Availability Of Alternative Options Research Articles

Cytomegalovirus Treatment in Solid Organ Transplantation: An Update on Current Approaches.

The article reviews the safety and efficacy of treatments for cytomegalovirus (CMV) in solid organ transplantation. A literature review was conducted in PubMed, MEDLINE, and Clinicaltrials.gov from database inception through January 2024, using terms CMV, therapy, and solid organ transplantation. Clinical trials, meta-analyses, cohort studies, case reports, and guidelines were included. Letters to the editor, reviews, and commentaries were excluded. After abstract screening and full-text review of 728 citations for eligibility, 53 were included. Valganciclovir and intravenous ganciclovir are drugs of choice for CMV management and, until recently, the availability of alternative options has been restricted due to toxicity. For instance, foscarnet and cidofovir serve as second-line agents due to potential bone marrow and renal toxicity. In patients with refractory or resistant CMV, maribavir, a novel oral agent, has proven efficacy and a lower adverse effect profile. However, in refractory or resistant CMV, foscarnet and cidofovir are preferred in invasive disease (CMV gastritis, CMV retinitis, and CMV encephalitis), high viral loads, and inability to tolerate oral preparations. Consensus guidelines have not been revised since approval of novel antivirals in solid organ transplantation. Valganciclovir and ganciclovir remain drugs of choice for initial CMV therapy. Foscarnet, cidofovir, and maribavir are treatments for refractory or resistant-CMV. Selection of CMV antiviral treatment should be determined by patient-specific factors, including severity of illness, resistant or refractory disease, dose-limiting adverse effects, and the preferred route of administration.

Research participants may not recall their participation but have a better understanding of alternative management options than patients in routine care

BackgroundPatient understanding of care interventions, of the clinical uncertainty, and of their participation in clinical research is often poor. We hypothesized that compared to routine care, patients would better understand the prevailing uncertainty when they participated in research. MethodsA questionnaire was administered to patients at the time they attended a follow-up neurovascular clinic 4 to 52 weeks after a care episode where they did or did not participate in a clinical trial. Patients were not reminded whether they had previously participated in a clinical trial. Questions concerned their understanding of the risks/benefits of interventions, the availability of alternative options, whether their personal opinion was taken into consideration, the reason for the final decision, their confidence at having received the best management, and whether they had been research participants. ResultsBetween June 2019 and June 2020, 167 patients were recruited; 71 had truly been research participants, while 96 had not. A greater proportion of research patients were aware of the existence of management alternatives (65% versus 44%; P=0.008). Patients of both groups believed their personal opinion counted in the final decision (76% versus 70%), and patients were equally confident that they had received the best management (94%). Research patients believed they had participated in research 46% of the time, compared to 12% of routine care patients (P=0.003). ConclusionMany patients do not recall that they participated in a clinical trial, but they have a better understanding of the clinical uncertainty and of the availability of alternative management options.

Protected Designation of Origin food chain arrangements: leveraging market power for small-scale producers in marginal regions

ABSTRACT Feta cheese is a Greek product under Protection Designation of Origin (PDO), benefiting its producing regions with its marketing potential. However, farmers are evidently often excluded from this value chain. This study aims at understanding the opportunities farmers in Greece have for supply chain arrangements (SCAs) that ensure fair market participation. It uses a two-step latent class analysis on data from a farm survey to explore and classify farmer–cheesemaker SCAs based on their perceived characteristics, farmers’ satisfaction, availability of alternative options and farmers’ sustainability objectives. Results highlight the importance of collective arrangements, economic incentives and price formulation mechanisms in forming farmer-inclusive SCAs.

Paediatric Agranulocytosis Associated with Metamizole Treatment.

Metamizole, which has antipyretic and pain-relieving properties, is generally used to treat fever in children who do not respond to paracetamol treatment. The most remarkable side effect of metamizole is that it causes myelotoxicity independently of dose. In this study, we aimed to present the clinical features of paediatric patients who developed agranulocytosis after the use of metamizole and draw attention to this side effect. The patients who were admitted to Eskişehir Osmangazi University Faculty of Medicine Hospital, Pediatric Infectious Diseases and Pediatric Hematology Service, between January 1, 2015, and December 31, 2018, with a diagnosis of secondary agranulocytosis to metamizole use were examined retrospectively. In all, 12 patients were included in the study; oral metamizole was used in these patients for fever reduction. The mean absolute neutrophil count was 225/mm3 ± 226 (0-600/mm3) at admission, and the neutrophil value of 11 patients was < 500/mm3. The mean length of hospitalisation of the patients was 9.92 ± 8 (3-28) days. Eight patients received intravenous antibiotic therapy and four patients received at least one of the following treatments: intravenous immunoglobulin, granulocyte colony-stimulating factor and methylprednisolone. Bone marrow aspiration examination showed neutrophil/band maturation delaying in the myeloid series with normocellular bone marrow in three patients. Hypocellularity in the bone marrow and decrease in myeloid precursors were observed in three patients. There were no fatal cases. The development of agranulocytosis after the use of metamizole causes long-term hospitalisation and may require the use of medications in treatment management. Considering the availability of alternative options to treat fever and pain, and given the side-effect profile of metamizole, it should not be the preferred, first-line antipyretic treatment in children.

