Platelet-rich plasma in clinical practice

The concept of using a patient’s own blood or components thereof (autologous), to enhance the physiological process of healing has been in place for many years. Autologous platelet-rich plasma (PRP) has been used for both soft tissue and bone healing and rejuvenation. PRP has also been used in orthopaedics for bone, tendon and muscle injuries, dentistry for dental implants, dermatology for wound healing, and in pathological conditions such as alopecia aereata. However, more recently, it has been used in the fast-growing field of aesthetic and anti-ageing medicine for skin rejuvenation. PRP seems like a logical, safe, relatively, cheap and easy procedure, but is this the case? Although safety and improved short-term outcomes for orthopaedic indications have been demonstrated in a few reviews, long-term improvement has not been demonstrated. Randomised controlled trials in dermatology and aesthetic indications are sparse, but show promise for alopecia areata and skin rejuvenation.Keywords: autologous, indications, platelet-rich plasma, PRP, skin rejuvenatio

Estimation of input costs for a Markov model in a German health economic evaluation of newer antidepressants

Background: Estimating input costs for Markov models in health economic evaluations requires health state-specific costing. This is a challenge in mental illnesses such as depression, as interventions are not clearly related to health states. We present a hybrid approach to health state-specific cost estimation for a German health economic evaluation of antidepressants. Methods: Costs were determined from the perspective of the community of persons insured by statutory health insurance (“SHI insuree perspective”) and included costs for outpatient care, inpatient care, drugs, and psychotherapy. In an additional step, costs for rehabilitation and productivity losses were calculated from the societal perspective. We collected resource use data in a stepwise hierarchical approach using SHI claims data, where available, followed by data from clinical guidelines and expert surveys. Bottom-up and top-down costing approaches were combined. Results: Depending on the drug strategy and health state, the average input costs varied per patient per 8-week Markov cycle. The highest costs occurred for agomelatine in the health state first-line treatment (FT) (“FT relapse”) with €506 from the SHI insuree perspective and €724 from the societal perspective. From both perspectives, the lowest costs (excluding placebo) were €55 for selective serotonin reuptake inhibitors in the health state “FT remission.” Conclusion: To estimate costs in health economic evaluations of treatments for depression, it can be necessary to link different data sources and costing approaches systematically to meet the requirements of the decision-analytic model. As this can increase complexity, the corresponding calculations should be presented transparently. The approach presented could provide useful input for future models

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Retrospective evaluation of whole exome and genome mutation calls in 746 cancer samples

Funder: NCI U24CA211006Abstract: The Cancer Genome Atlas (TCGA) and International Cancer Genome Consortium (ICGC) curated consensus somatic mutation calls using whole exome sequencing (WES) and whole genome sequencing (WGS), respectively. Here, as part of the ICGC/TCGA Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium, which aggregated whole genome sequencing data from 2,658 cancers across 38 tumour types, we compare WES and WGS side-by-side from 746 TCGA samples, finding that ~80% of mutations overlap in covered exonic regions. We estimate that low variant allele fraction (VAF < 15%) and clonal heterogeneity contribute up to 68% of private WGS mutations and 71% of private WES mutations. We observe that ~30% of private WGS mutations trace to mutations identified by a single variant caller in WES consensus efforts. WGS captures both ~50% more variation in exonic regions and un-observed mutations in loci with variable GC-content. Together, our analysis highlights technological divergences between two reproducible somatic variant detection efforts

