#bmj open quality

[academypediaen]

Top 21 Open Access Medical Journals That Technology Watch Experts Should Leverage

Introduction :   Keeping up with the ever-evolving technology landscape in the medical field can be a challenge. If you’re a technology watch expert, you need to be able to quickly identify emerging trends and make sound decisions based on them. But how can you do that ?   This a [...] https://is.gd/f0qghy

#business #communication #data #education #ict #information #intelligence #technology - Created by David Donisa from Academypedia.info

[familythings]

Singlehood vs. Partnership: How Being in a Relationship Impacts Blood Sugar Levels

Recent research published in BMJ Open Diabetes Research & Care has brought to light compelling findings about the profound impact of being in a relationship on blood sugar levels. The study reveals that individuals who share their lives with a partner tend to experience healthier blood sugar levels compared to their single counterparts, irrespective of the quality of their relationship. This…

[robustnesshealth]

Excelling in the Specialty Certificate Exam (SCE) in Rheumatology: Benefits and Preparation Tips

The Specialty Certificate Exam (SCE) in Rheumatology is a pivotal step for rheumatology trainees seeking to validate their knowledge and skills. Success in this exam not only enhances professional credibility but also opens doors to advanced career opportunities. Here are some key benefits of passing the SCE in Rheumatology and essential tips for effective preparation:

Professional Recognition:

Passing the SCE in Rheumatology signifies a high level of expertise and is recognized by employers and professional bodies worldwide. Speciality Exam Rheumatology SCE It confirms your competency in managing complex rheumatological conditions.

Career Advancement:

Successfully completing the SCE can accelerate your career progression, making you eligible for senior positions within your specialty. It can also pave the way for sub-specialization and leadership roles in clinical settings.

Enhanced Clinical Skills:

The rigorous preparation for the SCE hones your diagnostic and therapeutic skills, ensuring you are well-equipped to handle a wide range of rheumatological disorders. This translates to improved patient care and outcomes.

Continuing Professional Development:

The process of studying for the SCE keeps you updated with the latest advancements and evidence-based practices in rheumatology. It encourages a habit of continuous learning and professional development.

Global Opportunities:

With the SCE being recognized in many countries, passing the exam can expand your opportunities to work internationally, allowing you to practice in diverse healthcare environments and broaden your professional horizons.

Create a Study Schedule:

Develop a comprehensive study plan that covers all relevant topics in the rheumatology syllabus. Allocate specific time slots for each subject, ensuring balanced coverage and regular revision.

Utilize Quality Study Materials:

Invest in high-quality textbooks, online courses, and question banks specifically tailored for the SCE in Rheumatology. Resources like BMJ OnExamination, PassMedicine, and specialty-specific guides can provide invaluable insights.

Practice with Past Papers:

Regularly practicing with past exam papers and mock tests helps familiarize you with the exam format and question style. It also aids in identifying areas where you need further improvement.

Join Study Groups:

Collaborating with peers in study groups can enhance your understanding through discussion and shared knowledge. It also provides moral support and keeps you motivated throughout your preparation journey.

Seek Professional Guidance:

Consider enrolling in preparatory courses or seeking mentorship from experienced rheumatologists who have successfully passed the SCE. Their guidance can offer practical tips and tailored advice to boost your preparation.

Focus on Clinical Scenarios:

Given the clinical nature of the SCE, prioritize understanding and solving clinical scenarios. This approach ensures you can apply theoretical knowledge to real-world cases, SCE Test a critical skill for the exam.

Regular Self-Assessment:

Periodic self-assessment through quizzes and timed practice tests helps track your progress and identify weak areas. It allows you to adjust your study plan accordingly to address these gaps.

Maintain a Healthy Balance:

While rigorous study is essential, maintaining a healthy work-life balance is equally important. Incorporate stress management techniques such as regular exercise, adequate sleep, and relaxation activities to keep your mind and body in optimal condition.

By following these preparation tips and understanding the benefits of passing the SCE in Rheumatology, you can approach the exam with confidence and determination. Achieving success in this exam not only marks a significant milestone in your career but also enhances your ability to provide high-quality care to patients with rheumatological conditions.

[whataboutfractions]

@jelloapocalypse right?? going into bmj last year for my most recent revisit, i really wanted to like misty because i thought maybe i'd just been biased against her before and hadn't paid her enough attention to really develop an affinity for her like i had for characters like max or mujoe who i'd overlooked when i was younger, but...she's just really not written well at all. i can't even really attribute a distinct character feel to her because she feels more than anything a lopsided amalgamation of shout and birdy whose worst qualities have their counterbalances removed (shout's standoffishness and general shonen-girl-nagging no longer makes sense as the immaturity of a literal teenager struggling to manage difficult emotions, and birdy's edginess no longer receives comedic undercutting in mundane slice-of-life interactions), then further steeped in obligatory heterosexual romance lacking any real depth of character chemistry beyond "haha boy and girl get along with each other"

which is bland enough in itself, but they really try to shoehorn her into a major character role in season 2 following her reprise as a vehicle to introduce zero into the plot, and while it would work well if it was intended as a deliberate commentary on how mighty kept people at such arm's length that even his 2002-shonen-acceptable romantic interest has to face the belated revelation that he never truly opened up to her and let her know him as a person in a meaningful way, it...does not come off that way at all

[didanawisgi]

