Benign disease of the vulva

2020 ◽  
pp. 627-636
Author(s):  
Rosalind Simpson ◽  
David Nunns
Keyword(s):  
Health Professionals ◽  
Complex Disease ◽  
Treatment Strategies ◽  
Pain Syndrome ◽  
Skin Condition ◽  
Knowledge And Skills ◽  
Level Of Functioning ◽  
Individualized Management ◽  
Vulval Disease ◽  
Careful Assessment

This chapter aims to enhance knowledge and skills in patient assessment, vulval examination, and treatment of vulval disease, specifically dermatological conditions and vulval pain. The prompt identification and treatment of vulval conditions can reduce anxiety, alleviate symptoms, and preserve an acceptable level of functioning for patients. Often simple measures can benefit the patient (e.g. use of emollients), but many have complex disease and can present with more than one condition so careful assessment and individualized management is essential. Combining treatment strategies is sometimes needed. Vulvodynia is not a skin condition but a chronic pain syndrome and is also covered in this chapter. It is important that health professionals work within their own competencies. Patients with complicated, rare, and treatment-refractory disease should be referred on to a vulval service for a multidisciplinary opinion.

Current state-of-the-art antiplatelet and anticoagulation therapy in diabetic patients with coronary artery disease

2021 ◽  
Author(s):  
Johny Nicolas ◽  
Victor Razuk ◽  
Gennaro Giustino ◽  
Roxana Mehran
Keyword(s):  
Diabetes Mellitus ◽  
Complex Disease ◽  
Anticoagulation Therapy ◽  
Treatment Strategies ◽  
Diabetic Patients ◽  
Current State ◽  
Organ Systems ◽  
Patients With Diabetes ◽  
The Status ◽  
Artery Disease

Diabetes mellitus is a complex disease that leads to long-term damage to various organ systems. Among the numerous cardiovascular disease-related complications, thrombotic events frequently occur in patients with diabetes. Although guidelines exist for treating and preventing most diabetes-related co-morbidities, the evidence on antithrombotic therapy in primary and secondary prevention is limited due to the scarcity of randomized trials dedicated to patients with diabetes mellitus. Most of the available data are derived from studies that only included a small proportion of patients with diabetes. The present review provides an overview of the status of knowledge on antiplatelet and anticoagulation therapy in patients with diabetes, focusing on the risk–benefit balance of these therapies and future treatment strategies.

A Clinical Conundrum: The Pharmacist's Role in Evaluating Comorbid Urinary incontinence and Heart Failure

2021 ◽  
Vol 36 (3) ◽  
pp. 142-146
Author(s):  
Robin Parker ◽  
Aaron Henslee ◽  
Zachary L. Cox
Keyword(s):  
Heart Failure ◽  
Urinary Incontinence ◽  
Older Patients ◽  
Complex Disease ◽  
Treatment Strategies ◽  
Shared Decision ◽  
Patient Centered ◽  
Appropriate Prescribing ◽  
Therapeutic Competition ◽  
Improve Patient

Heart failure (HF) is a complex disease to manage, and treatment strategies for older adults are complicated by the presence of comorbidities such as urinary incontinence (UI). There is a therapeutic competition that exists in the treatment of patients with both HF and UI, as many of the agents indicated for control of HF may directly exacerbate UI. A reported 80% of adults with HF are older than 65 years of age, and 50% of HF patients have UI. The prevalence of conflicting therapeutic objectives in older patients presents an opportunity for intervention by senior care pharmacists. Pharmacists are equipped to optimize medication outcomes through the provision of appropriate prescribing and deprescribing recommendations, when necessary. This provides an opportunity for shared decision making to improve patient-centered outcomes and goals of care within this population.

scholarly journals OsteoporosAtlas: a human osteoporosis-related gene database

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e6778 ◽  
Author(s):  
Xun Wang ◽  
Lihong Diao ◽  
Dezhi Sun ◽  
Dan Wang ◽  
Jiarun Zhu ◽  
...  
Keyword(s):  
Complex Disease ◽  
Treatment Strategies ◽  
Osteoporotic Fractures ◽  
Relevant Information ◽  
Extensive Literature ◽  
Mineral Density ◽  
Common Complex Disease ◽  
Increased Risk ◽  
Prevention And Treatment ◽  
Pathway Analyses

