An adaptive dynamically weighted median filter for impulse noise removal

A new impulsive noise removal filter, adaptive dynamically weighted median filter (ADWMF), is proposed. A popular method for removing impulsive noise is a median filter whereas the weighted median filter and c...

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Inclusion of pregnant and breastfeeding women in research – Efforts and Initiatives

ABSTRACT

Pregnant and breastfeeding women have been rendered therapeutic orphans as they have been historically excluded from clinical trials. Labeling for most approved drugs does not provide information about safety and efficacy during pregnancy. This lack of data is mainly due to ethico-legal challenges that have remained entrenched in the post-diethylstilbestrol and thalidomide era, and that have led to pregnancy being viewed in the clinical trial setting primarily through a pharmacovigilance lens. Policy considerations that encourage and/or require the inclusion of pregnant or lactating women in clinical trials may address the current lack of available information. However, there are additional pragmatic strategies, such the employment of pharmacometric tools and the introduction of innovative clinical trial designs, which could improve knowledge about the safety and efficacy of medication use during pregnancy and lactation. This paper provides a broad overview of the pharmacoepidemiology of drugs used during pregnancy and lactation, and offers recommendations for regulators and researchers in academia and industry to increase the available pharmacokinetic and –dynamic understanding of medication use in pregnancy.

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The impact of delayed maternity on foetal growth in Spain: An assessment by population attributable fraction

Publication date: Available online 18 September 2017
Source:Women and Birth
Author(s): Carlos Varea, José Manuel Terán, Cristina Bernis, Barry Bogin
BackgroundDelayed childbearing is considered a risk factor for maternal–foetal health. As in other higher-income countries, in Spain age at maternity has steadily increased during the last two decades.AimTo quantify the impact of the delay in the age at maternity on small for gestational age (SGA) categories of <3rd, 3rd–5th and 5th–10th percentiles.Methods2,672,350 singleton live births born to Spanish mothers in 2007–2015 were analysed. Adjusted relative risk was calculated to estimate the adjusted partial population attributable fractions (PAFp) for mothers aged 35–39 and ≥40 years for each category of SGA considering the interaction between age at maternity and parity.FindingsPrimipara 35–39 years old mothers have the highest PAFp in the three categories of SGA, with the maximum value for SGA <3rd percentile (2.57%, 95% CI 2.25, 2.88). PAFp for both primipara and multipara ≥40 years old mothers were less than 1%. PAFp for primipara older mothers increased significantly in 2007–2015 for the three categories of SGA, more clearly among those aged 35–39 years. The contribution of multipara mothers of both age groups did not increase significantly during the period.ConclusionDelayed maternity is a significant adjusted risk factor for SGA, contributing to the increase of its prevalence. However, results also suggest a limited clinical impact of delayed maternity on foetal growth. Positive changes in maternal profile associated with the shift in maternal age might contribute to explain the limited impact of mothers aged 35 years and older on negative birth outcome in Spain.



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Advances in delivery of ambulatory autologous stem cell transplantation for multiple myeloma.

Purpose of review: Autologous stem cell transplantation (ASCT) is generally performed in the inpatient setting in its entirety. Several centers have demonstrated the feasibility of performing ASCT for myeloma in the ambulatory setting. We review the safety, cost-effectiveness, complications and outcomes of outpatient ASCT for myeloma. Recent findings: Published studies are heterogeneous but suggest that outpatient ASCT for myeloma is cost-effective and associated with a shorter or no initial hospitalization, albeit there is a high rate of readmission for complications. The transplant-related mortality rate is less than 1%. Stringent patient selection criteria that include emphasis on functional status, caregiving support and psychosocial aspects for each patient are critical for identifying patients most appropriate for ASCT in the ambulatory setting. There exists considerable variability in outpatient transplant models and supportive care guidelines and data do not support preference for one delivery model over another. Survival and other transplant-related outcomes have not been reported widely and whether patients fare better with outpatient transplantation remains to be explored. Summary: Outpatient ASCT for multiple myeloma is feasible and well tolerated in selected patients. Several care models for outpatient ASCT exist and can be implemented based on transplant resources and preference. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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The role of vitamin D in cancer cachexia.

Purpose of review: The possibility to use vitamin D supplementation to improve muscle wasting, with particular focus on cancer cachexia, is discussed. Recent findings: Vitamin D exerts biological actions on myogenic precursor proliferation and differentiation, impinging on muscle regeneration. However, the effects of VitD supplementation in diseases associated with muscle atrophy, such as cancer cachexia, are poorly investigated. Data obtained in experimental models of cancer cachexia show that the administration of vitamin D to tumor-bearing animals is not able to prevent or delay both muscle wasting and adipose tissue depletion, despite increased expression of muscle vitamin D receptor. Not just vitamin D supplementation impairs muscle damage-induced regeneration, suggesting that upregulation of vitamin D receptor signaling could contribute to muscle wasting. Summary: Vitamin D supplementation is likely beneficial to reduce or delay aging-related sarcopenia and osteoporosis, although the available data still put in evidence significant discrepancies. By contrast, VitD supplementation to tumor-bearing animals or to rats with arthritis was shown to be totally ineffective. In this regard, the adoption of VitD treatment in patients with cancer cachexia or other chronic diseases should be carefully evaluated, in particular whenever a regenerative process might be involved. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Population-based models of planning for palliative care in older people.

Purpose of review: Health service planning requires demographic, clinical, and health systems data and is unique to each health system. Planning for palliative care in older people must include patients and their carers. This review explores literature from the last 24 months. Recent findings: The proportion of people living in skilled nursing facilities is increasing and many residents require quality palliative care. Simultaneously, the complexity of care for older people is also increasing. Systematic approaches to improving palliative care in these facilities have shown benefits that are cost-effective. Although advance care planning is widely promoted, a randomized controlled trial failed to show the benefits seen in nonrandomized trials. This requires a reconceptualization of current programs that seek to increase uptake. Caregivers take on complex decision-making which can be stressful. By contrast, patients are often very confident that the people who are close to them will make good decisions on their behalf. Specific subgroups considered in this review include carers (and the challenges they face), the 'oldest old' and people with dementia. Summary: Excellent research is being done to improve the care of older people with palliative care needs. Ultimately, how can key findings be incorporated into clinical care? Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Health professionals' quality of life in relation to end of life care.

Purpose of review: Palliative care professionals are frequently exposed to stressful and demanding situations in the assistance of patients and their families, therefore research related to their quality of life is a relevant topic to provide evidence on interventions oriented to professional self-care. Recent findings: Research about professionals' quality of life is having a profuse development with core concepts being under review. Summary: Currently, burnout syndrome and compassion fatigue are considered relevant determinants of professionals' quality of life. Self-awareness-based interventions could bring positive influence on the context of a multidimensional approach to professionals' self-care. Self-care topics should be considered to be included in professional training programmes. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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