“Revelations of poor practices at a contract research company helping to carry out Pfizer’s pivotal covid-19 vaccine trial raise questions about data integrity and regulatory oversight. Paul D Thacker reports

In autumn 2020 Pfizer’s chairman and chief executive, Albert Bourla, released an open letter to the billions of people around the world who were investing their hopes in a safe and effective covid-19 vaccine to end the pandemic. “As I’ve said before, we are operating at the speed of science,” Bourla wrote, explaining to the public when they could expect a Pfizer vaccine to be authorised in the United States.1

But, for researchers who were testing Pfizer’s vaccine at several sites in Texas during that autumn, speed may have come at the cost of data integrity and patient safety. A regional director who was employed at the research organisation Ventavia Research Group has told The BMJ that the company falsified data, unblinded patients, employed inadequately trained vaccinators, and was slow to follow up on adverse events reported in Pfizer’s pivotal phase III trial. Staff who conducted quality control checks were overwhelmed by the volume of problems they were finding…”

[monikagrin]

Hey there, 

Suicide in Lithuania has become a significant social issue in the country due to its high rate. According to the fact, after looking through the codebook for the Gapminder study, I have decided that I am particularly interested in mortality due to self-inflicted injury. 

I am not sure which variables I will use regarding suicide rate, so for now I will include all the relevant variables in my personal codebook (please find the screenshot attached).

My topics of interest:

a) Is Gross Domestic Product per capita associated with mortality due to self-inflicted injury? b) Is life expectancy at birth associated with mortality due to self-inflicted injury?

Main keynotes after a literature review:

1) “Advancement in socio-economic factors was associated with lower female suicide rates relative to those of males.” 2) “There was a very significant association between national life expectancy and male/female suicide ratio, with life expectancy accounting for approximately 4% of the variance in this relation. This suggest that as the national wellbeing improves, it results in a widening of the relative risk of males dying from suicide compared to females. This differs with a prior analysis by Mayer where an inverse association was obsverved (Mayer, 2000). However data were only available for 37 countries in this earlier analysis which used data from 1996, so the two results are not directly comparable. A similar sized association is seen with per capita GDP, and it is likely that these observations are related and hence co-linear to each other as economic development is one of the main drivers for an increase in life expectancy (Pradhan, 2015).”

(Alothman, D. and Fogarty, A., 2020. Global differences in geography, religion and other societal factors are associated with sex differences in mortality from suicide: An ecological study of 182 countries. Journal of affective disorders, 260, pp.67-72.)

3) “The rises were associated with some measures of income inequality and GDP.” 4) “Japan and France experienced a recession but did not show evidence of a concurrent rise in suicide rates. Japan and Republic of Korea's previously rising suicide rates reversed soon after the 2008 economic recession. Poland neither experienced a recession nor rises in suicide rates. Furthermore, based on their 95% confidence intervals, Spain and Germany's temporary upturn in suicide rates may have occurred around the time of the 2008 economic recession, as may the deceleration in Italy's downward suicide rate trend. Nonetheless, we found no statistical evidence that countries with rising suicide rates were more likely to have been affected by the 2008 global economic recession (Fisher’s exact test: p=0.49). This was unchanged when we reclassified Australia as not having experienced a recession (Fisher's exact test: p=1.00), and also when we excluded the two countries that experienced temporary upturns in suicide rates (Germany and Spain) (Fisher's exact test: p=1.00).” 5) “There is evidence that absolute GDP per capita in 2008 (the year the global recession began), is higher in countries with rising suicide rates (Wilcoxon rank sum test z=-2.27; p=0.02). Japan and the Republic of Korea experienced prolonged rises in suicide rates during the study period, followed by declines from 2009 onwards. Our findings were similar in a sensitivity analysis excluding these two countries (Wilcoxon rank sum test z=-1.96; p=0.05).”

(Okada, M., Hasegawa, T., Kato, R. and Shiroyama, T., 2020. Analysing regional unemployment rates, GDP per capita and financial support for regional suicide prevention programme on suicide mortality in Japan using governmental statistical data. BMJ open, 10(8), p.e037537.)  

6) “The suicide rate varies greatly between countries with different levels of development. The findings suggest that richer countries are associated with an increased risk of suicidal behaviors.”

(Mendez, J. and Semblante, J., Analysis of Mental Health Program based on Suicide Rate Trends: 1985 to 2015.)  

7) “ Economic quality and inequality were not related to overall suicide mortality rates. However, economic inequality was correlated with a higher ratio of male/female suicides. This study provides a recent update of cross‐national suicide trends in adolescents. Findings replicate prior patterns related to age, sex, geographic region, and common suicide methods. New to this review are findings relating suicide method accessibility to suicide mortality rates and the significant association between income inequality and the ratio of male/female suicide. Future research directions include expanding the worldwide coverage to more low‐ and middle‐income countries, examining demographic groupings beyond binary sex and to race/ethnicity within countries, and clarifying factors that account for cross‐national differences in suicide trends.”

(Glenn, C.R., Kleiman, E.M., Kellerman, J., Pollak, O., Cha, C.B., Esposito, E.C., Porter, A.C., Wyman, P.A. and Boatman, A.E., 2020. Annual Research Review: A meta‐analytic review of worldwide suicide rates in adolescents. Journal of child psychology and psychiatry, 61(3), pp.294-308.)  

My hypothesis is that a country’s GDP per capita and life expectancy have associations with its suicide rate.

