Activiteit

The MET receptor tyrosine kinase and the ligand hepatocyte growth factor (HGF) have been implicated as oncogenes and drivers of non-small-cell lung cancer (NSCLC). Newer MET TKIs including capmatinib and tepotinib more recently showed not only improved localized control and response, but early data suggests intracranial activity as compared to first-generation MET TKIs, both in the front-line and the refractory setting. This is a case report demonstrating an effective duration of response in a patient with widely metastatic lung adenocarcinoma harboring a MET exon 14 mutation.This month, a dog owner describes what she experienced when her local practice started using an out-of-hours provider.Ian Wright argues that although there are environmental concerns regarding ‘blanket’ flea treatment of cats and dogs, without this measure pet owners would be at risk of potentially developing bartonellosis.Josh Loeb discusses just how easy it is for members of the public to purchase a pet monkey.Young people and adults diagnosed with an HIV indicator condition should be offered an HIV test (NICE [National Institute of Clinical Excellence] guidance). Community-acquired pneumonia (CAP) is considered to be an HIV indicator condition as it has an undiagnosed HIV prevalence of 0.76%. We observed however, that the offer of HIV testing to patients with radiologically diagnosed CAP remained low even after a senior respiratory physician review. Our aim was to improve the percentage of patients being offered an HIV test with CAP requiring hospital admission across four acute medical wards at Royal Derby Hospital within 12 months. We identified several key steps in the process. These included the identification of CAP, the role of the medical clerking team and the respiratory infections nursing team that manage pneumonia admissions. After collecting baseline data and staff interviews, we conducted seven plan-do-study-act (PDSA) interventions. These included; iterative communication, educational interventions, snew CAP bundle to help streamline the request of HIV testing at the first clinician clerking. Our dedicated respiratory infection nursing team also ensures that patients with CAP have a documented offer of an HIV test.Thousands of children experience a cardiac arrest event in the hospital each year, with more than half of these patients not surviving to hospital discharge. Cardiopulmonary resuscitation (CPR) depth, rate, velocity and percentage of high-quality chest compressions are modifiable factors associated with improved survival. Therefore, we created a novel and standardised process to track and analyse cardiac arrests in the Duke paediatric intensive care unit (PICU). Our aim was to identify areas for improved American Heart Association (AHA) compliance and implement education and communication-based initiatives to enhance early recognition of at-risk patients leading to improved outcomes. From January 2017 to December 2018, all cardiac arrests in our PICU were tracked, reviewed and presented at monthly morbidity and mortality conference. We used the data to track compliance with AHA guidelines and identify opportunities for improvement. Through these efforts, we established a multidisciplinary cardiac arrest education and review programme. Over the 2-year period, we tracked 45 cardiac arrests, which comprised 2% of all PICU admissions. In 2017, during the first year of development, 16 of 22 arrests (73%) were not reported to code committee members in time for complete review. Of the six cardiac arrests with complete reviews, only 17% followed AHA guidelines. In 2018, all 23 arrest events were communicated and 76% of resuscitations were found to be compliant with AHA guidelines. Tetrazolium Red molecular weight Survival of patients to discharge was 47% in 2017 and increased to 63% in 2018 with similar percentage of PICU admissions having a cardiac arrest between the 2 years. The primary aim of this project was to establish a multidisciplinary comprehensive cardiac arrest review process. This programme allowed for comprehensive analysis of individual events, promoted quality improvement initiatives and improved consistent delivery of high-quality CPR.

To assess for long-term positive effects of buprenorphine treatment (BT) on opioid use disorder (OUD) at a Nishnawbe Aski Nation high school clinic.

Postgraduation telephone survey of high school students between March 2017 and January 2018.

Dennis Franklin Cromarty High School in Thunder Bay, Ont.

All 44 students who had received BT in the high school clinic during its operation from 2011 to 2013 were eligible to participate.

Current substance use, BT status, and social and employment status.

Thirty-eight of the 44 students who had received BT in the high school clinic were located and approached; 32 consented to participate in the survey. A descriptive analysis of the surveyed indicators was undertaken. Almost two-thirds (n = 20, 62.5%) of the cohort had graduated from high school, more than one-third (n = 12, 37.5%) were employed full time, and most (n = 29, 90.6%) rated their health as “good” or “OK.” A greater percentage of participants who continued taking BT after high school (n = 19, 61.3%t as the treatment of choice for OUD in the general population; they should consider adding youth to the population that might also benefit.

A few patients have previously presented to my clinic with palpable purpura, joint inflammation, and severe abdominal pain characteristic of Henoch-Schönlein purpura (HSP). Considering that renal injury is the primary long-term complication of HSP, are corticosteroids effective in preventing or treating renal disease in children with HSP?

Henoch-Schönlein purpura is self-limiting in 94% of children, but permanent renal injury is reported in one-fifth of children with nephritic or nephrotic features. Corticosteroids have been considered as candidates for preventing and treating renal involvement in HSP. There is a moderate level of evidence to suggest corticosteroids are not effective in preventing renal involvement in HSP. However, based on low-level evidence and similarities with primary immunoglobulin A nephropathy, experts recommend corticosteroids in treating renal involvement in HSP to prevent long-term kidney injury. Dose and duration of therapy should be carefully considered in consultation with a pediatric nephrologist.