A Prospective Open-Label Observational Study of a Buffered Soluble 70 mg Alendronate Effervescent Tableton Upper Gastrointestinal Safety and Medication Errors: The GastroPASS Study

Upper gastrointestinal (GI) side effects are a main reason for discontinuing bisphosphonate treatment, an important therapeuticoption for osteoporosis patients. Consequently, the development of novel formulations with improved tolerability is warranted. Inthis multicenter prospective, observational, postauthorization safety study conducted in Italy and Spain, postmenopausal women(PMW) with osteoporosis (naïve to bisphosphonates) were treated weekly with a buffered soluble alendronate 70 mg effervescent(ALN-EFF) tablet (Binosto®) and followed for 12 3 months. Information was collected on adverse events (AEs), medication errors,persistence, and compliance using the Morisky-Green questionnaire. Patients (N = 1028) aged 67 9 years (mean SD) receivedALN-EFF weekly. The cumulative incidence of upper GI AEs (oesophageal toxicity, gastritis, gastric ulcers, and duodenitis) relatedto ALN-EFF (primary endpoint) was 9.6% (95% condence interval [CI] 7.9–11.6%), the vast majority being of mild intensity. The mostfrequently occurring upper GI AEs related to ALN-EFF were dyspepsia (2.7%), gastroesophageal reux disease (2.4%), and nausea(2.2%). None of the relevant upper GI AEs listed in the primary endpoint and no serious AEs were reported. At least one medicationerror occurred in 29.9% (95% CI 27.1–32.8%) of patients. However, the majority of medication errors were associated with adminis-tration instructions applicable to any oral bisphosphonate and only seven medication errors were associated with the ALN-EFF for-mulation. ALN-EFF was discontinued in 209 of 1028 (20.3%) patients. The most frequent reasons for discontinuation were AEsrelated to ALN-EFF (46.9%) and patients’ decision (42.6%). Compliance with ALN-EFF was high, reected by a mean Morisky-Greenscore of 92.8 18.6. PMW with osteoporosis treated with ALN-EFF in a real-world setting experienced few upper GI AEs. In addition,they had a low discontinuation and high compliance compared with other formulations, suggesting that ALN-EFF may increasepatient satisfaction and therefore long-term adherence and efcac

Thinking about Later Life: Insights from the Capability Approach

A major criticism of mainstream gerontological frameworks is the inability of such frameworks to appreciate and incorporate issues of diversity and difference in engaging with experiences of aging. Given the prevailing socially structured nature of inequalities, such differences matter greatly in shaping experiences, as well as social constructions, of aging. I argue that Amartya Sen’s capability approach (2009) potentially offers gerontological scholars a broad conceptual framework that places at its core consideration of human beings (their values) and centrality of human diversity. As well as identifying these key features of the capability approach, I discuss and demonstrate their relevance to thinking about old age and aging. I maintain that in the context of complex and emerging identities in later life that shape and are shaped by shifting people-place and people-people relationships, Sen’s capability approach offers significant possibilities for gerontological research

Real world safety of methoxyflurane analgesia in the emergency setting: a comparative hybrid prospective-retrospective post-authorisation safety study.

BACKGROUND: Low-dose analgesic methoxyflurane (Penthrox®) was approved in Europe for emergency relief of moderate to severe pain in conscious adults with trauma in 2015. A comparative post-authorisation safety study (PASS) was conducted to assess the risk of hepatotoxicity and nephrotoxicity with methoxyflurane during routine clinical practice. METHODS: This was a comparative hybrid prospective-retrospective cohort study. The comparative cohorts consisted of adults who were given methoxyflurane (methoxyflurane cohort) or another analgesic (concurrent cohort) routinely used for moderate to severe trauma and associated pain in the emergency setting (ambulance and Emergency Department) in the UK between December 2016 and November 2018. Hepatic and renal events were captured in the ensuing 12 weeks. A blinded clinical adjudication committee assessed events. A historical comparator cohort (non-concurrent cohort) was identified from patients with fractures in the English Hospital Episode Statistics (HES) accident and emergency database from November 2013 and November 2015 (before commercial launch of methoxyflurane). Hepatic and renal events were captured in the ensuing 12 weeks via linkage with the Clinical Practice Research Datalink (CPRD) and HES hospital admissions databases. RESULTS: Overall, 1,236, 1,101 and 45,112 patients were analysed in the methoxyflurane, concurrent and non-concurrent comparator cohorts respectively. There was no significant difference in hepatic events between the methoxyflurane and concurrent cohorts (1.9% vs. 3.0%, P = 0.079) or between the methoxyflurane and non-concurrent cohorts (1.9% vs. 2.5%, P = 0.192). Renal events were significantly less common in the methoxyflurane cohort than in the concurrent cohort (2.3% vs. 5.6%, P < 0.001). For methoxyflurane versus non-concurrent cohort the lower occurrence of renal events (2.3% vs. 3.2%, P = 0.070) was not statistically significant. Multivariable adjustment did not change these associations. CONCLUSIONS: Methoxyflurane administration was not associated with an increased risk of hepatotoxicity or nephrotoxicity compared with other routinely administered analgesics and was associated with a reduced risk of nephrotoxicity compared with other routinely administered analgesics. TRIAL REGISTRATION: Study registered in the EU PAS Register (ENCEPP/SDPP/13040)