[o-behave]

OPTIMISING PLACEBOS AND MINIMISING NOCEBOS

LESSONS FROM BEHAVIOURAL SCIENCE

By Chloe Hutchings-Hay, Analyst at Ogilvy Consulting’s Behavioural Science Practice

Placebo Effect

The placebo effect was first established when Henry Beecher, a World War II doctor, ran out of morphine, and decided to give his patients a salt-water injection instead. He was surprised to learn that many of his patients (around a third) responded as though they had actually received morphine.

Since then, the benefits of placebo have been observed in treatments for illnesses as disparate as depression and Parkinson’s disease. One study even found that sham shoulder surgeries were as effective at improving symptoms as the real surgery itself (Schroder et al., 2017).

Whilst initially these benefits were thought of as ‘fake’, and those who experienced placebo effects were deemed suggestible, growing evidence suggests that there are real neurobiological mechanisms underpinning placebo effects. Supporting this is the mounting evidence from open-label placebo studies, where improvement has still been observed even when patients know they are receiving a placebo (BMJ, 2018), suggesting that conditioning alone can bring about the placebo effect.  What’s more, personality factors are shown to be less important in determining response to placebo than factors determined by the broader context, like expectancy effects and the quality of the doctor-patient relationship.

The understanding that the context is crucial in eliciting the placebo response lends itself to the use of behavioural nudges to optimise the placebo response. Doctors already routinely prescribe placebos in their practices (Howick et al., 2013). Understanding how to best optimise the placebo response is important for medicine generally, as the success of conventional treatments is also bolstered via the placebo effect.

How Can We Optimise the Placebo Effect?

1.    Priming: Placebos need to look legitimate, with branding and pricing being especially important. One study found higher-priced painkillers to be more effective than discounted painkillers (Waber et al., 2008); higher prices anchor expectations upwards. The colour of pills is important too, with learned associations having an impact on how we respond to drugs. We associated blue pills with sedation, yellow pills with mood enhancement and white pills with pain relief (Cohen, 2014). Setting the scene with good branding, thoughtful design and realistic pricing is key.

2.    Affect: Creating a positive therapeutic relationship between patient and doctor is vital in eliciting the placebo response; our expectations about the efficacy of the medication are largely set in this interaction. The placebo effect is enhanced when doctors are more empathetic, have a warmer approach and spend longer with their patients (Benedetti, 2013). An initial positive interaction can improve the expectation that treatment is going to work and helps to ease anxiety.

Nocebo Effect

Sometimes thought of as the ‘evil twin’ of the placebo effect is the nocebo effect, referring to the development of side-effects following exposure to a sham substance. Evidence for the nocebo effect also abounds, with sham medication leading to increased side-effect reporting for conditions including hypertension and cancer (Enck et al., 2013). Systematic reviews find that around half of placebo groups in clinical trials experience adverse effects that are attributed to the drug (Howick et al. 2018).

The nocebo effect is often observed during public health outbreaks, putting huge pressure onto health providers. For example, in 1985 ‘radioactive caesium 137’ was scavenged from a disused hospital site in Goiânia, Brazil. 120,000 people subsequently sought screening for radioactive contamination at health facilities, however of the first 60,000 people screened, only 5,000 were symptomatic. This begs the question; why do people sometimes think they are unwell when they haven’t been exposed to anything harmful?

People sometimes believe they are unwell because they re-interpret pre-existing common symptoms in light of information about the health outbreak, like fatigue or headaches. Anxiety about a health outbreak can also be sufficient in and of itself to also generate physical symptoms.

Aside from these influences, the nocebo effect can also have a very real influence on generating harmful side-effects, in the same way that placebo effects can have a tangible positive influence on the body. Expectancy, rather than conditioning, is the crucial mechanism underpinning the nocebo effect. One study found that verbal suggestion alone was sufficient to make low-level electric shocks be experienced as highly painful (Colloca, Sigaudo & Benedetti, 2008).

How Can We Minimise the Nocebo Effect?

1.     Positive Framing: At present, we are often all too aware of the possible side-effects that may come about as a result of trying a new medication. Even mere mentions of such side-effects can be sufficient to generate expectations of such symptoms (Colloca, Sigaudo & Benedetti, 2008). These potential negative outcomes can weigh more heavily in our minds than the possible benefits.

Changing the conversation to make it more positive may subsequently lessen the experience of side-effects, with patients having greater expectancy that the treatment will be effective. Positive framing is needed in the doctor-patient interaction, but also on information leaflets and drug packaging, which at present tend to focus on the riskiness of medication, rather than the benefits.

2.     Reducing Salience of Side-Effect Information: Research suggests that a particularly effective strategy to ward against nocebo effects is to omit information about side-effects altogether (Webster & Rubin, 2019), which poses something of an ethical dilemma. However, given that we know that people can experience side-effects just because they expect to experience them, it makes sense to be reporting on the potential for adverse experiences in a responsible way.

One example of this going wrong comes from press coverage over side-effects associated with statins. In 2013; it was estimated that 200,000 people in the UK stopped taking statins as a result. Expectancy of side-effects seemed to be sufficient for many people to change their perception of their experience of taking statins. As a result, it is predicted that the incidence of cardiovascular disease will rise by an additional 2000 cases over the next decade (Horton, 2016).

Tackling medical consent therefore poses something of a thorny issue: how do we adequately warn people of possible risks without inadvertently creating negative outcomes? There has been discussion over the idea of contextualised consent: where adverse effects are presented as more of a ‘grey area’, instead of a definite likelihood, and where doctors can withhold certain pieces of information in the best interest of the patient (Chamsi-Pasha, Albar & Chamsi-Pasha, 2017).  

