ABSTRACT
BACKGROUND: Lymphedema is a significant and disabling disorder affecting millions of people worldwide. Compression therapy is an important component of lifelong treatment but the specifics of appropriate compression garment selection and prescribing is not always well understood by practitioners and payers. METHOD: An expert panel of the American Vein and Lymphatic Society was convened to write a Position Statement with explanations and recommendations for the appropriate compression therapy to be used in the treatment of lymphedema patients. RESULT: A Position Statement was produced by the expert panel with recommendations for documentation and compression therapy treatment. Their recommendations were reviewed, edited, and approved by the Guidelines Committee of the society. CONCLUSION: This societal Position Statement provides a useful document for reference for medical care providers for the appropriate compression therapy selection and treatment of patients with lymphedema.
Subject(s)
Lymphedema , Humans , United States , Lymphedema/therapy , VeinsABSTRACT
The International Compression Club (ICC) is a partnership between academics, clinicians and industry focused upon understanding the role of compression in the management of different clinical conditions. The ICC meet regularly and from these meetings have produced a series of eight consensus publications upon topics ranging from evidence-based compression to compression trials for arm lymphoedema. All of the current consensus documents can be accessed on the ICC website (http://www.icc-compressionclub.com/index.php). In May 2011, the ICC met in Brussels during the European Wound Management Association (EWMA) annual conference. With almost 50 members in attendance, the day-long ICC meeting challenged a series of dogmas and myths that exist when considering compression therapies. In preparation for a discussion on beliefs surrounding compression, a forum was established on the ICC website where presenters were able to display a summary of their thoughts upon each dogma to be discussed during the meeting. Members of the ICC could then provide comments on each topic thereby widening the discussion to the entire membership of the ICC rather than simply those who were attending the EWMA conference. This article presents an extended report of the issues that were discussed, with each dogma covered in a separate section. The ICC discussed 12 'dogmas' with areas 1 through 7 dedicated to materials and application techniques used to apply compression with the remaining topics (8 through 12) related to the indications for using compression.
Subject(s)
Consensus , Leg Ulcer/therapy , Stockings, Compression , Belgium , Congresses as Topic , Humans , International CooperationSubject(s)
Postthrombotic Syndrome/therapy , Venous Thrombosis/therapy , Attitude of Health Personnel , Delivery of Health Care, Integrated , Education, Medical, Graduate , Evidence-Based Medicine , Health Knowledge, Attitudes, Practice , Humans , Patient Care Team , Postthrombotic Syndrome/etiology , Postthrombotic Syndrome/prevention & control , Practice Guidelines as Topic , Preventive Health Services , Program Development , Risk Assessment , Risk Factors , Treatment Outcome , Venous Thrombosis/complications , Venous Thrombosis/prevention & controlABSTRACT
A novel three-step synthesis of the highly functionalized antifungal agent CANCIDAS (caspofungin acetate, 2) is described, starting from the natural product pneumocandin B0 (1). The highlights of the synthesis include a stereoselective formation of a phenylthioaminal, a remarkable chemoselective, high-yielding, one-step borane reduction of a primary amide, and a stereoselective substitution of the phenylthioaminal with ethylenediamine producing 2 in a 45% overall yield.
Subject(s)
Antifungal Agents/chemical synthesis , Glucosyltransferases/antagonists & inhibitors , Peptides, Cyclic/chemistry , Peptides, Cyclic/chemical synthesis , Amides/chemistry , Amines/chemistry , Antifungal Agents/chemistry , Antifungal Agents/isolation & purification , Caspofungin , Chromatography, High Pressure Liquid , Echinocandins , Lipopeptides , Molecular Structure , Peptides, Cyclic/isolation & purification , Sulfhydryl Compounds/chemistryABSTRACT
[reaction: see text] The relative and absolute configuration of the pneumocandin B(0) side chain has been established as (10R,12S)-dimethylmyristoyl by the stereocontrolled synthesis of both antipodes of the side chain acid and their comparison to a sample derived from the natural product.