Exploring the Prescribing Process of Domperidone for Low Milk Supply:A Qualitative Study Among Mothers, IBCLCs, and Family Doctors

BACKGROUND: When mothers are confronted with milk supply problems, taking domperidone is regularly suggested. However, domperidone has been associated with sudden cardiac death and caution in prescribing is advised. In 2016, a multidisciplinary group of authors from a tertiary academic hospital (Erasmus MC) published a clinical protocol in a leading Dutch physicians’ journal to support Dutch family physicians in prescribing domperidone to stimulate lactation. RESEARCH AIM: To explore consumer and health care provider perspectives and experiences regarding the prescribing of domperidone for lactation insufficiency following publication of a national clinical protocol. METHODS: A cross-sectional qualitative study was performed using semi-structured interviews (N = 40) based on a topic list covering the prescribing process. Participants were mothers (n = 18) who had been advised to try domperidone to boost their milk supply between November 2016 and May 2018, their International Board Certified Lactation Consultants (n = 9), and their family physicians (n = 15). Another group of participants (mothers; n = 6) answered short questionnaires. All interviews were recorded, transcribed and analyzed using ATLAS.ti software. The resulting list of codes was organized according to the topics. RESULTS: In the process leading to domperidone use to stimulate lactation, participant family physicians relied on the IBCLC, pharmacist, or mother to guide the prescription of domperidone, often citing the published national clinical protocol as back up. The medical safeguards incorporated in the protocol (e.g., taking medical history, physical exam, performing electrocardiograms, limiting dosage) were usually not implemented. CONCLUSIONS: Though the availability of a national clinical protocol in which the prescribing of domperidone for lactation is supported appeared to increase the willingness of participant family physicians to prescribe, gaps were identified between clinical practice and this clinical protocol for prescribing domperidone

What are the benefits of preemptive versus non-preemptive kidney transplantation? A systematic review and meta-analysis

Opting for a preemptive kidney transplant (PKT) can help avoid costs and morbidity associated with dialysis. However, while multiple studies have shown clinical benefits of PKT, other studies have not demonstrated this, leading to controversy in the literature regarding the exact benefits of PKT. Therefore, this study aimed to determine the clinical outcomes of PKT versus non-preemptive kidney transplantation (nPKT) in adult patients. Multiple databases were searched up to May 4, 2022. Independent reviewers selected studies for inclusion and extracted relevant data. Risk of bias was assessed using the Downs and Black checklist. Eighty-seven studies including 859,715 adult kidney transplant patients were included the review. The risk of patient death (relative risk [95% confidence interval] 0.74 [0.60–0.91]) was significantly lower in PKT versus nPKT patients for living donor (LD) transplants, whereas the risk of overall graft loss was significantly lower in PKT compared to nPKT patients for both LD (0.72 [0.62–0.83]) as well as deceased donor (DD) transplants (0.80 [0.69–0.92]). The evidence suggests that LD PKT patients have a lower risk of patient death and graft loss compared to nPKT patients, and DD PKT patients have a lower risk of graft loss than nPKT patients.</p

Electronic Health Record-Triggered Research Infrastructure Combining Real-world Electronic Health Record Data and Patient-Reported Outcomes to Detect Benefits, Risks, and Impact of Medication:Development Study

BACKGROUND: Real-world data from electronic health records (EHRs) represent a wealth of information for studying the benefits and risks of medical treatment. However, they are limited in scope and should be complemented by information from the patient perspective. OBJECTIVE: The aim of this study is to develop an innovative research infrastructure that combines information from EHRs with patient experiences reported in questionnaires to monitor the risks and benefits of medical treatment. METHODS: We focused on the treatment of overactive bladder (OAB) in general practice as a use case. To develop the Benefit, Risk, and Impact of Medication Monitor (BRIMM) infrastructure, we first performed a requirement analysis. BRIMM’s starting point is routinely recorded general practice EHR data that are sent to the Dutch Nivel Primary Care Database weekly. Patients with OAB were flagged weekly on the basis of diagnoses and prescriptions. They were invited subsequently for participation by their general practitioner (GP), via a trusted third party. Patients received a series of questionnaires on disease status, pharmacological and nonpharmacological treatments, adverse drug reactions, drug adherence, and quality of life. The questionnaires and a dedicated feedback portal were developed in collaboration with a patient association for pelvic-related diseases, Bekkenbodem4All. Participating patients and GPs received feedback. An expert meeting was organized to assess the strengths, weaknesses, opportunities, and threats of the new research infrastructure. RESULTS: The BRIMM infrastructure was developed and implemented. In the Nivel Primary Care Database, 2933 patients with OAB from 27 general practices were flagged. GPs selected 1636 (55.78%) patients who were eligible for the study, of whom 295 (18.0% of eligible patients) completed the first questionnaire. A total of 288 (97.6%) patients consented to the linkage of their questionnaire data with their EHR data. According to experts, the strengths of the infrastructure were the linkage of patient-reported outcomes with EHR data, comparison of pharmacological and nonpharmacological treatments, flexibility of the infrastructure, and low registration burden for GPs. Methodological weaknesses, such as susceptibility to bias, patient selection, and low participation rates among GPs and patients, were seen as weaknesses and threats. Opportunities represent usefulness for policy makers and health professionals, conditional approval of medication, data linkage to other data sources, and feedback to patients. CONCLUSIONS: The BRIMM research infrastructure has the potential to assess the benefits and safety of (medical) treatment in real-life situations using a unique combination of EHRs and patient-reported outcomes. As patient involvement is an important aspect of the treatment process, generating knowledge from clinical and patient perspectives is valuable for health care providers, patients, and policy makers. The developed methodology can easily be applied to other treatments and health problems