Nutrition och egenvård vid KOL- Kronisk Obstruktiv Lungsjukdom

Sammanfattning Viktförlust och malnutrition (brist på eller obalans av energi, protein och andra näringsämnen) är vanligt för patienter som har kronisk obstruktiv lungsjukdom (KOL). Risken att drabbas ökar med sjukdomens svårighetsgrad. KOL är en allvarlig sjukdom som kan leda till svår invaliditet och för tidig död. Nutritionsstatusen påverkar KOL-sjukdomens svårighetsgrad och därmed patientens prognos. Syftet med studien var att beskriva vilken betydelse nutritionen har för patienter med KOL och hur sjuksköterskan kan mäta och bedöma nutritionsstatus samt hur sjuksköterskan kan stötta till egenvård för att patienten själv ska kunna upprätthålla optimal nutritionsstatus. För att få svar på frågeställningarna valdes en systematisk litteraturstudie. Data samlades in via databaserna Pub Med och Cinahl. Sökorden som valdes var KOL, nutrition, malnutrition, omvårdnad och MNA. Resultatet baseras på 14 vetenskapliga artiklar där det framkom olika symtom och följder av försämrat nutritionsstatus som påverkade KOL sjukdomens förlopp. Ju fler symtom desto allvarligare KOL sjukdom. Mätmåttet FFM gav mer information om svårighetsgraden av KOL och om muskelkapaciteten än BMI. Likaså var FFM ett starkare mått på dödlighet än BMI, därför bör BMI mätning kompletteras med FFM mätning för att få en bättre mätning på nutritionsstatus. Sjuksköterskan skall vara extra uppmärksam på nutritionsaspekterna när det gäller äldre, rökande, ensamma och överviktiga KOL patienter. Det är viktigt att sjuksköterskan upptäcker patienter med risk för undernäring i tid för att då kunna stötta patienten till den egenvård som är nödvändig innan patienten blir malnutrierad.     Nyckelord: KOL (Kronisk Obstruktiv Lungsjukdom) nutrition, omvårdnadAbstract Weight loss and malnutrition (deficiency or imbalance of energy, protein and other nutrients) is common for patients that have chronic obstructive pulmonary disease (COPD). The risk increases with disease severity. COPD is a serious disease that can lead to severe disability and premature death. Nutrition status affects the COPD disease severity and thus the patient's prognosis. The aim of the study was to describe the importance of nutrition for the patients with COPD and how the nurse can measure and assess the nutritional status and how the nurse can support self-care for the patient to maintain optimum nutritional status. To get answers to the questions is a systematic literature review chosen. Data was collected via databases Pub Med and Cinahl. Keywords chosen were COPD, nutrition, malnutrition, care and MNA. The result is based on 14 scientific articles which stated various symptoms and consequences of impaired nutritional status that influenced COPD disease. The more symptoms the more severe COPD disease. The measurement FFM gave more information about the severity of COPD and muscle capacity than the BMI, likewise was FFM a stronger measure of mortality than the BMI, therefore, BMI measurement is supplemented by FFM measurement to get a better measurement of nutritional status. The nurse should be extra attentive to nutrition aspects of the elderly, smokers, lonely and obese COPD patients. It is important that the nurse detect patients at risk of malnutrition in time to then be able to support the patient to self-care which is necessary before the patient becomes malnourished.   Keywords: COPD (Chronic Obstructive Pulmonary Disease), nutrition, nursing car

Nutrition och egenvård vid KOL- Kronisk Obstruktiv Lungsjukdom

Sammanfattning Viktförlust och malnutrition (brist på eller obalans av energi, protein och andra näringsämnen) är vanligt för patienter som har kronisk obstruktiv lungsjukdom (KOL). Risken att drabbas ökar med sjukdomens svårighetsgrad. KOL är en allvarlig sjukdom som kan leda till svår invaliditet och för tidig död. Nutritionsstatusen påverkar KOL-sjukdomens svårighetsgrad och därmed patientens prognos. Syftet med studien var att beskriva vilken betydelse nutritionen har för patienter med KOL och hur sjuksköterskan kan mäta och bedöma nutritionsstatus samt hur sjuksköterskan kan stötta till egenvård för att patienten själv ska kunna upprätthålla optimal nutritionsstatus. För att få svar på frågeställningarna valdes en systematisk litteraturstudie. Data samlades in via databaserna Pub Med och Cinahl. Sökorden som valdes var KOL, nutrition, malnutrition, omvårdnad och MNA. Resultatet baseras på 14 vetenskapliga artiklar där det framkom olika symtom och följder av försämrat nutritionsstatus som påverkade KOL sjukdomens förlopp. Ju fler symtom desto allvarligare KOL sjukdom. Mätmåttet FFM gav mer information om svårighetsgraden av KOL och om muskelkapaciteten än BMI. Likaså var FFM ett starkare mått på dödlighet än BMI, därför bör BMI mätning kompletteras med FFM mätning för att få en bättre mätning på nutritionsstatus. Sjuksköterskan skall vara extra uppmärksam på nutritionsaspekterna när det gäller äldre, rökande, ensamma och överviktiga KOL patienter. Det är viktigt att sjuksköterskan upptäcker patienter med risk för undernäring i tid för att då kunna stötta patienten till den egenvård som är nödvändig innan patienten blir malnutrierad.     Nyckelord: KOL (Kronisk Obstruktiv Lungsjukdom) nutrition, omvårdnadAbstract Weight loss and malnutrition (deficiency or imbalance of energy, protein and other nutrients) is common for patients that have chronic obstructive pulmonary disease (COPD). The risk increases with disease severity. COPD is a serious disease that can lead to severe disability and premature death. Nutrition status affects the COPD disease severity and thus the patient's prognosis. The aim of the study was to describe the importance of nutrition for the patients with COPD and how the nurse can measure and assess the nutritional status and how the nurse can support self-care for the patient to maintain optimum nutritional status. To get answers to the questions is a systematic literature review chosen. Data was collected via databases Pub Med and Cinahl. Keywords chosen were COPD, nutrition, malnutrition, care and MNA. The result is based on 14 scientific articles which stated various symptoms and consequences of impaired nutritional status that influenced COPD disease. The more symptoms the more severe COPD disease. The measurement FFM gave more information about the severity of COPD and muscle capacity than the BMI, likewise was FFM a stronger measure of mortality than the BMI, therefore, BMI measurement is supplemented by FFM measurement to get a better measurement of nutritional status. The nurse should be extra attentive to nutrition aspects of the elderly, smokers, lonely and obese COPD patients. It is important that the nurse detect patients at risk of malnutrition in time to then be able to support the patient to self-care which is necessary before the patient becomes malnourished.   Keywords: COPD (Chronic Obstructive Pulmonary Disease), nutrition, nursing car

