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Quality Assurance of the Treatment Planning Process
Published in W. P. M. Mayles, A. E. Nahum, J.-C. Rosenwald, Handbook of Radiotherapy Physics, 2021
Systematic photographs can also be quite helpful both to check patient identification and to confirm the use of any additional patient-positioning device. Ultimately, devices such as stereotactic frames (see Section 40.3) ensure both efficient patient immobilisation and accurate repositioning. In all cases, the devices used for treatment should also be used for patient data acquisition. This includes the table top of the imaging system, which should resemble, as much as possible, the table top of the treatment couch. Positioning aids such as laser pointers are also essential. If bolus is used for treatment (see Section 20.1.2 and 24.5), it should preferably be present at the time of patient data acquisition.
Nutrition for children with chronic diseases and syndromes
Published in Judy More, Infant, Child and Adolescent Nutrition, 2021
Tube feeding can be either continuous or bolus feeding:In continuous feeding the food is supplied over a long period of time via a pump. The flow rate can be adjusted. This is usual for overnight feeding when a child is in bed. For daytime tube feeding a child can wear a small backpack containing a small portable pump. The child can carry on with most daily activities while being tube fed this way.Bolus feeding can also use a pump or can be administered using gravity for the feed to drain down the tube.
Respiratory, endocrine, cardiac, and renal topics
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Cardiac toxicity depends on the cumulated dose administered and on the duration of infusion (the risk is much higher for bolus injection, as compared to continuous infusion). The individual risk factors are yet to be identified. The guidelines to reduce the risk of cardiac toxicity are: Do not exceed the recommended maximum cumulative doses (doxorubicin < 5 5 0 mg/m2).Do not administer anthracyclines as bolus injections, but rather by infusion of at least 6 hours, or even by continuous infusion of 24 to 48 hours. Infusion of more than 24 hours increases the risk of acute mucositis.
Opioid MOP receptor agonists in late-stage development for the treatment of postoperative pain
Published in Expert Opinion on Pharmacotherapy, 2022
Qiu Qiu, Joshua CJ Chew, Michael G Irwin
The ATHENA trial was a phase-III, open-label, multicenter study investigating oliceridine in both postoperative and non-operative, moderate to severe pain. This study aimed to emulate real-world conditions, allowing the use of PCA, clinician boluses and concomitant non-opioid medications. It also included a broad population of inpatients, emergency department patients and outpatients. For clinician administered IV boluses, the dose was 1–3 mg every 1–3 hours as required. The PCA protocol was a loading dose of 1.5 mg followed by bolus doses of 0.5 mg with a 6 min lockout time. The total dose limit for 12 hours was 60 mg. oliceridine provided a rapid and significant reduction in pain, with a mean reduction of 2.2 on a 11-point NPRS, 30 min after administration. The mean reduction at the end of treatment or 1 h after the last dose of oliceridine was 3.1. ATHENA reported a 3% rate of adverse effects, most commonly nausea, vomiting and constipation but not all of these were assessed to be attributable to oliceridine [51].
Correlation between dysphonia and dysphagia evolution in amyotrophic lateral sclerosis patients
Published in Logopedics Phoniatrics Vocology, 2021
Chiara Mezzedimi, Enza Vinci, Fabio Giannini, Serena Cocca
FEES was performed with a fiberoptic rhinopharyngoscope for studying the physiology and physiopathology of certain stages of swallowing, particularly the pharyngeal stage. As far as concerns the static investigation, three main positions were performed for the tip of the endoscope: rhino-pharyngeal, upper position and lower position. In the upper position (with the endoscope next to the velum palati), it was possible to detect stagnation of secretion in the glosso-epiglottic valleculae, the pyriform recesses, the interarytenoid area and the laryngeal vestibule. The lower position (the endoscope is placed at the laryngeal aditus) was tested by simply inviting the patient to cough, swallow saliva and carry out a Valsalva maneuver. Static evaluation of the morphology and function of the upper airways and upper digestive tract was followed by a dynamic evaluation of swallowing, administering a bolus to the patient. At least four bolus types were administered: 5 ml of thin liquid from a spoon, thin liquid from a cup (self-administered), 5 ml of a semisolid from a spoon, and a cookie.
A critical review of apomorphine hydrochloride sublingual film for the treatment of Parkinson’s disease ‘OFF’ episodes
Published in Expert Review of Neurotherapeutics, 2021
Christopher Y. Caughman, Stewart Factor
As a result, an expert consensus indicated apomorphine is a suitable therapeutic option for PD patients who experience troublesome ‘off’ periods despite optimized treatment with oral medications [22]. Ideally, injections would be given in anticipation of approaching off periods, but in the event that patients have dose failures and are akinetic, it is recommended that a caretaker be available to assist with injections [22]. A common adverse effect of subcutaneous apomorphine is nausea, although this is best managed by pre-treatment with trimethobenzamide prior to initiation, which can then be weaned after 6–8 weeks [23,24]. Injection training is required, as is an in clinic or home challenge for dose finding with a nurse or physician available to supervise and with documented improvement in UPDRS [21]. Studies showed subcutaneous apomorphine to be safe in patients with a history of hallucinations, and case reports suggest possible improvement in diphasic dyskinesias, and dystonia, pain, anxiety, voiding dysfunction, and esophageal motility associated with off times [19]. Additional side effects can include dizziness, hypotension, somnolence, dyskinesias, and occasional hallucinations, and the benefit of bolus injections has been shown to only last up to 41 months, as potential benefit may decline as disease progresses [15]. These side effects in conjunction with the need for injection pens and caregivers leave room for improvement in drug delivery.