, principles and technique of BT applications, target and normal tissue definition, dose prescriptions, BT planning, reporting parameters, common complications of BT and their management, scope for research, etc. In summary, we present here practical tips and tricks, recording and reporting of cervical cancer brachytherapy, which can be implemented in various clinical environments and forms the basis of this report.

ObjectivesTo determine the proportion of patients who received a treatment for Clostridioides difficile infection (CDI) among those presenting a discordant C. difficile diagnostic assay and to identify patient characteristics associated with the decision to treat CDI.DesignCross-sectional study.SettingMonocentric study in a tertiary care hospital, Geneva, Switzerland.ParticipantsAmong 4562 adult patients tested for C. difficile between March 2017 and March 2019, 208 patients with discordant tests’ results (positive nucleic acid amplification test (NAAT+)/negative enzyme immunoassay (EIA−)) were included.Main outcome measuresTreatment for CDI.ResultsCDI treatment was administered in 147 (71%) cases. In multivariate analysis, an abdominal CT scan with signs of colitis (OR 14.7; 95% CI 1.96 to 110.8) was the only factor associated with CDI treatment.ConclusionsThe proportion of NAAT+/EIA− patients who received treatment questions the contribution of the EIA for the detection of toxin A/B after NAAT to limit overtreatment. Additional studies are needed to investigate if other factors are associated with the decision to treat.

Diabetes mellitus (DM) can cause complication to various body systems. One complication that often happens is diabetic foot. Obedience in carrying out foot treatment has an essential role in therapy management of the patient with DM. This treatment aims to find out behaviour factors related to foot treatment. This research is a correlation description with the cross-sectional approach, conducted on 100 respondents in Rejosari Health Center. The sampling technique used was purposive sampling. Data analyzed by univariate and bivariate analysis. The research result obtained is that there is no relation between age, gender, and the duration of suffering from DM and result of foot treatment with each p-value of 0.200, 0.739, 0.876 and 0.156 (>0,05). There is the relation between education, occupation, counselling, family support, knowledge and perception to foot treatment practice with each p-value of 0.019, 0.041, 0.008, 0.001, 0.040 and 0.006 (< 0.05). It is expected that Rejosari Health Center is more often to give counselling about foot treatment to prevent the occurrence of complication.

Background/Aim: In treatment practice of obesity, losing excess weight and then maintaining an ideal body weight are very important. By the sleeve gastrectomy initial weight loss is easier, but the progress of patients have diverse variability in terms of maintaining weight loss. Predicting models for weight changes may provide doctors and patients a good tool to modify their approach to obesity treatment.The main objective of this research is to verify the dependence of weight loss on sleeve coefficients and to forecast the weight loss. The weight loss and its dependence on remnant gastric volume compartmants (antral and body parts), after laparoscopic sleeve gastrectomy (LSG) is discussed in this paper. Data was obtained from a previous study which included 63 patients. Deep analysis of weight loss after LSG and its relation with remnant gastric volume is still a challenge due to weight loss dependence on multiple factors. During this research, with the aid of machine learning regression classifier, the relationship(s) between the sleeve coefficients’ formulae and weight loss formulae (%EWL and %TWL), are developed in a novel way. Other factors such as age and gender are also taken into account. A robust approach of artificial intelligence, i.e. the “Neural Network Bayesian Regularization” is adopted to utilize the third month, sixth month and first year weight loss data, to forecast the second year weight loss. Models are proposed to demonstrate the dependance of total weight loss on crucial parameters of components of remanat gastric volumes. A comparative study is conducted for the appropriate selection of artificial intelligence training algorithm.

Deep learning has benefits to find complicated interactions between biological entities and could make useful estimation. In clinical practice, the prediction of platinum resistance in ovarian cancer is an important problem because it alters treatment options for patients and subsequently their quality of life. In this paper, Deep Neural Network (DNN) models are designed and evaluated with several feature selection approaches. Among the feature selection approaches, genes selected by group difference in gene expression showed the best performance of 0.838 in test accuracy and 0.889 in test AUC. Hybrid ensemble approaches displayed a performance of 0.903 in test accuracy and 0.869 in test AUC. An alternative hybrid ensemble model with removed partially sensitive samples displayed the performance of 0.903 in test accuracy and 0.914 in test AUC. These results suggest that a hybrid ensemble approach could help prediction of platinum resistance in ovarian cancer and subsequent treatment practice in clinics.