Mucinous cystadenoma of the appendix misdiagnosed as cystic hydatid disease of the liver: a case report

<p>Abstract</p> <p>Introduction</p> <p>Primary neoplastic lesions presenting with a mucocele of the appendix are very rare and can be divided into benign variants of mucinous adenomas or cystadenomas, mucinous tumours of uncertain malignant potential or mucinous cystadenocarcinomas. Most of these tumourous mucoceles are asymptomatic and are found incidentally. The major complication of neoplastic mucinous appendiceal tumours is the development of a pseudomyxoma peritonei due to spreading of mucin-producing cells within the abdominal cavity.</p> <p>Case presentation</p> <p>A 44-year-old man presented with a history of non-specific symptoms of right upper abdominal pain. Abdominal ultrasound and computed tomography scan identified a cystic mass consistent with the morphological characteristics of an echinococcal hydatid cyst. After completing systemic albendazole therapy, an explorative laparotomy revealed a cystic tumour of the appendix. Ileocaecal resection was performed and pathology reports confirmed the diagnosis of a mucinous cystadenoma of the appendix. The postoperative course was uneventful.</p> <p>Conclusion</p> <p>Here we present the case of a man with a mucinous cystadenoma of the appendix mimicking cystic hydatid disease. We discuss the importance of re-evaluation and differential diagnostic reflections in cases of appendiceal mucocele.</p

From passionate labour to compassionate work: Cultural co-ops, do what you love and social change

This article focuses on the relation between work and pleasure in the cultural sector. I first unpack the concept of passionate work, situating it within four possible ways of relating work and pleasure. I argue that the work ethic of do what you love, contrary to what it promises, limits the prospects of loveable work. As part of a neoliberal work culture, do what you love transfers the battleground from society onto the self. It favours self-management over politics. Drawing on findings from interview research with members of worker co-operatives in the UK cultural industries, I then go on to explore the relation between work and pleasure within cultural co-ops. I discuss how cultural co-ops might inspire and contribute to a movement for transforming the future of work by turning the desire for loveable work from a matter of individual transformation and competition into a practice of co-operation and social change

Can deliberate efforts to realise aspirations increase capabilities? A South African case study

This paper takes up Appadurai's suggestion that aspirations could be used as a key to unlock development for people who are economically marginalised, and that their capabilities could be increased by this approach. The notion of “aspirations” is theoretically and conceptually framed, and then Amartya Sen's use of the term capabilities as the space within which development should be assessed is explored. I subsequently describe a five-year programme in which economically marginalised women in Khayelitsha near Cape Town were assisted in voicing and attempting to realise their aspirations, while being assisted with access to some resources. Capability outcomes and constraints are described and analysed, and the question of adaptive preferences is addressed. I conclude that deliberate efforts to realise aspirations, accompanied by some facilitation, can increase capabilities, but that there are also structural constraints to capability expansion for these women that frustrate their aspiration of class mobility.International Bibliography of Social Science

Examining if being overweight really confers protection against dementia: Sixty-four year follow-up of participants in the Glasgow University alumni cohort study

BACKGROUND: Recent large-scale studies suggest that obesity and overweight may confer protection against future dementia. This observation could, however, be generated by reverse causality. That is, weight loss in the incipient phase of dementia ascribed to diminished self-care, including sub-optimal nutrition, would have the effect of generating such an inverse association. One approach to circumventing this problem would be to measure weight in a population which is young enough to be free of the symptoms of dementia which is then followed up for dementia occurrence over many decades. METHODS: In a prospective cohort study, body mass index, and other potential risk factors, were measured in 9547 male university undergraduates (mean age 20.5 years) in 1948-68 who were then linked to national mortality registers. RESULTS: Of 2537 deaths over a mean of 50.6 years follow up, 140 were ascribed to dementia. There was no association between overweight and future dementia deaths (age-adjusted hazard ratio; 95 % confidence interval: 0.93; 0.49, 1.79). CONCLUSION: In this cohort study of former university students, being overweight in youth did not confer protection against later dementia death

Carcinoma developing in ectopic pancreatic tissue in the stomach: a case report

The development of pancreatic tissue outside the confines of the main gland, without anatomic or vascular connections between them, is a congenital abnormality referred to as heterotopic pancreas. A heterotopic pancreas in the gastrointestinal tract is usually discovered incidentally and the risk of its malignant transformation is extremely low. In this study, we describe the first case of endoepithelial carcinoma arising in a gastric heterotopic pancreas of a 56-year old woman in Greece. She presented with epigastric pain, periodic nausea and vomiting. Esophagogastroduodenoscopy revealed an ulcerated lesion in the gastric antrum, biopsies of which showed intense epithelial dysplasia with incipient malignant degeneration. The pathology report of the distal gastrectomy specimen demonstrated a 2 cm in diameter ulcerative mass in the gastric antrum. Microscopically, an endoepithelial (in situ) carcinoma of the gastric antrum was determined, which in places turned into an microinvasive endomucosal adenocarcinoma. It also incidentally demonstrated heterotopic pancreatic ducts, detected within the mucosa to the muscularis propria of the same region of the stomach, in which an endoepithelial (in situ) carcinoma was evolving. The follow-up course was uneventful 6 months postoperatively