Platelet-rich plasma in clinical practice

The concept of using a patient’s own blood or components thereof (autologous), to enhance the physiological process of healing has been in place for many years. Autologous platelet-rich plasma (PRP) has been used for both soft tissue and bone healing and rejuvenation. PRP has also been used in orthopaedics for bone, tendon and muscle injuries, dentistry for dental implants, dermatology for wound healing, and in pathological conditions such as alopecia aereata. However, more recently, it has been used in the fast-growing field of aesthetic and anti-ageing medicine for skin rejuvenation. PRP seems like a logical, safe, relatively, cheap and easy procedure, but is this the case? Although safety and improved short-term outcomes for orthopaedic indications have been demonstrated in a few reviews, long-term improvement has not been demonstrated. Randomised controlled trials in dermatology and aesthetic indications are sparse, but show promise for alopecia areata and skin rejuvenation

Föräldrars upplevelse av hembesök från BVC : En studie baserad på inlägg från föräldraforum

Bakgrund: I Sverige är barnhälsovården frivillig, att få ett hembesök när barnet är nyfött är ett erbjudande. Sedan år 2015 erbjuds föräldrar ytterligare ett hembesök när barnet är åtta månader. För att ge bra stöd till föräldrarna i deras egenvårdande roll är det viktigt att veta hur föräldrarna upplever hembesök från barnavårdcentralen (BVC). Syfte: Att undersöka föräldrars upplevelse och erfarenhet av hembesök från BVC. Metod: Data samlades in genom att lägga ut frågor på 2 föräldraforum under 3 månader och söka inlägg på 11 föräldraforum som svarade på studiens frågeställningar och som var skrivna år 2013 - 2016. Data analyserades med induktiv innehållsanalys. Resultat: Föräldrar hade varierade upplevelser av hembesök från BVC, från bekvämlighet, exempelvis upplevdes det som positivt att slippa ge sig ut i dåligt väder, till en känsla av att bli kontrollerad som förälder.  Många föräldrar kände inte till att BVC erbjuder 8-månaders hembesök, och en del kände inte till att BVC erbjöd hembesök överhuvudtaget. Flera föräldrar uttryckte en osäkerhet runt syftet med hembesök. Slutsats: Det är viktigt att distriktssköterskan har en bra rutin för hur, var och när informationen om hembesök skall ges för att informationen om hembesök skall nå fram till alla föräldrar. Informationen kan ha en stor betydelse för hur föräldrar kommer att uppleva hembesöket från BVC och om föräldrar tackar ja till hembesök.Background: In Sweden, child healthcare is voluntary and home visit by a nurse when the baby is newborn is an offer. Since 2015, parents are offered a second home visit when the baby is eight months. To provide good support to the parents in their caring role it is important to know how the parents experience the home visits by the child health center (CHC). Objective: To investigate the parents' experience of home visits from CHC. Method: Data was collected by posting questions in two parent forums during 3 months and searching for posts in 11 parent forums from 2013 to 2016. Data was analyzed by inductive content analysis. Results: The parents had varying experiences of home visits; from comfort, for example was perceived as positive to avoid having to go out in bad weather, to a sense of being controlled as a parent. Many parents were unaware that the CHC offers a home visit at eight months, and some were unaware that home visits were offered at all. Several parents expressed an uncertainty about the purpose of the home visit. Conclusion: It is important that the district nurse has a good routine of how, where and when information about home visits is given to reach all parents. The information can have a significant impact on how parents will experience home visit from the CHC, and if they will accept home visits