Background In 2016 EULAR evidence based clinical guidelines on Gout treatment have been updated.1 Objectives to assess current daily practice physicians’ approach to management of chronic gout patients Methods a cross-sectional anonymous survey had been offered to hospital and outpatient departments physicians dealing with gout patients resulting in 97 back-feed replies yielded. This publication deals with chronic gout treatment practice. Results all survey participants were divided into 3 groups. Group 1 consisted of 18 rheumatologists (professional experience median 19.6 years, range 1 to 43), group 2 included 60 general practitioners (GP, professional experience 27; 4–47), group 3 included other specialists (cardiologists, surgeons etc.) who reported frequent contacts with gout patients (professional experience 16.5; 1–44). Rheumatologists reported to contact median 15 (range 2–40) gouty subjects per month, while group 2 reported to see 31 – 10 and group 3 consults 41 – 12 patients per month. All rheumatologists and 45 GPs reported initiation of allopurinol or febuxostat after gouty arthritis resolution, while 11 general practitioners did not start antihyperuricemic drugs in subjects with kidney and/or cardiovascular comorbidities. In Group 3 only 6 responders had experience of antihyperuricemic drugs administration, but 3 of them reported allopurinol initiation during gout flare. Only 2 rheumatologists and 2 GPs were aware of gout flare low dose colchicin prophylaxis during allopurinol dose adjustment. Administration of maximal allopurinol daily maintenance doses over 300 mg was reported only by 7 rheumatologists and 7 GPs. Other specialists did not have any personal experience of allopurinol dose adjustment. By responders’ assessment every 2–3 patient continues to experience gout flares in spite of prescribed treatmen Conclusions intensive educational intervention is urgently required to change current practice of chronic gout treatment in Russia. Reference [1] Richette P, et al. 2016updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis2017;76:29–42 Disclosure of Interest None declared

Background and objectives: To explore if intravenous iron isomaltoside (Monofer®) leads to a better relief of fatigue than current treatment practice with oral iron in women suffering from severe f...

OBJECTIVES: Malignant pleural mesothelioma (MPM) is a rare and aggressive cancer, for which treatment is often limited to palliative combination chemotherapy. Multimodality-therapy, including radical surgery, is largely restricted to clinical trials, leaving its benefit currently unclear. This study aimed to get a comprehensive view on real-world MPM treatment at the Belgian population level, to assess survival and to identify prognostic factors. MATERIALS AND METHODS: The study period covered the incidence years 2004-2012 (N = 1453). Starting from the Belgian Cancer Registry, additional information regarding patient characteristics, diagnosis and treatment was retrieved from multiple data sources. Adjusted cox proportional-hazard regression models using time-dependent covariates were performed to assess survival in relation to treatment patterns and centre volume. RESULTS: Sixty-nine percent of patients underwent tumour-directed treatment, mostly cisplatin-pemetrexed chemotherapy. Radical surgery was mainly performed in younger patients with epithelioid subtype. Centre volume, surgery and chemotherapy showed a positive relation with survival in univariable analyses, but only chemotherapy remained significantly relevant in multivariable analyses. Younger patients, females, and epithelioid subtypes also independently had a better survival. CONCLUSION: This large population-based study provides insights in MPM treatment practice in Belgium. Centre volume and surgery being related to survival in univariable analyses, only chemotherapy remained prognostic after adjustment. ispartof: LUNG CANCER vol:125 pages:258-264 ispartof: location:Ireland status: published

Introduction: Hypertension, also known as high or raised blood pressure, is a global public health issue and is the major contributory factor for the burden of heart disease, stroke, renal failure, premature mortality and morbidity worldwide. Objective : 1. To determine the community prevalence of hypertension.2. To Assess the Household Awareness Of hypertension.3. To study the pattern and regularity of treatment in hypertensives. Methodology: A cross sectional study was carried out in 40 Households of Grama-Kshema Project in Kuthar and Manjanady villages (semi urban ) which belong to the field practice area of K.S. Hegde Medical Academy, Mangalore. A structured Questionnaire was used to collect data. Questions on awareness were scored and analyzed. Result: The community prevalence of hypertension among the households surveyed was 9.6 percent out of which 12.5 % were female and 5.9 % were male. Among them 46.7% were in the age group 51-70 years, 40% in the age group 31-50 years and 13.3% in the age group above 70 years.40 % of hypertensive visit their doctor on monthly basis.66.7% of the hypertensives visit private dispensary for their treatment and follow up. 93.3% are on anti-hypertensives of which 33.3 % use calcium channel blockers. Awareness scoring showed that 40% had poor score and 37.5 % average score. Conclusion: In the present study the prevalence of hypertension was found to be low. Among those diagnosed of hypertension, majority of them were females. Most of the hypertensive's visit private dispensaries on monthly basis. Awareness of Hypertension among the households was poor.

