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Background and importanceBisphosphonates should be the first choice for osteoporosis treatment, with lower cost and no less benefit than denosumab.Aim and objectivesTo evaluate the indication for treatment with denosumab and to develop proposals for optimising osteoporosis treatment.Material and methodsCross-sectional study in a primary care area (8 centres). Data from the ECAP digital medical record of denosumab-treated patients during January 2020 were reviewed by the Pharmacy Service. Variables: demographic (age and sex), diagnosis, bone mineral density (BMD) and previous fractures, indication, previous treatment and adherence.ResultsA total of 394 denosumab-treated patients, aged 74.9 ± 9.6 years, 92.6% women, were included. BMD T-score was ≤–2.5 (indicative of osteoporosis) in 48.3% of men and 64.1% of women, while it was >–2.5 in 6.9% of men and 14.8% of women. There was no densitometric test in the remaining patients. The most prevalent previous fracture in men was hip fracture (31%), while previous fracture was not present in most women (49.6%). Other fractures in men: 27.6% none, 24.1% vertebral, 17.3% ≥2 vertebral. In women: 16.7% ≥2 vertebral, 13.7% vertebral, 13.4% hip, 6.6% peripheral. Therefore, 80.8% of patients actually suffered from osteoporosis, while 19.2% had no true diagnosis. Osteoporosis patients receiving denosumab without a clear indication were 47.1%. Some 63% received prior treatment and 72.6% were adherent. Regarding those with an indication, 54.9% were due to ≥2 previous vertebral or hip fractures, 21.3% to adverse effects or poor adherence to bisphosphonates, 7.9% to chronic corticosteroid therapy, 7.4% to incident hip fracture or increased risk of fracture with age between 65 and 70 years, 5% to digestive alteration that contraindicates the use of therapeutic alternatives, and finally 3.5% to glomerular filtration <35 mL/min/m2. Denosumab should be withdrawn in 22% of patients and it should be changed to bisphosphonate in 25.1%, thus leading to a theoretical €75 100 annual saving.Conclusion and relevanceDenosumab should be withdrawn or replaced in 47.1% of patients. The proposals of the clinical pharmacist contribute to safe drug use and health system efficiency. It would be necessary to know the final implementation of the proposals by rheumatologists, which were pending due to the COVID-19 pandemic.References and/or acknowledgementsConflict of interestNo conflict of interest
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Use in the Virtual Reality (VR) world has spiked with the outbreak of domestic lockdowns and social distancing measures for the covid-19 pandemics and the simultaneous market launch of the Oculus Quest 2 standalone VR device. TRIPP is a VR app in the VR world as a wellness platform based on scientific research, e.g., Artificial Intelligence (AI), binaural beats, differential color tuning, VR-based relaxation, and mindfulness. This paper analyses the dynamic of emotional and mood transitions of a large set of TRIPP users exposed to VR devices' emotional experiences from the end of 2019 (i.e., when the pandemic started) to April 2021, when our study has begun. A clear and well-documented data analysis is presented, focusing on emotional well-being. In particular, this study presents a data breakdown of users' accesses and analyzed the impact on emotional well-being based on the feedback given within the app, access time, and users' anagraphical distributions. The systematic experimental analysis of anonymized data found the studied AI and VR wellness techniques to be indicators and positive modifiers of users' mental and emotional states during the most impactful global crisis of the millennium. © 2021 ACM.
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BACKGROUND: Bone grafting is an important surgical procedure to reconstruct alveolar bone defects in patients with cleft lip and palate. Polyphosphate (PolyP) is a physiological polymer present in the blood, primarily in platelets. PolyP plays a role as a phosphate source in bone calcium phosphate deposition. Moreover, the cleavage of high-energy bonds to release phosphates provides local energy necessary for regenerative processes. In this study, polyP is complexed with calcium to form Calcium polyP microparticles (Ca-polyP MPs), which were shown to have osteoinductive properties in preclinical studies. The aim of this study was to evaluate the feasibility, safety, and osteoinductivity of Ca-polyP MPs, alone or in combination with BCP, in a first-in-human clinical trial. METHODS: This single-blinded, parallel, prospective clinical pilot study enrolled eight adolescent patients (mean age 18.1: range 13-34 years) with residual alveolar bone cleft. Randomization in two groups (four receiving Ca-polyP MPs only, four a combination of Ca-polyP MPs and biphasic calcium phosphate (BCP)) was performed. Patient follow-up was 6 months. Outcome parameters included safety parameters and close monitoring of possible adverse effects using radiographic imaging, regular blood tests, and physical examinations. Osteoinductivity evaluation using histomorphometric analysis of biopsies was not possible due to COVID restrictions. RESULTS: Due to surgical and feasibility reasons, eventually, only 2 patients received Ca-polyP MPs, and the others the combination graft. All patients were assessed up to day 90. Four out of eight were able to continue with the final assessment day (day 180). Three out of eight were unable to reach the hospital due to COVID-19 restrictions. One patient decided not to continue with the study. None of the patients showed any allergic reactions or any remarkable local or systematic side effects. Radiographically, patients receiving Ca-polyP MPs only were scored grade IV Bergland scale, while patients who got the BCP/Ca-polyP MPs combination had scores ranging from I to III. CONCLUSIONS: Our results indicate that Ca-polyP MPs and the BCP/Ca-polyP MPs combination appear to be safe graft materials; however, in the current setting, Ca-polyP MPs alone may not be a sufficiently stable defect-filling scaffold to be used in alveolar cleft repair. TRIAL REGISTRATION: Indonesian Trial Registry under number INA-EW74C1N by the ethical committee of Faculty of Medicine, Hasanuddin University, Makassar, Indonesia with code number 1063/UN4.6.4.5.31/PP36/2019 .