Why do young nurses leave their organization? A qualitative descriptive study

Nurse turnover is a major problem all over the world. It is known that young nurses who constitute the new nurse labour force are more likely to leave their organization, especially in their first year. However, qualitative studies that approach the problem from the perspective of young nurses and focus on the reasons for their decision to leave their organization are limited. To understand the reasons for young nurses' leaving their organization and determine their experiences, focusing on their point of view. The study had a descriptive qualitative design and was conducted between January and February 2019. Purposeful sampling was used, and the sample included 15 nurses that voluntarily decided to leave a university hospital in Turkey and agreed to participate in the study. Data were collected with semi-structured interviews, and the interviews were audio-recorded. The data obtained from the interviews were evaluated by content analysis. The young nurses' reasons for leaving their organization were found to be in three categories: the Negative work environment, Nursing shortage, and Unsatisfied individual expectations. The Negative work environment category included the subcategories of lack of professional solidarity, lack of support from managers, inadequacy of preceptorship process, and horizontal violence. The Nursing shortage category consisted of the subcategories of excessive workload and overtime. The category of Unsatisfied individual expectations comprised the subcategories of work-social life imbalance, availability of alternative options, and family-related reasons. It was determined that the young nurses left their organization because they did not receive sufficient support from their managers and colleagues during the transition period. This finding shows that nurse executives must have the managerial skills and understanding to regulate the work environment, increase peer support, and carefully plan each stage of the transition process for the retention of young nurses in their organization. In addition, nurse executives should encourage and be involved with policy making and policymakers and other managers in their organizations to develop institutional and national strategies to ensure that young nurses remain in nursing.

Геоинформационный анализ устойчивости энергосистемы к климатическим нагрузкам

This paper presents a comprehensive method of GIS-modeling and mapping the sustainability of electrical networks to climatic affects (including wind and sleet loads) on the example of the southwestern part of the Krasnodar region. We have proposed a number of improvements in the part of climate modeling (the use of morphometric indicators, spatially weighted regression) on the example of maximum sleet loads during 25 years period. We have also suggested an original approach to the assessment of structural sustainability of power grids. It provides the stability of energy supply to the end user due to the availability of alternative options for connecting to the power centers. Structural stability assessment is carried out on the basis of network modeling and acts as an indicator of the network parts which are the most vulnerable to natural disasters. The combined use of climate and network model allows justifying the strategy of the energy systemdevelopment by increasing the reliability of energy supply to the end user.

Media reporting of health interventions in New Zealand: a retrospective analysis.

To evaluate New Zealand media articles on their coverage of key issues regarding health interventions and whether it is consistent with available evidence. A retrospective analysis was carried out of all articles published in five New Zealand media sources over a 6-week period between 15 October and 26 November 2014. Articles were included if their primary focus was on health interventions involving medications, devices or in-hospital procedures. Articles were assessed for coverage of key issues using previously validated 10-point criteria. A literature review was performed to compare content with scientific evidence. We identified 30 articles for review. Only 4 of 30 articles covered indications, benefits and risks, and of these, two were consistent with available evidence (7%, 95% CI 1%-22%). For articles that discussed at least one of indications, benefits or risks, and there was corresponding evidence available, there was a high level of consistency with the evidence (89%, 95% CI 77%-95%). The overall mean value of coverage from the 10-point criteria was 51% (95% CI 45%-58%). Single questions regarding the potential harm, costs associated with the intervention and the availability of alternative options were particularly poorly covered. They were rated as 'satisfactory' in 13%, 23% and 33% of the 30 articles respectively. New Zealand news articles covering medical treatments and interventions are largely consistent with available evidence but are incomplete. Vital information is being consistently missed, especially around the potential harms and costs of medical interventions.

Recognition and Management of Anaphylaxis in Older Adults.