Background In 2011 the legal foundations of coercive treatment in German forensic psychiatric clinics were declared to be unconstitutional. In the present study we analyzed the frequency of coercive procedures in forensic psychiatric hospitals before and after 2011, the consequences for medical care as well as the ethical assessments by attending chief physicians. Methods By a questionnaire-based survey of views of attending chief physicians in forensic psychiatric clinics in 2013, data on the current state of patient care were collected and analyzed from an ethical perspective. These were compared with treatment data from a large forensic psychiatric clinic collected over the period 2007-2013. Results Even after 2011 coercive forms of treatment were applied in forensic psychiatric hospitals. In practice, there is a high degree of legal uncertainty regarding the limits of coercive treatment. Of all patients treated in forensic psychiatric clinics in 2012, on average 13 % had been in isolation at least once, approximately 3 % had been treated under fixation at least once and 2.2 % had been subjected to coercive medical treatment at least once. Conclusion From an ethical perspective an open debate about the practice of coercive treatment is urgently required. Legal regulations, ethical guidelines and treatment standards have to be developed for the special situation of patient care in forensic psychiatric hospitals.

Aim This study aimed to determine the strategies used by dietitians to assess, treat and monitor elderly patients diagnosed with, or at increased risk of, malnutrition and to compare these with evidence-based guidelines and the current literature. Methods An online survey was distributed to members of the Dietitians Association of Australia (DAA) working in an inpatient/outpatient facility or private practice/consultancy. Dietitians working with elderly people (≥65 years old) were invited to participate. The survey was informed by DAA's evidence-based guidelines and was pre-tested. Responses of dietitians were analysed by years of experience, service setting and approaches taken to assess and manage malnutrition. Results One hundred sixty surveys were returned. Fourteen per cent of respondents worked in services that had no malnutrition policies. A Subjective Global Assessment tool was used by 59% of respondents and 95% recommended oral nutrition supplements when malnutrition or risk of malnutrition was diagnosed. Eighty-three per cent focused on increasing both energy and protein intake; however, 64% of respondents did not consider the nature of the protein source and only 62% discussed sarcopenia. Patients at risk of malnutrition were monitored slightly less frequently than those with diagnosed malnutrition. Conclusions Respondents generally use practices that align with current assessment and treatment practice guidelines and use validated assessment tools; however, at sites where no policies exist, protocols are needed. Treatment protocols exist in less than 50% of workplaces, suggesting that specific malnutrition treatment guidelines for the elderly may be needed.

New Zealand has a much higher rate of reported campylobacteriosis cases than the rest of the developed world. It has been assumed that New Zealand C. jejuni strains have greater heat tolerance and thus are better able to survive cooking. Therefore there is a need to fully determine the temperature dependence of Campylobacter spp. and to update the current knowledge of kinetic parameters such as D and z values of Campylobacter spp. The significantly higher reported D- values for Campylobacter spp. already seen in the Netherlands requires a practical stance in ensuring appropriate evaluation of thermal process lethality of Campylobacter spp. An extensive search of data bases for publications on Campylobacter heat resistance was conducted. The kinetic parameters obtained in New Zealand under isothermal and dynamic conditions in broths or in food matrix are broadly in agreement with previously published international data and do not indicate that New Zealand strains are more heat resistant than other strains. This finding has a significant impact to regulators, consumers, food industry and researchers as it has revealed the scientific evidence to maintain the standards for the heat treatment practices. Any change of heat treatment practice can cause unpredicted loss to the poultry industry and challenges the regulatory bodies to convey the message of altering the consumers cooking temperature to all consumers with a short time given the reluctance of consumers in using thermometers to verify the cooking temperature at home. Consumers play an important role in making certain the food they prepare is safe by preventing cross-contamination in order to avoid the risk of food borne diseases.