Background Osteoporosis is a common, complex disease of bone with a strong heritable component, characterized by low bone mineral density, microarchitectural deterioration of bone tissue and an increased risk of fracture. Due to limited drug selection for osteoporosis and increasing morbidity, mortality of osteoporotic fractures, osteoporosis has become a major health burden in aging societies. Current researches for identifying specific loci or genes involved in osteoporosis contribute to a greater understanding of the pathogenesis of osteoporosis and the development of better diagnosis, prevention and treatment strategies. However, little is known about how most causal genes work and interact to influence osteoporosis. Therefore, it is greatly significant to collect and analyze the studies involved in osteoporosis-related genes. Unfortunately, the information about all these osteoporosis-related genes is scattered in a large amount of extensive literature. Currently, there is no specialized database for easily accessing relevant information about osteoporosis-related genes and miRNAs. Methods We extracted data from literature abstracts in PubMed by text-mining and manual curation. Moreover, a local MySQL database containing all the data was developed with PHP on a Windows server. Results OsteoporosAtlas (http://biokb.ncpsb.org/osteoporosis/), the first specialized database for easily accessing relevant information such as osteoporosis-related genes and miRNAs, was constructed and served for researchers. OsteoporosAtlas enables users to retrieve, browse and download osteoporosis-related genes and miRNAs. Gene ontology and pathway analyses were integrated into OsteoporosAtlas. It currently includes 617 human encoding genes, 131 human non-coding miRNAs, and 128 functional roles. We think that OsteoporosAtlas will be an important bioinformatics resource to facilitate a better understanding of the pathogenesis of osteoporosis and developing better diagnosis, prevention and treatment strategies.

A Clinical Conundrum: The Pharmacist’s Role in Evaluating Comorbid Urinary Incontinence and Heart Failure

2021 ◽  
Vol 36 (3) ◽  
pp. 142-146
Author(s):  
Robin Parker ◽  
Aaron Henslee ◽  
Zachary L. Cox
Keyword(s):  
Heart Failure ◽  
Urinary Incontinence ◽  
Older Patients ◽  
Complex Disease ◽  
Treatment Strategies ◽  
Shared Decision ◽  
Patient Centered ◽  
Appropriate Prescribing ◽  
Therapeutic Competition ◽  
Improve Patient

Heart failure (HF) is a complex disease to manage, and treatment strategies for older adults are complicated by the presence of comorbidities such as urinary incontinence (UI). There is a therapeutic competition that exists in the treatment of patients with both HF and UI, as many of the agents indicated for control of HF may directly exacerbate UI. A reported 80% of adults with HF are older than 65 years of age, and 50% of HF patients have UI. The prevalence of conflicting therapeutic objectives in older patients presents an opportunity for intervention by senior care pharmacists. Pharmacists are equipped to optimize medication outcomes through the provision of appropriate prescribing and deprescribing recommendations, when necessary. This provides an opportunity for shared decision making to improve patient-centered outcomes and goals of care within this population.

Barriers to and facilitators of health services utilisation by refugees in resettlement countries: an overview of systematic reviews

2020 ◽  
Vol 44 (1) ◽  
pp. 132 ◽  
Author(s):  
Jamuna Parajuli ◽  
Dell Horey
Keyword(s):  
Health Care ◽  
Health Service ◽  
Health Services ◽  
Systematic Reviews ◽  
Health Professionals ◽  
Health Service Utilisation ◽  
Barriers And Facilitators ◽  
Service Utilisation ◽  
Knowledge And Skills ◽  
Overview Of Systematic Reviews

Objective The aim of this study was to provide an overview of the previously reviewed research literature to identify barriers and facilitators to health service utilisation by refugees in resettlement countries. Methods An overview of systematic reviews was conducted. Seven electronic databases (Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, ProQuest Central, Scopus, EBSCO and Google Scholar) were searched for systematic reviews of barriers and facilitators to health-seeking behaviour and utilisation of health services by refugees following resettlement. The two authors independently undertook data selection, data extraction and quality assessment using a validated tool. Results Nine systematic reviews covered a range of study areas and refugee populations. Barriers to health service utilisation fell into three broad areas: (1) issues related to refugees, including refugee characteristics, sociocultural factors and the effects of previous experiences; (2) issues related to health services, including practice issues and the knowledge and skills of health professionals; and (3) issues related to the resettlement context, including policies and practical issues. Few facilitators were identified or evaluated, but these included approaches to care, health service responses and behaviours of health professionals. Conclusions Barriers to accessing health care include refugee characteristics, practice issues in health services, including the knowledge and skills of health professionals, and the resettlement context. Health services need to identify barriers to culturally sensitive care. Improvements in service delivery are needed that meet the needs of refugees. More research is needed to evaluate facilitators to improving health care accessibility for these vulnerable groups. What is known about the topic? Refugee health after resettlement is poor, yet health service use is low. What does this paper add? Barriers to accessing health services in resettlement countries are related not only to refugees, but also to issues regarding health service practices and health professionals’ knowledge and skill, as well as the context of resettlement. Few facilitators to improving refugee access to health services have been identified. What are the implications for practitioners? The barriers associated with health professionals and health services have been linked to trust building, and these need to be addressed to improve accessibility of care for refugees.