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From 20 March to 10 May 2020, the “stay at home” countermeasures for the Covid-19 emergency lockdown were defined in the United Kingdom (UK) as leaving home for only the following reasons: “Key worker travelling to work”, “Shopping for basic necessities”, “Any medical need” or “Exercise once a day”. Data collected from the UK Office for National Statistics through online and telephone questionnaires are an exceptional baseline data set on people behaviour during the Covid-19 pandemics. In this paper, data from demographic surveys from the UK are compared to statistical and feedback data from the Virtual Reality app called TRIPP for meditation in the experiences called Focus and Calm. Our data analysis shows that during lockdown the psychological and emotional mindset, severely challenged, has been successfully enhanced with the use of Virtual Reality. © 2021, Springer Nature Switzerland AG.
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Aims The rate of incidence and outcome of COVID-19 infection following endoscopic procedures during the first UKlockdown period was evaluated. We also assessed risk factors for transmission of COVID-19 infection post-endoscopy. Methods Patients who had endoscopic procedures in our unit from 23/3/2020 to 31/5/2020 were included. During thisperiod, only emergency and urgent procedures were undertaken. Follow up calls were made subsequently to all patients toenquire about COVID-19 symptoms, hospital admissions and COVID-19 testing within 14 days of their procedures. Toidentify risk factors for COVID-19 transmission post-endoscopy, we performed binominal logistic regression. Results 391 endoscopies were included (table). 1.5 % (6/391) patients developed COVID-19 symptoms post-endoscopy.Median age is 80 (mean 75.8) with female to male ratio 2:1. The most common symptoms were fever, cough andbreathlessness 83.3 % (5/6). The percentage of the confirmed cases by COVID-19 PCR swab test was 1.3 % (5/391). Themedian days that those 5 patients developed confirmed COVID-19 post-endoscopy was 7 (range 3-13). 0.8 % (3/391) diedfrom COVID-19-related complications within 30 days after endoscopic procedure. One had gastroscopy, one flexiblesigmoidoscopy and one ERCP, these procedures were performed on different dates and by different teams. The unadjusted30-days all-cause mortality rate post-endoscopy was 3.6 % (14/391), all of them were inpatients. On univariate binominal logistic regression, age as a continuous variable (OR 1.122;95 % CI [1.021-1.234];p = 0.017), lessthan 10 day hospital stay (OR 0.057;95 % CI [0.008-0.400];p = 0.004) and hospital stay between 11-20 days (OR 0.067;95 % CI [0.005-0.842];p = 0.036) were associated with COVID-19 transmission. Combining the above factors into amultivariable regression model, no factor achieved statistical significance. Conclusions The risk of transmission of clinical COVID-19 seems to be low for patients in the context of endoscopyprocedures when the appropriate personal protective measures are in place. No risk factor reached statistical significance.
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With the COVID-19 pandemic progressing, guidance on strategies to mitigate its devastating effects in nursing facilities (NFs) is critical to preventing additional tragic outcomes. Asymptomatic spread of COVID-19 from nursing facility staff and residents is a major accelerator of infection. Facility-wide point-prevalence testing is an emerging strategy in disease mitigation. Because time is not available to await the results of randomized controlled trials before implementing strategies in this high-risk setting, an expert Delphi panel composed of experienced long-term care medicine professionals has now met to provide testing guidance for SARS-Coronavirus-2 to NFs. After many email and telephone discussions, the panel responded to a questionnaire that included six different scenarios, based on varying availability of Polymerase Chain Reaction (RT-PCR) testing and personal protective equipment (PPE). The panel endorsed facility-wide testing of staff and residents without dissent when diagnostic RT-PCR was available. While the panel recognized the limitations of RT-PCR testing, it strongly recommended this testing for both staff and residents in NFs that were either COVID-19 naive or had limited outbreaks. There was also consensus on testing residents with atypical symptoms in a scenario of limited testing capability. The panel favored testing every 1 to 2 weeks if testing was readily available, reducing the frequency to every month as community prevalence declined or as the collection of additional data further informed clinical critical thinking and decision-making. The panel recognized that frequent testing would have consequences in terms of potential staff shortages due to quarantine after positive tests and increased PPE use. However, the panel felt that not testing would allow new clusters of infection to form. The resulting high mortality rate would outweigh the potential negative consequences of testing. The panel also recognized the pandemic as a rapidly evolving crisis, and that new science and increasing experience might require an updating of its recommendations. The panel hopes that its recommendations will be of value to the long-term care industry and to policy makers as we work together to manage through this challenging and stressful time.