The use of placebos provides a cost-effective way to create tangible improvements in patients’ lives. Behavioural science is key to maximising the benefits from placebos, in part through limiting the likelihood of developing side-effects from taking them.

References

Benedetti, F. (2013). Placebo and the new physiology of the doctor-patient relationship. Physiological reviews, 93(3), 1207-1246.

Chamsi-Pasha, M., Albar, M. A., & Chamsi-Pasha, H. (2017). Minimizing nocebo effect: Pragmatic approach. Avicenna Journal of Medicine, 7(4), 139-143.

Cohen, T. F. (2014, October 13). The Power of Drug Color. Retrieved from: https://www.theatlantic.com/health/archive/2014/10/the-power-of-drug-color/381156/

Colloca, L., Sigaudo, M., & Benedetti, F. (2008). The role of learning in nocebo and placebo effects. Pain, 136(1-2), 211-218.

De Pascalis, V., Chiaradia, C., & Carotenuto, E. (2002). The contribution of suggestibility and expectation to placebo analgesia phenomenon in an experimental setting. Pain, 96 (3), 393-402. Enck, P., Bingel, U., Schedlowski, M., & Rief, W. (2013). The placebo response in medicine: minimize, maximize or personalize?Nature reviews Drug discovery,12(3), 191.

Horton, R. (2016). Offline: Lessons from the controversy over statins. The Lancet, 388(10049), 1040.

Howick, J., Bishop, F. L., Heneghan, C., Wolstenholme, J., Stevens, S., Hobbs, F. R., & Lewith, G. (2013). Placebo use in the United Kingdom: results from a national survey of primary care practitioners. PLoS One, 8(3), e58247. 

Howick, J. (2018, October 1). Is back pain really all in the mind?Retrieved from: https://www.pressreader.com/uk/the-daily- telegraph/20181001/281509342121606

Howick, J., Webster, R., Kirby, N., & Hood, K. (2018). Rapid overview of systematic reviews of nocebo effects reported by patients taking placebos in clinical trials. Trials, 19(1), 674.

Kaptchuk, T. J., & Miller, F. G. (2018). Open label placebo: can honestly prescribed placebos evoke meaningful therapeutic benefits?. British Medical Journal, 363, k3889.

Schrøder, C. P., Skare, Ø., Reikerås, O., Mowinckel, P., & Brox, J. I. (2017). Sham surgery versus labral repair or biceps tenodesis for type II SLAP lesions of the shoulder: a three-armed randomised clinical trial. Br J Sports Med, 51(24), 1759-1766.

Waber, R. L., Shiv, B., Carmon, Z., & Ariely, D. (2008). Commercial features of placebo and therapeutic efficacy. Jama, 299(9), 1016-7.

Webster, R. K., Weinman, J., & Rubin, G. J. (2016). A systematic review of factors that contribute to nocebo effects. Health Psychology, 35(12), 1334.

Webster, R., & Rubin, G. J. (2019). Influencing side-effects to medicinal treatments: A systematic review of brief psychological interventions. Frontiers in Psychiatry, 9, 775.

[kaizenoncology1]

Dr. Santosh Chellapuram

 Consultant Medical, Pediatric and Hemato-Oncologist - Care Hospitals, Hyderabad

Dr. Santosh Kumar Chellapuram, who has an exceptional academic record brings along a lot of proven research experience. This rare quality can be attributed to his all-encompassing research projects and publications.

Dr. Santosh Chellapuram, consultant medical oncologist and Pediatric Haemato oncologist in hyderabad with an exceptional academic record from AIIMS has rich research experience proven in his publications and projects.

Email: drsantosh@kaizenoncology.com

Phone Number: 9154143858

My Qualifications

DM in Medical, DM in Medical Oncology - AIIMS - New Delhi

MD in Medicine , MD in Medicine – AIIMS - New Delhi

MBBS, MBBS - Osmania Medical College -Hyderabad

Experience

Consultant Medical Oncologist, CARE Hospitals,Hyderabad

Publications

Chellapuram Santosh Kumar, Srujana Joga, Bivas Biswas, Deepak Dabkara, Kuruswamy Thurai Prasad, Navneet Singh, Prabhat Singh Malik, Sachin Khurana, Sandip Ganguly, Valliappan Muthu, Ullas Batra,Immune checkpoint inhibitors in advanced non–small cell lung cancer: A metacentric experience from India,Current Problems in Cancer, Volume 44, Issue 3, 2020

Chellapuram Santosh Kumar, Lalit & Pramanik, Raja & Sharma, Aparna & Sharma, Atul & Sahoo, Ranjit & Malik, Prabhat & Cyriac, Sunu. (2019). POEMS SYNDROME: A single centre study of 68 patients and comparison of consolidation Autologous stem cell transplant(ASCT) versus non-ASCT cohorts.. Clinical Lymphoma Myeloma and Leukemia. 19. e307-e308. 10.1016/j.clml.2019.09.505.