Plasmonics on a Neural Implant: Engineering Light–Matter Interactions on the Nonplanar Surface of Tapered Optical Fibers

Optical methods are driving a revolution in neuroscience. Ignited by optogenetic techniques, a set of strategies has emerged to control and monitor neural activity in deep brain regions using implantable photonic probes. A yet unexplored technological leap is exploiting nanoscale light-matter interactions for enhanced bio-sensing, beam-manipulation and opto-thermal heat delivery in the brain. To bridge this gap, we got inspired by the brain cells’ scale to propose a nano-patterned tapered-fiber neural implant featuring highly-curved plasmonic structures (30 μm radius of curvature, sub-50 nm gaps). We describe the nanofabrication process of the probes and characterize their optical properties. We suggest a theoretical framework using the interaction between the guided modes and plasmonic structures to engineer the electric field enhancement at arbitrary depths along the implant, in the visible/near-infrared range. We show that our probes can control the spectral and angular patterns of optical transmission, enhancing the angular emission and collection range beyond the reach of existing optical neural interfaces. Finally, we evaluate the application as fluorescence and Raman probes, with wave-vector selectivity, for multimodal neural applications. We believe our work represents a first step towards a new class of versatile nano-optical neural implants for brain research in health and disease.M.D.V., M.G., and Fe.P. jointly supervised and are co-last authors in this work. Fi.P., A.B., and Fe.P. acknowledge funding from the European Research Council under the European Union’s Horizon 2020 Research and Innovation Program under Grant Agreement No. 677683. F.D.A., L.M.d.l.P., M.V., M.D.V., and Fe.P. acknowledge funding from the European Union’s Horizon 2020 Research and Innovation Program under Grant Agreement No. 828972. Fi.P., M.D.V., and Fe.P. acknowledge that this project has received funding from the European Union’s Horizon 2020 Research and Innovation Program under Grant Agreement No. 101016787. M.P., Fe.P., and M.D.V. were funded by the U.S. National Institutes of Health (Grant No. 1UF1NS108177-01). Open access funding provided by Istituto Italiano di Tecnologia within the CRUI-CARE agreemen

Holographic Manipulation of Nanostructured Fiber Optics Enables Spatially-Resolved, Reconfigurable Optical Control of Plasmonic Local Field Enhancement and SERS

Integration of plasmonic structures on step-index optical fibers is attracting interest for both applications and fundamental studies. However, the possibility to dynamically control the coupling between the guided light fields and the plasmonic resonances is hindered by the turbidity of light propagation in multimode fibers (MMFs). This pivotal point strongly limits the range of studies that can benefit from nanostructured fiber optics. Fortunately, harnessing the interaction between plasmonic modes on the fiber tip and the full set of guided modes can bring this technology to a next generation progress. Here, the intrinsic wealth of information of guided modes is exploited to spatiotemporally control the plasmonic resonances of the coupled system. This concept is shown by employing dynamic phase modulation to structure both the response of plasmonic MMFs on the plasmonic facet and their response in the corresponding Fourier plane, achieving spatial selective field enhancement and direct control of the probe's work point in the dispersion diagram. Such a conceptual leap would transform the biomedical applications of holographic endoscopic imaging by integrating new sensing and manipulation capabilities.L.C. and Fi.P. contributed equally to this work. M.D.V. and Fe.P. jointly supervised and are co-last authors of this work. L.C., D.Z., L.M.P., C.C., M.D.V., and Fe.P. acknowledge European Union’s Horizon 2020 Research and Innovation Program under Grant Agreement No. 828972. Fi.P., A.B., and Fe.P. acknowledge European Research Council under the European Union’s Horizon 2020 Research and Innovation Program under Grant Agreement No. 677683. Fi.P., M.D.V., and Fe.P. acknowledge European Union’s Horizon 2020 Research and Innovation Program under Grant Agreement No 101016787. M.P. and M.D.V. acknowledge European Research Council under the European Union’s Horizon 2020 Research and Innovation Program under Grant Agreement No. 692943. M.P., Fe.P., and M.D.V. acknowledge U.S. National Institutes of Health (Grant No. 1UF1NS108177-01). M.D.V. acknowledges U.S. National Institutes of Health (Grant No. U01NS094190)