PD Assistance and Relationship to Co-Existing Geriatric Syndromes in Incident Peritoneal Dialysis Therapy Patients

2019 ◽  
Vol 39 (4) ◽  
pp. 375-381 ◽  
Author(s):  
Janine F. Farragher ◽  
Matthew J. Oliver ◽  
Arsh K. Jain ◽  
Susan Flanagan ◽  
Kathleen Koyle ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Complex Disease ◽  
Functional Dependence ◽  
Treatment Strategies ◽  
Outpatient Setting ◽  
Cognitive Testing ◽  
Cognitive Changes ◽  
Study Objective ◽  
Home Dialysis ◽  
Observational Study Design

Background Home dialysis therapies, including peritoneal dialysis (PD), are preferred treatment strategies, offering flexibility and improved wellbeing. However, patients with complex disease and comorbidity may require assistance with personal care and healthcare-related tasks. The study objective was to formally assess the type and frequency of PD assistance received by patients over 50, and the relationship to observed frailty, functional status, and cognitive ability at the time of PD therapy initiation. Methods Using a multicentered, prospective observational study design, patients aged ≥ 50 years were recruited from those starting PD. Patients underwent formal evaluation using validated components of a Comprehensive Geriatric Assessment. The receipt and nature of assistance with PD tasks were assessed 1 month after dialysis start by questionnaire. Results A total of 121 patients (age 69 ± 10 years, 67% male, 54% diabetic) were recruited. A total of 75 (62%) patients received assistance for a variety of tasks from friends or family ( n = 41, 34%) or a paid caregiver ( n = 34, 28%) 1 month after starting dialysis. At baseline, there was a high prevalence of functional dependency (79/120, 66%), frailty (71/110, 65%), and impaired cognition (68/115, 59%). Only 5% were fully independent, clinically robust, and scored within the normal range on cognitive testing. Factors associated with PD assistance included comorbidity ( p < 0.03), cognitive impairment ( p < 0.0001), and functional dependence ( p < 0.02). Conclusion Older patients initiating PD in the outpatient setting have high rates of frailty, functional dependence, and cognitive changes at the time they initiate dialysis. More research is required to better understand how those factors contribute to the use of PD assistance.

Experience with Sorafenib in 3 Hospitals in Sao Paulo

2018 ◽  
Vol 17 (5) ◽  
pp. 0-10
Author(s):  
Rogério Camargo-Pinheiro-Alves ◽  
Daniele E. Viera-Alves ◽  
Arthur Malzyner ◽  
Otavio Gampel ◽  
Thaisa de F. Almeida-Costa ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Complex Disease ◽  
Objective Response ◽  
Evaluation Criteria ◽  
Treatment Strategies ◽  
Sao Paulo ◽  
Advanced Hepatocellular Carcinoma ◽  
São Paulo ◽  
Sorafenib Therapy

Introduction and aim. Sorafenib has been the standard of care for first-line treatment of advanced hepatocellular carcinoma, a complex disease that affects an extremely heterogenous population. Thereby requiring multidisciplinary individualized treatment strategies that match the disease characteristics and the patients’ specific needs. Material and methods. Data for 175 patients who received sorafenib for hepatocellular carcinoma in three different hospitals in Sao Paulo, Brazil over a span of nine years were retrospectively analyzed. Results. The median age was 62 years. Percentages of patients with Child-Pugh A, B and C liver cirrhosis were 61%, 31% and 5%, respectively. Approximately half of the patients had Barcelona Clinic Liver Cancer stage B disease, and the other half had stage C. The median treatment duration was 253 days. Sorafenib dose was reduced to 400 mg/day in 41% of the patients due to toxicity. Overall objective response rate as per Response Evaluation Criteria in Solid Tumors and its modified version was 39%. Patients who received transarterial chemoembolization (TACE) at any point during sorafenib therapy were significantly more likely to experience an objective response. After a median follow-up of 339 days, the median overall survival was 380 days. Child-Pugh cirrhosis, tumor response and concomitant chemoembolization were independent prognostic factors for overall survival in multivariate analysis. Conclusion. Our results suggest that, in experienced hands, sorafenib therapy may benefit carefully selected hepatocellular carcinoma patients for whom other therapies are initially contraindicated, including those patients with Child-Pugh B liver function and those patients who are subsequently treated with concomitant TACE.