Chellapuram Santosh Kumar, Malik Prabhat S, Kumar Lalit Containing coronavirus (COVID-19) spread in an oncology day care facility in India.IJMPO.Year : 2020 | Volume: 41 | Issue Number: 4 | Page: 468-470

Chellapuram Santosh Kumar, Gogia Ajay Systemic therapy for breast cancer during SARS-CoV-2 pandemic.CRST:Year : 2020 | Volume: 3 | Issue Number: 5 | Page: 35-39

Chellapuram Santosh Kumar & Gogia, Ajay. (2020). Authors' reply to D'Souza et al.. Cancer Research, Statistics, and Treatment. 3. 334. 10.4103/CRST.CRST_189_20.

Chellapuram Santosh Kumar, Sharma S K :Dengue virus infection: Editorial, NMJI, Year : 2016 | Volume: 29 | Issue Number: 2 | Page: 61-63

Kumar, Lalit & Chellapuram Santosh Kumar & Sahoo, Ranjit & Gupta, Ritu. (2019). VRd versus VCd as induction therapy for newly diagnosed multiple myeloma: A Phase III, randomized study. Clinical Lymphoma Myeloma and Leukemia. 19. e361. 10.1016/j.clml.2019.09.597.

Gogia, A., Kumar, S., Chellapuram Santosh Kumar. et al. Primary Mediastinal B Cell Lymphoma: A Limited Institutional Experience with Uniform DAEPOCH-R Protocol. Indian J Hematol Blood Transfus (2020). https://doi.org/10.1007/s12288-020-01301-z

Gundu Naresh, Lalit Kumar, Atul Sharma, Chellapuram Santosh Kumar, Prabhat Singh Malik, Ranjeet Kumar Sahoo, Raja Pramanik, Ahitagni Biswas .An Experience of Primary Amyloidosis from an Indian Tertiary Cancer Centre: A Retrospective Study.https://doi.org/10.1016/j.clml.2019.07.330

Sharma A, Ganguly S, Chellapuram Santosh Kumar, et al Addition of aprepitant improves acute emesis control in children and adolescents receiving induction chemotherapy for acute myeloid leukaemia: a randomised, open-label trial BMJ Supportive & Palliative Care Published Online First: 29 October 2020. doi: 10.1136/bmjspcare-2020-002595

Kumar, Lalit & Chellapuram Santosh Kumar & Mookerjee, Anjali & Sahoo, Ranjit & Malik, Prabhat & Gupta, Ritu & Sharma, Om & Biswas, Ahitagni. (2019). Characteristics and Outcome of Relapsed Myeloma after Single Autologous Stem Cell Transplant: 20-year Experience. Clinical Lymphoma Myeloma and Leukemia. 19. e210-e211. 10.1016/j.clml.2019.09.350.

Kumar, Lalit & Chellapuram Santosh Kumar & Dev, Ramavat & Varshneya, Ankur & Pawar, Satyajit & Sharma, Aparna & Mookerjee, Anjali & Sahoo, Ranjit & Malik, Prabhat & Sharma, Atul & Gupta, Ritu & Sharma, Omdutta & Biswas, Ahitagni & Kumar, Rakesh & Thulkar, Sanjay & Mallick, Saumyaranjan. (2019). Induction Therapy with Novel Agents and Autologous Stem Cell Transplant Overcomes the Adverse Impact of Renal Impairment in Multiple Myeloma. Clinical Hematology International. 1. 10.2991/chi.d.190805.003.

Tripathy, Sarthak & Shamim, Shamim & Chellapuram Santosh Kumar & Barwad, Adarsh & Rastogi, Sameer. (2019). Primary Ewing Sarcoma/Primitive Neuroectodermal Tumor of Kidney With Inferior Vena Cava Thrombus: Findings on 18F-FDG PET/CT. Clinical Nuclear Medicine. 45. 1. 10.1097/RLU.0000000000002865.

Published Chapters

Chellapuram Santosh Kumar, Lalit Kumar : Cardiac amyloidosis, CSI Cariology Update 2018

Chellapuram Santosh Kumar, Satyajit pawar, Atul Batra: Palliative Care for patients with breast cancer. Problem oriented Pall Care" by Oxford University Press.(In Press)

[healthflex]

Knee Brace Centre

Healthflex is now able to provide a range of knee braces that can help improve the symptoms of certain  conditions. One of our clinicians, Richard Lopez, has been trained by Ossur and is now able to provide this service for us. These braces require careful assessment before provision so a consultation by appointment is required. Ossur is a market leader in the custom made brace industry and it’s braces  are both technically excellent and made of high quality materials that  are made to last  

ACL/PCL Injury Solutions

Form Fit® Knee Hinged

The Form Fit® Knee brace is for patients suffering from mild to  moderate strains, sprains or ligament tears (ACL/PCL/MCL/LCL). It  provides excellent stability, protection and compression during injury  recovery. Made from strong, breathable materials, it offers comfort  while remaining highly durable. The open popliteal area reduces material  bulging and potential irritation, while the malleable rigid hinge arms  provide an intimate fit. Available in a wrap or sleeve version.

Product Highlights

Breathable material

Easy pull-on

Malleable hinges

Universal buttress

Open popliteal

Indications for Use

Mild to moderate ACL and PCL tears

MCL and LCL tears

Combined mild knee sprains and strains

Instabilities of the knee

CTi®    Brace

This brace is a more controlling device for more severe ligamentous injuries.