Removing the physician from the equation:Patient-controlled, home-based therapeutic drug self-monitoring of tacrolimus

The dosing of tacrolimus, which forms the backbone of immunosuppressive therapy after kidney transplantation, is complex. This is due to its variable pharmacokinetics (both between and within individual patients), narrow therapeutic index, and the severe consequences of over- and underexposure, which may cause toxicity and rejection, respectively. Tacrolimus is, therefore, routinely dosed by means of therapeutic drug monitoring (TDM). TDM is performed for as long as the transplant functions and frequent and often lifelong sampling is therefore the rule. This puts a significant burden on patients and transplant professionals and is associated with high healthcare-associated costs. Furthermore, by its very nature, TDM is reactive and has no predictive power. Finally, the current practice of TDM does not foresee in an active role for patients themselves. Rather, the physician or pharmacist prescribes the next tacrolimus dose after obtaining the concentration measurement test results. In this article, we propose a strategy of patient-controlled, home-based, self-TDM of the immunosuppressant tacrolimus after transplantation. We argue that with the combined use of population tacrolimus pharmacokinetic models, home-based sampling by means of dried blood spotting and implementation of telemedicine, this may become a feasible approach in the near future

Chronic Propafenone Application Increases Functional K IR2.1 Expression In Vitro.

Expression and activity of inwardly rectifying potassium (K IR) channels within the heart are strictly regulated. K IR channels have an important role in shaping cardiac action potentials, having a limited conductance at depolarized potentials but contributing to the final stage of repolarization and resting membrane stability. Impaired K IR2.1 function causes Andersen-Tawil Syndrome (ATS) and is associated with heart failure. Restoring K IR2.1 function by agonists of K IR2.1 (AgoKirs) would be beneficial. The class 1c antiarrhythmic drug propafenone is identified as an AgoKir; however, its long-term effects on K IR2.1 protein expression, subcellular localization, and function are unknown. Propafenone's long-term effect on K IR2.1 expression and its underlying mechanisms in vitro were investigated. K IR2.1-carried currents were measured by single-cell patch-clamp electrophysiology. K IR2.1 protein expression levels were determined by Western blot analysis, whereas conventional immunofluorescence and advanced live-imaging microscopy were used to assess the subcellular localization of K IR2.1 proteins. Acute propafenone treatment at low concentrations supports the ability of propafenone to function as an AgoKir without disturbing K IR2.1 protein handling. Chronic propafenone treatment (at 25-100 times higher concentrations than in the acute treatment) increases K IR2.1 protein expression and K IR2.1 current densities in vitro, which are potentially associated with pre-lysosomal trafficking inhibition

Estado de calidad de resúmenes de trabajos de titulación de Medicina de la Universidad Técnica de Manabí

La academia desempeña un rol protagónico en la formación investigativa de profesionales de la salud. Esto genera la necesidad de análisis y evaluación de la producción científica que involucra el trabajo de titulación de pre y postgrado. Con el objetivo de evaluar la calidad de los resúmenes de trabajos de titulación de la Escuela de Medicina de la Universidad Técnica de Manabí, Ecuador, se realizó un estudio cualitativo, descriptivo y retrospectivo, durante el período 2016 y 2017. Se utilizó la metodología de Bobenrieth con modificaciones para evaluación de artículos científicos. La población de estudio estuvo constituida por 91 resúmenes disponibles en el repositorio de trabajos de titulación de la institución. Más de la mitad de las investigaciones correspondieron a Pediatría, Ginecobstetricia y Cirugía. En la redacción de títulos el problema más frecuente fue la extensión de los mismos. Mientras que, en la calidad de los resúmenes conspiraron la gramática, incoherencia en la redacción, así como el empleo inadecuado del tiempo verbal. Otro problema fue la ausencia de objetivo general y conclusiones y/o consideraciones no relacionadas con el objetivo. No obstante, se observó un salto cualitativo del año 2016 al 2017.Palabras clave: Trabajo de titulación; metodología de la investigación; artículo científico. AbstractThe academy plays a leading role in the research training of health professionals. This generates the need for analysis and evaluation of scientific production that involves undergraduate and graduate degree work. A qualitative, descriptive and retrospective study was carried out during the period 2016 and 2017 with the aim of evaluating the quality of the abstracts of the degree works of the School of Medicine of the Technical University of Manabí, Ecuador, during the period 2016 and 2017. Bobenrieth with modifications for evaluation of scientific articles. The study population consisted of 91 abstracts available in the institution's repository of degree works. More than half of the investigations corresponded to Pediatrics, Obstetrics and Gynecology and Surgery. In the writing of titles, the most frequent problem was their extension. While, in the quality of the summaries conspired the grammar, incoherence in the writing, as well as the inappropriate use of the verb tense. Another problem was the absence of general objective and conclusions and/or considerations not related to the objective. However, a qualitative jump was observed from 2016 to 2017.Keywords: Thesis; research methodology; scientific article