Defining the pathophysiology of the paclitaxel-acute pain syndrome

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19613-19613
Author(s):  
S. L. Wolf ◽  
C. L. Loprinzi ◽  
K. Maddocks-Christianson ◽  
R. D. Rao ◽  
P. B. Dyck ◽  
...  
Keyword(s):  
Acute Pain ◽  
Weight Bearing ◽  
Treatment Strategies ◽  
Pain Syndrome ◽  
Structured Interview ◽  
Cellular Injury ◽  
Effective Prevention ◽  
Increased Sensitivity ◽  
Structural Injury ◽  
Positive Step

19613 Background: Paclitaxel therapy often results in a unique sub-acute pain syndrome, whose pathophysiology is unknown. While this syndrome is often termed as a ‘myalgia’ or ‘arthralgia’, it has not been demonstrated to be associated with any structural injury of muscles or joints. Identifying the pathophysiology mechanisms that result in the paclitaxel-acute pain syndrome might be a positive step in the development of effective prevention and/or treatment strategies. With the hypothesis that the paclitaxel-acute pain syndrome occurs as a result of nerve injury, an observational study to clarify the clinical characteristics of this syndrome was initiated. Methods: Oncology patients who were treated with at least one dose of paclitaxel and reported developing sub-acute pain were questioned using a detailed structured interview. Various aspects of the pain, including the time of onset, duration, location, severity, and exacerbating factors were evaluated. Data were tabulated descriptively. Results: Eighteen patients were interviewed. The onset of pain typically occurred 1–2 days after therapy and lasted for a median of 4–5 days. Pain was most commonly located in the back, hips, shoulders, thighs, legs and feet, with the most common descriptors used being ‘aching’ or ‘deep pain’. Commonly used adjectives to describe the pain were: ‘radiating’, ‘shooting’, ‘aching’, ‘stabbing’ and ‘pulsating’. Some patients described increased pain with weight bearing or walking. Fifteen of 18 patients specifically denied localization of pain to either joints or muscles. Conclusions: The nature of the pain, i.e. , generalized, deep aching pain, the notation of increased sensitivity with weight bearing (mechanical hyperalgesia) and the lack of localization to joints or muscles, support the hypothesis that the paclitaxel-acute pain syndrome results from a hyperalgesic dysfunction of nociceptive receptors, their fibers, or the spinothalamic system. These clinical conclusions are supported by the recent findings that markers of cellular injury can be identified in peripheral nerve tissues shortly following paclitaxel administration in an animal model (Peters CM, et al., Exp Neurol. 2007 Jan;203(1):42- 54). No significant financial relationships to disclose.

scholarly journals Experiences with perinatal loss from the health professionals’ perspective

2011 ◽  
Vol 19 (6) ◽  
pp. 1405-1412 ◽  
Author(s):  
Sonia María Pastor Montero ◽  
José Manuel Romero Sánchez ◽  
César Hueso Montoro ◽  
Manuel Lillo Crespo ◽  
Ana Gema Vacas Jaén ◽  
...  
Keyword(s):  
Health Professionals ◽  
Training Programs ◽  
Perinatal Death ◽  
Perinatal Loss ◽  
Phenomenological Approach ◽  
Knowledge And Skills ◽  
Perinatal Bereavement ◽  
Loss And Grief ◽  
Healthcare Practice ◽  
Action Strategies

The purpose of this paper is to know the experience of health professionals in situations of perinatal death and grief and to describe their action strategies in the management of perinatal loss. A qualitative study with a phenomenological approach was carried out through interviews conducted with 19 professionals. Three thematic categories were identified: Healthcare practice, feelings aroused by perinatal loss and meaning and beliefs about perinatal loss and grief. The results revealed that the lack of knowledge and skills to deal with perinatal loss are identified as the main reason behind unsuitable attitudes that are usually adopted in these situations. This generates anxiety, helplessness and frustration that compromise professional competency. The conclusion reached is that the promotion of training programs to acquire knowledge, skills and abilities in management of perinatal bereavement and the development of a clinical practice guideline for perinatal loss are necessary.

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