Key Features

-       Solid CTi carbon frame providing a rigid exoskeleton to stabilise the knee joint

-       Anatomically correct Accutrac® hinges and flexible cuffs and buckles

-       Breathable liners coated with Sensil® silicone to ensure brace remains properly positioned

-       Comes in OTS (Off The Shelf) or Custom

-       Pro sport version available

Osteoarthritis Solutions

Unloader One®   Brace

Key Features

-       Innovative design to help with symptoms associated with uni-compartmental osteoarthritis

-       Dual Dynamic Force Straps increase unloading capabilities

-       Straps are easily fine-tuned using the Smart-Dosing® system

-       Clinically proven effective in an 8 year study published in the BMJ

-       Össur Sensil® liners designed to improve comfort and reduce migration

-       Provides excellent suspension and unloading leverage

[health28]

Study highlights the lack of evidence-based clinical management guidelines for monkeypox

Study highlights the lack of evidence-based clinical management guidelines for monkeypox

A dearth of high quality, up to date clinical guidance on monkeypox may be hampering effective and safe treatment of the infection around the world, concludes a review of what’s available to guide patient care and published in the open access journal BMJ Global Health. Existing guidance, such as it is, too often lacks sufficient detail, fails to include different groups, and is contradictory, say…

[cancerabcs]

Caution - Men with Prostate Cancer Are More Likely to Develop Dangerous Blood Clots.

According to new research published in the online journal BMJ Open, men with prostate cancer had a 50% higher chance of having major and potentially fatal blood clots within the five years following their cancer diagnosis than men of the same age who do not have prostate cancer.

Although the risk is not as high as other types of cancer, experts are advising practitioners and patients to be aware of the danger in order to provide appropriate diagnosis and treatment if a blood clot occurs.

This is significant because venous thromboembolism (VTE), the kind of blood clot studied, is a leading cause of death among cancer patients, with the risk being higher in those with more advanced disease. People with cancer are more likely than non-cancer patients to develop venous thromboembolism (VTE), which are severe but curable blood clots in the veins. The risk varies depending on the type of cancer and its stage. VTEs are the major cause of patient death.

Because prostate cancer is the most common malignancy in middle-aged and older men, men with prostate cancer are at risk of developing VTE.

According to some older research, the risk of VTE is two to three times higher in men with prostate cancer than in men of similar age without the disease.

However, the researchers requested more recent data due to the substantial changes in how men with prostate cancer are managed over the last decade. This includes the widespread use of newer antiandrogens as well as anticoagulant medications for other ailments that may reduce the risk of VTE.

A group of European researchers conducted a large-scale study using nationwide data from males in Sweden collected between 2007 and 2017 to compare the occurrence of VTE among 92,105 men with prostate cancer and 466,241 men of the same age who did not have prostate cancer (the comparison group).

They discovered that 3.2 percent of men with prostate cancer had a VTE within five years of their cancer diagnosis, compared to 2.1 percent of men in the comparison group.

They projected that around seven men with prostate cancer would develop a VTE each year, compared to approximately four men without prostate cancer.

After accounting for factors that could influence VTE risk in their analysis (such as the presence of cardiovascular disease and socioeconomic factors), the researchers discovered that men with prostate cancer had a 50% higher risk than those in the comparison group over the five-year study period, with the most dangerous period being the first six months after a cancer diagnosis.

Because this was an observational trial, it is unclear how much of the elevated risk was caused by prostate cancer and how much was caused by other variables between the two groups of men that could have altered VTE risk but could not be controlled for. One weakness of the study, for example, was the lack of information on smoking status and alcohol consumption.

However, this was a large study, and the data sources employed (a variety of national registers) were recognized to be of high quality. Because the study used data from men across Sweden, the findings are likely to be an accurate picture of VTE risk in men with and without prostate cancer. "The degree of increased VTE risk reported in our analysis among men with prostate cancer is lower than that seen in prior studies for other cancer types, and is likely owing to the high proportion of individuals with localized illness and at low risk of cancer progression," the scientists stated.

"However, clinicians treating men with prostate cancer should be aware of the significant increase in VTE risk in these men, particularly in the first six months after a cancer diagnosis, to help assure timely VTE diagnosis." 

 BMJ Open

DOI

10.1136/bmjopen-2021-055485 

[fluidcomplex]

More are more whistleblowers have been coming out, reporting on dodgy practices within Pfizer and/or its subcontractors, regarding their COVID-19 vaccine trials.

Perhaps, at the end of the day, all this will be immaterial. But from what I estimate (based on my own lived experience, as well as those of close friends and family), there are likely hundreds of thousands of people suffering severe adverse reactions (Bell’s Palsy, persistent headaches, ongoing chest pain, and other systemic issues) that continue for weeks and months, yet the medical establishment seems reluctant to pin these on the vaccine despite no other plausible causes.

[newsfire]

Zinc supplements may help reduce symptoms of respiratory infections: Study

Zinc supplements may help reduce symptoms of respiratory infections: Study

Zinc supplements may help stave off the symptoms of respiratory tract infections such as coughing, congestion and sore throat, and cut illness duration, according to a review of studies. However, the study published in the journal BMJ Open cautions that the quality of the evidence on which these findings are based is variable, and it is not clear what an optimal formulation or dose of this…

[harpianews]

Zinc supplements may help ease symptoms of respiratory infections: Study

Zinc supplements may help ease symptoms of respiratory infections: Study

According to a review of studies, zinc supplements may help reduce respiratory tract infections such as cough, congestion and sore throat, and shorten the duration of illness. However, the study published in the journal BMJ Open caution that the quality of the evidence on which these findings are based is variable, and it is unclear what the optimal formulation or dosage of this nutrient may…

