Notes

A singular rat type of interbody mix according to anterior lower back corpectomy and fusion (ALCF).
Over two billion people around the world suffer from anemia. Majority of populations are using dietary supplements and herbal medicines for the management of the anemic conditions. Many polyherbal formulations such as RaktavardhakKadha (RK), are available in the Indian market as a nutritional supplement and herbal-based medicine for anemia.

The present study is aimed at investigating antianemic potential of polyherbal formulation, RK, against phenylhydrazine-induced anemia in rats.

RK was subjected to preliminary phytochemical analysis and iron estimation. Anemia was induced by phenylhydrazine administration (40mg/kg, i.p.) for 2 consecutive days. Antianemic activity of RK was investigated at the dose of 1.8ml/kg, twice daily for 12 days by estimating blood parameters and pathological changes in liver, heart, spleen and bone marrow.

RK was found to contain saponins, steroids, flavonoids, tannins and phenolic compounds. Iron content was found to be 5 mg/100ml in RK. Anemia induction by phenylhydrazine injections to rats caused significant decrease in red blood cells (RBCs), hemoglobin and hematocrit. These decreased levels of RBCs, hemoglobin and hematocrit in blood was significantly improved by the treatment with RK. Furthermore, RK restored pathological changes in liver, heart, spleen and bone marrow tissues near to normal.

This study suggests antianemic activity of RK, which can be attributed to its iron content and ability to prevent hemolysis.
This study suggests antianemic activity of RK, which can be attributed to its iron content and ability to prevent hemolysis.
Evaluation of a multilevel implementation program on shared decision making (SDM) for breast cancer clinicians.

The program was based on the 'Measurement Instrument for Determinants of Innovations-model' (MIDI). Key factors for effective implementation were included. Eleven breast cancer teams selected from two geographical areas participated; first six surgery teams and second five systemic therapy teams. EZH1 inhibitor A mixed method evaluation was carried out at the end of each period Descriptive statistics were used for surveys and thematic content analysis for semi-structured interviews.

Twenty-eight clinicians returned the questionnaire (42%). Clinicians (96%) endorse that SDM is relevant to breast cancer care. The program supported adoption of SDM in their practice. Limited financial means, time constraints and concurrent activities were frequently reported barriers. Interviews (n=21) showed that using a 4-step SDM model - when reinforced by practical examples, handy cards, feedback and training - helped to internalize SDM theory. Clinicians experienced positive results for their patients and themselves. Task re-assignment and flexible outpatient planning reinforce sustainable change. Patient involvement was valued.

Our program supported breast cancer clinicians to adopt SDM.

To implement SDM, multilevel approaches are needed that reinforce intrinsic motivation by demonstrating benefits for patients and clinicians.
To implement SDM, multilevel approaches are needed that reinforce intrinsic motivation by demonstrating benefits for patients and clinicians.
To understand advanced cancer patients' experience of uncertainty when receiving comprehensive tumor genomic profiling (CTGP) results, and their perceptions of how healthcare provider (HCP) communication impacts uncertainty.

Thirty-seven semi-structured interviews with advanced cancer patients were conducted within two weeks of patients receiving CTGP results. Transcripts were thematically analyzed, using an inductive approach.

We identified three themes that illustrate patient experience of uncertainties when receiving CTGP results 1. Type and degree of uncertainty fluctuates along with changing illness circumstances and the nature of the CTGP results; 2. HCPs' co-ordination of care and communication shapes uncertainty, with immediate, clearer and simpler information promoting certainty; and 3. Patients felt that communicating results to reduce relatives' uncertainty is important, with patients choosing the time and process for achieving this and desiring HCPs support.

Oncology patients are confronted with an array of uncertainties. Clear, simple communication from HCPs about results and their implications, and support to manage uncertainty, will be of benefit.

If CTGP is to become routine clinical practice, clear communication will be crucial in reducing uncertainty. Awareness of potential uncertainties experienced by patients when receiving results, will assist HCPs to address uncertainties, reduce uncertainty where possible, and offer targeted support to patients struggling with uncertainty.
If CTGP is to become routine clinical practice, clear communication will be crucial in reducing uncertainty. Awareness of potential uncertainties experienced by patients when receiving results, will assist HCPs to address uncertainties, reduce uncertainty where possible, and offer targeted support to patients struggling with uncertainty.Gastro-oesophageal reflux disease (GORD) is one of the most frequent conditions associated with asthma. GORD has an impact on asthma control and quality of life of asthmatic patients. Its treatment relies on lifestyle modifications, anti-acidic treatment with proton pump inhibitors (PPI) and/or surgical management by fundoplication in some situations. The impact of lifestyle modifications has not been analysed on asthma outcomes alone. Several randomised controlled trials assessed the efficacy of PPI on asthma control, peak expiratory flow and/or quality of life. The impact of fundoplication in asthma has mainly been analysed in retrospective or prospective observational studies. This review highlights the limited impact of GORD treatment on asthma control. Current guidelines are to restrict GORD treatment in asthma to asthmatic patients with actual symptomatic GORD. Given the lack of controlled studies, the place of surgical management of GORD in asthma is currently not defined.Cases of myasthenia gravis with inflammatory myopathy usually show elevated creatine kinase (CK) levels. There are few case reports of myasthenia gravis with inflammatory myopathy without elevated CK levels, and clinical features and useful diagnostic methods for these patients are little known. We describe the case of a 79-year-old man with myasthenia gravis that was complicated with inflammatory myopathy without elevated CK levels and successfully treated with immunological treatment. Initially, he was diagnosed with ocular myasthenia gravis and treated with pyridostigmine, but dysphagia and weakness in the neck and bilateral upper limb without fatigability gradually developed. Needle electromyography revealed myopathic changes, and the results of muscle biopsy were consistent with inflammatory myopathy. Blood tests showed normal CK levels throughout the clinical course and elevated myoglobin levels alone. The possibility of developing inflammatory myopathy in patients with myasthenia gravis cannot be excluded, even if CK levels are normal.
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