Methadone has several unique characteristics that make it an attractive option for pain relief in serious illness, but the safety of methadone has been called into question after reports of a disproportionate increase in opioid-induced deaths in recent years. The American Pain Society, College on Problems of Drug Dependence, and the Heart Rhythm Society collaborated to issue guidelines on best practices to maximize methadone safety and efficacy, but guidelines for the end-of-life scenario have not yet been developed. A panel of 15 interprofessional hospice and palliative care experts from the U.S. and Canada convened in February 2015 to evaluate the American Pain Society methadone recommendations for applicability in the hospice and palliative care setting. The goal was to develop guidelines for safe and effective management of methadone therapy in hospice and palliative care. This article represents the consensus opinion of the hospice and palliative care experts for methadone use at end of life, including guidance on appropriate candidates for methadone, detail in dosing, titration, and monitoring of patients' response to methadone therapy. 相似文献
Aims: This study analyses how Finnish and Norwegian teenagers and parents of teenagers perceive the appropriateness, desirability or harmfulness of different drinking situations. The focus is on whether teenagers and parents perceive the situations similarly or differently.
Methods: Our data consist of focus group interviews from Finland and Norway with teenagers aged 14–17 years (n?=?8 groups, n?=?44 participants) and parents (n?=?8 groups, n?=?38). Three pictures portraying different drinking situations were presented to the participants, who were asked to describe (1) what kind of situation the picture depicts, (2) whether the way of drinking in the picture was acceptable or not and (3) whether they identified with the situation or not.
Findings: Our analysis showed that teenagers and parents defined the situations similarly and applied rather similar criteria when assessing the appropriateness of drinking. The most important criteria related to the amount and the way of drinking, and whether or not children were present in the situation. Regarding the identification with the situations, teenagers seemed to have somewhat stricter attitudes towards intoxication than adults, which can be perceived as a sign of an ongoing trend of decreasing youth drinking.
Conclusions: Overall, our analysis suggests that the alcohol worlds of parents and teenagers resembled each other, supporting the notion that the generational gap between parents and teenagers is diminishing. 相似文献
Induction chemotherapy with cytarabine and an anthracycline (7+3) remains the standard of care for acute myeloid leukemia (AML).
Patients and Methods
We retrospectively analyzed 183 newly diagnosed AML patients to compare the utility of rapid peripheral blast clearance (PBC), day of peripheral blast disappearance, residual blasts, and cellularity at day 14 bone marrow biopsy (D14BM) in predicting clinical response to 7+3 induction, overall survival (OS), and relapse-free survival (RFS).
Results
In multivariable logistic regression analysis, day 2 PBC > 85% [P = .0016] was the only predictor of remission status, with sensitivity and specificity of 75%. Peripheral blast disappearance within 5 days after induction and < 10% cellularity in D14BM predicted superior OS and RFS in multivariate analysis. Median follow-up of patients was 28 months since diagnosis. Two-year OS and RFS for patients with ≤ 10% versus > 10% cellularity at D14BM was 60.6% [95% confidence interval (CI), 50.8%-72.2%] versus 32.5% [95% CI, 23.0%-45.8%], and 51.9% [95% CI, 41.9%-64.3%] versus 28.8% [95% CI, 19.1%-43.4%], respectively [P = .0003 for OS and .002 for RFS].
Conclusion
Rapid PBC after 7+3 induction showed a significant improvement in specificity compared with D14BM, with similar sensitivity. Neither of these methods were reliably specific tools for the decision of early reinduction, despite their prognostic value. Our findings indicate that morphological cellularity in D14BM is an independent prognostic factor for OS and RFS, regardless of blast percentage, and that ≤ 10% cellularity defines D14BM hypoplasia. 相似文献
Mutations in the desmosomal protein desmoplakin have been associated with various conditions affecting the skin and heart. The prototype is Carvajal syndrome, characterized by cardiomyopathy, woolly hair, palmoplantar keratoderma (PPK), and skin fragility. We report the case of a 3‐year‐old boy presenting with severe left‐sided heart failure with a preceding history of cutaneous abnormalities including congenital alopecia, PPK, nail dystrophy, and follicular hyperkeratosis on the extensor surfaces. Genetic testing revealed a novel combination of two heterozygous mutations in the DSP gene encoding desmoplakin: R1400X and R2284X. Both are predicted to be deleterious to protein function. This case adds to our understanding of the spectrum of clinical presentations of syndromes associated with desmoplakin mutations and highlights the need for cardiac examination in patients with characteristic cutaneous findings. 相似文献
AIM: To investigate the effect of broccoli sprouts juice in preventing lens protein aggregation in diabetic rat model.
METHODS: Totally 25 male Wistar rats were divided into negative control group, diabetic group without juice treatment as positive control and diabetic group given broccoli sprouts juice 0.25, 0.5 and 1 g/d for 28d. Diabetic rat model was obtained by administering a single dose streptozotocin 65 mg/kg intraperitoneal. At the end of the study, all rats were examined for fasting blood sugar level (FBS), visual cataract score using slit lamp biomicroscope and lens αB-crystallin expression using Western blot method. Statistical analysis was performed using one way ANOVA with post hoc test, correlation test, and simple linear regression.
RESULTS: Positive control group had the highest cataract score and lens aggregated αB-crystallin expression. Broccoli sprout juice dose of 1 g/d group had the mildest cataract score, as well as the expression of lens aggregated αB-crystallin compared to treatments groups 1 and 2, opposite to lens native αB-crystallin expression. The broccoli sprout juice groups gave a significant decrease in cataract score, and also in lens aggregated αB-crystallin expression in diabetic rat models (P<0.05).
CONCLUSION: Broccoli sprout juice has a significant effect in preventing lens protein aggregation in diabetic rat model. The higher dose gives better visual cataract scores, lower lens aggregated αB-crystallin expression and higher lens native αB-crystallin expression. 相似文献