[gerarddupin]

#PfizerGate

[your-dietician]

Long-Term CRYSVITA® ▼ (burosumab) Treatment Reduces the Burden of Disease in Adults With X-Linked Hypophosphataemia (XLH), a Rare Genetic Metabolic Bone Disease

New Post has been published on https://depression-md.com/long-term-crysvita-%e2%96%bc-burosumab-treatment-reduces-the-burden-of-disease-in-adults-with-x-linked-hypophosphataemia-xlh-a-rare-genetic-metabolic-bone-disease/

Long-Term CRYSVITA® ▼ (burosumab) Treatment Reduces the Burden of Disease in Adults With X-Linked Hypophosphataemia (XLH), a Rare Genetic Metabolic Bone Disease

TOKYO–(BUSINESS WIRE)–Kyowa Kirin Co., Ltd. (TSE:4151, Kyowa Kirin) today announced the publication of new data highlighting the sustained benefits of treatment with CRYSVITA® (burosumab) in adults with X-linked hypophosphataemia (XLH), a rare genetic metabolic bone disease. The data show that adults with XLH experience substantial pain, stiffness, fatigue and impairment in physical and ambulatory function. Treatment with CRYSVITA was associated with a significant improvement from baseline after 96 weeks.1

The data are from a randomised, double-blind, placebo-controlled, phase 3 study with an open-label extension to assess the efficacy and safety of CRYSVITA in adults with XLH.2 The study met its primary endpoint, showing a statistically significant effect in increasing serum phosphorus concentrations at 24 weeks, compared to placebo.3 After 24 weeks, all patients were switched to CRYSVITA treatment and data was collected on metabolic and biochemical markers, patient reported outcomes (PROs) and measures of mobility up to 96 weeks. This new publication focuses on the results from the PRO analysis and mobility scores.1

At week 96, the study showed statistically significant improvements in PROs, including the Western Ontario and the McMaster Universities Osteoarthritis Index (WOMAC), Brief Pain Inventory–Short Form (BPI-SF) and Brief Fatigue Inventory (BFI), compared to baseline.1 Statistically significant improvements in ambulatory function, measured by the 6-minute walk test (6MWT), were also seen at 96 weeks compared to baseline.1 Data previously published at 48 weeks also showed improvements in some PROs, including stiffness and pain, as well as fracture healing.3

Lead author Pr Karine Briot, Hôpital Cochin, Paris, France said: “The study highlights the many physical challenges faced by adult patients with XLH, including pain, stiffness, fatigue and difficulty walking or physical function. Burosumab treatment has previously been shown to improve phosphate homeostasis in adult XLH patients, compared to placebo. This new analysis suggests that, despite the long-term complications and physical impairment associated with XLH in adults, treatment with burosumab can also improve the physical function and quality of life of adults with XLH over the longer term.”

Tomohiro Sudo, Executive Officer, Head of Global Product Strategy Department of Kyowa Kirin, said: “Kyowa Kirin is committed to improving the lives of people with XLH and their families. One of our areas of focus is to generate new data that improve our understanding of how best to manage and treat XLH. These important new data highlight the many physical challenges that people living with XLH face every day, how their needs could be better met and how Kyowa Kirin is delivering on its purpose, to make people smile.”

The data were published today in the BMJ journal RMD Open, Rheumatic and Musculoskeletal Diseases.1 CRYSVITA is licensed in Europe for the treatment of XLH in children and adolescents aged 1 to 17 years with radiographic evidence of bone disease, and in adults.4

▼This medicinal product is subject to additional monitoring.

About X-linked hypophosphataemia

X-linked hypophosphataemia (XLH) is a rare, genetic disease that causes abnormalities in the bones, muscles, and joints.5,6 XLH is not life-threatening, but its burden is life-long and progressive, and it may reduce a person’s quality of life.7

People with XLH have a genetic defect on the X-chromosome, which causes an excessive loss of phosphate through the urine and poor absorption from the gut due to excess of a hormone known as fibroblast growth factor-23 (FGF23), resulting in chronically low levels of phosphate in the blood.4,8 Phosphate is a key mineral needed for maintaining the body’s energy levels, muscle function, and the formation of healthy bones and teeth.9,10 While there is no cure for XLH, therapies aimed at helping to restore and maintain phosphate to normal levels within the body may help to improve the progression of disease symptoms.2

XLH is the most common form of hereditary rickets.11 It can sometimes appear in individuals with no family history of the disease but is usually passed down from a parent who carries the defective gene.12

About CRYSVITA® (burosumab)

CRYSVITA (burosumab) was created and developed by Kyowa Kirin and is a recombinant fully human monoclonal IgG1 antibody against the phosphaturic hormone fibroblast growth factor 23 (FGF23). FGF23 is a hormone that reduces serum levels of phosphate by regulating phosphate excretion and active vitamin D production by the kidney. Phosphate wasting and resulting hypophosphataemia in X-linked hypophosphataemia (XLH) is caused by excess FGF23. CRYSVITA is designed to bind to, and thereby inhibit, the biological activity of FGF23. By blocking excess FGF23 in patients, CRYSVITA is intended to increase phosphate reabsorption from the kidney and increase the production of active vitamin D, which enhances intestinal absorption of phosphate and calcium.