To discuss medications that cause anaphylaxis in older adults and its treatment, with a focus on epinephrine. A search of PubMed using the terms "anaphylaxis," "drug-induced anaphylaxis," "epinephrine autoinjectable," "anaphylaxis diagnosis," "anaphylaxis treatment," and "epinephrine cost" was performed. English-language articles from January 2000 to August 2016 appearing in these searches were reviewed. Relevant review articles, consensus statements, practice parameters, task force recommendations, and original articles were assessed for recognition and treatment of drug-induced anaphylaxis. Anaphylaxis is a serious allergic reaction that occurs with food, insect stings, latex, radio contrast agents, and medications. Medications that are commonly used by older adults can cause anaphylaxis. Epinephrine remains the first-line treatment option and does not have any contraindications. Early recognition of drug-induced anaphylaxis symptoms is critical and medication should be administered immediately to prevent cardiac arrest. Additionally, health care providers can provide others with education on administration of epinephrine auto-injectable agents, availability of alternative options, and patient-assistance programs to lower the cost of epinephrine agents.

Traditional healers, faith healers and medical practitioners: the contribution of medical pluralism to bottlenecks along the cascade of care for HIV/AIDS in Eastern and Southern Africa

ObjectivesThere are concerns that medical pluralism may delay patients’ progression through the HIV cascade-of-care. However, the pathways of impact through which medical pluralism influence the care of people living with...

Development of biosimilars in an era of oncologic drug shortages.

Acute and chronic shortages of various pharmaceuticals and particularly of sterile injectable products are being reported on a global scale, prompting evaluation of more effective strategies to manage current shortages and development of new, high-quality pharmaceutical products to mitigate the risk of potential future shortages. Oncology drugs such as liposomal doxorubicin and 5-fluorouracil represent examples of first-choice drugs critically affected by shortages. Survey results indicate that the majority of hospitals and practicing oncologists have experienced drug shortages, which may have compromised patient safety and clinical outcomes, and increased health care costs, due to delays or changes in treatment regimens. Clinical trials evaluating novel agents in combination with standard-of-care drugs are also being affected by drug shortages. Clinical and ethical considerations on treatment objectives, drug indication, and availability of alternative options may help in prioritizing cancer patients involved in active drug shortages. The United States Food and Drug Administration and the European Medicines Agency have identified manufacturing problems, delays in supply, and lack of available active ingredients as the most frequent causes of recent or ongoing drug shortages, and have released specific guidance to monitor, manage, and reduce the risk of shortages. The upcoming loss of exclusivity for a number of anticancer biologics, together with the introduction of an abbreviated approval pathway for biosimilars, raises the question of whether these products will be vulnerable to shortages. Future supply by reliable manufacturers of well characterized biosimilar monoclonal antibodies, developed in compliance with regulatory and manufacturing guidelines and with substantial investments, may contribute to prevent future biologics shortages and ensure access to effective and safe treatment options for patients with cancer. Preclinical and clinical characterization is ongoing for potential biosimilars of trastuzumab, rituximab, and bevacizumab, with promising results.

Dying in the Age of Choice

Due to the unprecedented increase in the United States aging demographics, many more people are living longer and reaching older ages than ever before. However, a longer life is not necessarily a better life, as the vast majority will face a period of prolonged deteriorating health prior to death. Although notable efforts have been underway that are designed to improve the end-of-life experience, increasing numbers of individuals express a desire and/or act upon an intent to end their lives precipitously. Though still limited, the options to actively participate in their own deaths are growing. Requests for a hastened death can occur among people of all ages and includes those with advanced illness as well as others wanting to die due to unbearable suffering. This article provides an overview of the ongoing discourse about the experience of dying faced by many older adults, including aspects frequently associated with “a good death.” The limitations of established practices which seek to provide a “better” dying experience are identified followed by discussion of the growing availability of alternative options. Reflective considerations are presented to guide practice vis-à-vis the changing landscape surrounding options in dying.

Pattern of intravenous immunoglobulins (IVIG) use in a pediatric intensive care facility in a resource limited setting

Intravenous Immunoglobulin (IVIG) preparations are scarce biological products used for replacement or immunomodulatory effects. Guidelines have been issued by regulatory health authorities to ensure provision of the products for patients who are in severe need. The study aimed at description of the pattern of IVIG use (label/off label indications), adverse effects observed, reason for choice of IVIG among other modalities and efficacy in a pediatric intensive care setting. A retrospective chart review. The study included 45 cases admitted from 2008 through 2011 in a Pediatric Intensive Care Unit (PICU) of a tertiary referral pediatric hospital. The clinical diagnoses included neurology (35%), neonatology (16%), hematology (11%), autoimmune disorders (11%) immunodeficiency disorders (11%), infections other than neonatal sepsis (9%) and cardiology (6.5 %). The indications for IVIG use had an Evidence category Ia / Ib in 62 % of cases whereas the other 38 % had level II and III evidence. Choice of IVIG as a therapeutic option was based on failure of other treatment options to achieve response in 46.5%, lack of alternative treatment options 15.5 % and the need for urgent response in 38 %. Adverse events, duration and doses are reported. IVIG use is governed by availability of alternative options and the need for urgent response in critically ill children. Guidelines should be issued based on locally available treatment options and their cost effectiveness.