CRYSVITA has been available for clinical use since 2018. The first approval came from the European Commission, that granted a conditional marketing authorisation for CRYSVITA for the treatment of XLH with radiographic evidence of bone disease in children one year of age and older and adolescents with growing skeletons. In 2020, this authorisation was subsequently expanded to include older adolescents and adults.2

CRYSVITA is approved by the US Food and Drug Administration (FDA) for patients with XLH aged 6 months and older and by Health Canada for patients with XLH aged one year and older.13,14

In 2019, CRYSVITA received approval from Japan’s Ministry of Health, Labour and Welfare for the treatment of FGF23-related hypophosphataemic rickets and osteomalacia. In 2020, CRYSVITA was reimbursed by National Health Insurance (NHI) in Japan as a self-injection presentation for the treatment of FGF23-related hypophosphataemic rickets and osteomalacia.

In January 2020, Swissmedic approved CRYSVITA for the treatment of adults, adolescents and children (one year of age and older) with XLH.15

In June 2020, the U.S. Food and Drug Administration (FDA) approved CRYSVITA for patients aged two and older with tumour-induced osteomalacia (TIO), a rare disease that is characterised by the development of tumours that cause weakened and softened bones.16

Kyowa Kirin and Ultragenyx Pharmaceutical Inc. (NASDAQ: RARE: Ultragenyx) have been collaborating in the development and commercialisation of CRYSVITA globally, based on the collaboration and licence agreement between Kyowa Kirin and Ultragenyx.

About Kyowa Kirin

Kyowa Kirin strives to create and deliver novel medicines with life-changing value. As a Japan-based Global Specialty Pharmaceutical Company with a more than 70-year heritage, the company applies cutting-edge science including an expertise in antibody research and engineering, to address the needs of patients and society across multiple therapeutic areas including Nephrology, Oncology, Immunology/Allergy and Neurology. Across our four regions – Japan, Asia Pacific, North America and EMEA/International – we focus on our purpose, to make people smile, and are united by our shared values of commitment to life, teamwork/Wa, innovation, and integrity. You can learn more about the business of Kyowa Kirin at: https://www.kyowakirin.com/

Kyowa Kirin International

http://www.international.kyowa-kirin.com / www.kyowakirin.com

Galabank Business Park

Galashiels, TD1 1QH

United Kingdom

References

1 Briot K, Portale AA, Brandi ML, et al. RMD Open 2021;7:e001714. doi: 10.1136/rmdopen-2021-001714.

2 Insogna KL, Rauch F, Kamenický P, et al. Burosumab improved histomorphometric measures of osteomalacia in adults with X-linked hypophosphatemia: a Phase 3, single-arm, international trial. J Bone Miner Res. 2019;34:2183-2191.

3 Portale AA, Carpenter TO, Brandi ML, et al. Calcif Tissue Int 2019;105:271–84.

4 European Medicines Agency. CRYSVITA EPAR product information. Summary of Product Characteristics. Available at: Crysvita, INN-burosumab; (europa.eu). Last updated: June 2021. Last accessed: July 2021.

5 Linglart A, Biosse-Duplan M, Briot K, et al. Therapeutic management of hypophosphatemic rickets from infancy to adulthood. Endocr Connect. 2014;3:R13-30.

6 Haffner D, Emma F, Eastwood DM, et al. Consensus Statement. Evidence-based guideline. Clinical practice recommendations for the diagnosis and management of X-linked hypophosphatemia. Nat Rev Nephrol. 2019;15;435-455.

7 Skrinar A, Dvorak-Ewell M, Evins A, et al. The lifelong impact of X-linked hypophosphatemia: Results from a burden of disease survey. J Endocr Soc. 2019;3:1321-1334.

8 Beck-Nielsen SS, Mughal Z, Haffner D, et al. FGF23 and its role in X-linked hypophosphatemia-related morbidity. Orphanet J Rare Dis. 2019;14:58.

9 Pesta D, Tsirigotis DN, Befroy DE, et al. Hypophosphatemia promotes lower rates of muscle ATP synthesis. The FAESB Journal. 2016;39:3378-3387.

10 Unnanuntana A, Rebolledo BJ, Khair MM, et al. Diseases affecting bone quality: beyond osteoporosis. Clin Orthop Relat Res. 2011;469:2194-2206.

11 Carpenter TO, Imel EA, Holm IA, et al. A clinician’s guide to X-linked hypophosphatemia. J Bone Miner Res. 2011;26:1381-8.

12 National Center for Advancing Translational Sciences. X-linked hypophosphatemia. Available at: https://rarediseases.info.nih.gov/diseases/12943/x-linked-hypophosphatemia. Last updated: February 2018. Last accessed: July 2021.

13 Health Canada. Regulatory Decision Summary – CRYSVITA. Available at: https://hpr-rps.hres.ca/reg-content/regulatory-decision-summary-detail.php?linkID=RDS00463. Last updated: April 2020. Last accessed: April 2021.

14 Available at : https://www.kyowakirin.com/media_center/news_releases/2019/e20190930_01.html. Last accessed: July 2021

15 Swissmedic. Crysvita, injektionslösung (burosumabum). Available at: https://www.swissmedic.ch/swissmedic/en/home/humanarzneimittel/authorisations/new-medicines/vrysvita-injektionsloesung_burosumabum.html. Last updated: January 2020. Last accessed: July 2021.

16 FDA. Available at: FDA Approves First Therapy for Rare Disease that Causes Low Phosphate Blood Levels, Bone Softening | FDA. Last accessed: July 2021

KKI/INT/BUR/1174

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