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1.
Transplantation ; 104(10): 1972-1973, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32969986
4.
Br J Haematol ; 186(2): 327-329, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30768682
5.
Cytotherapy ; 21(3): 327-340, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30685216

RESUMO

Clinical trials of adoptively transferred CD19 chimeric antigen receptor (CAR) T cells have delivered unprecedented responses in patients with relapsed refractory B-cell malignancy. These results have prompted Food and Drug Administration (FDA) approval of two CAR T-cell products in this high-risk patient population. The widening range of indications for CAR T-cell therapy and increasing patient numbers present a significant logistical challenge to manufacturers aiming for reproducible delivery systems for high-quality clinical CAR T-cell products. This review discusses current and novel CAR T-cell processing methodologies and the quality control systems needed to meet the increasing clinical demand for these exciting new therapies.


Assuntos
Imunoterapia Adotiva/métodos , Instalações Industriais e de Manufatura/normas , Neoplasias/terapia , Controle de Qualidade , Receptores de Antígenos Quiméricos , Antígenos CD19/imunologia , Remoção de Componentes Sanguíneos/métodos , Sobrevivência Celular , Criopreservação/métodos , Endotoxinas/análise , Humanos , Imunoterapia Adotiva/efeitos adversos , Ativação Linfocitária , Mycoplasma , Linfócitos T/imunologia , Transdução Genética/métodos
6.
Arch Dis Child Fetal Neonatal Ed ; 103(6): F573-F576, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29122828

RESUMO

OBJECTIVE: To analyse the referral patterns of perinatal patients referred to a specialist palliative care service (SPCS), their demographics, diagnoses, duration of illness, place of death and symptom profile. DESIGN: A retrospective chart review of all perinatal referrals over a 4-year period to the end of 2015. SETTING: A consultant-led paediatric SPCS at Our Lady's Children's Hospital, Crumlin, Dublin, and the Coombe Women & Infants University Hospital, Dublin. RESULTS: 83 perinatal referrals were received in a 4-year period. Chromosomal abnormalities accounted for 35% of diagnoses, congenital heart disease 25%, complex neurological abnormalities 11% and renal agenesis 4%. 22 referrals (26.5%) were made antenatally, with 61 (73.5%) postnatally. Of the postnatal referrals, 27 (44%) were asymptomatic on referral. An opioid medication was recommended (regularly or as required) in 46 cases. Symptom control was achieved without dose titration in 43 of these cases (93%). Of 47 deaths in this group referred postnatally, 22 of these (47%) died at home with support from community teams. Discharge home for best supportive care required complex interagency communication and cooperation. CONCLUSIONS: Perinatal palliative care requires effective multidisciplinary work, whether delivered in the inpatient setting or in the community. With appropriate support, end-of-life care can be delivered in the community.


Assuntos
Cuidados Paliativos/estatística & dados numéricos , Assistência Perinatal/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Feminino , Humanos , Irlanda , Masculino , Gravidez , Estudos Retrospectivos
7.
Int J Palliat Nurs ; 23(2): 88-97, 2017 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-28245162

RESUMO

This paper reports the findings from a Delphi Study undertaken to identify the research priorities in children's palliative care in Ireland. Palliative care for children is a small and highly specialised field of healthcare that focuses on improving the quality of life of children living with, or dying from, a life-limiting condition. Ideally, support for children requiring palliative care begins at the time of diagnosis, which for many children with life-limiting conditions can be from birth. There is a notable overlap between the needs of children requiring palliative care and those with disabilities and other complex care needs, resulting in care being provided by a range of voluntary and statutory agencies. As a new specialty, there is a need to develop an evidence-based approach to providing children's palliative care. In order to do this in a systematic way, identification of the research priorities in children's palliative care within Ireland is required.


Assuntos
Cuidados Paliativos , Pediatria , Pesquisa , Bases de Dados Factuais , Técnica Delfos , Necessidades e Demandas de Serviços de Saúde , Cuidados Paliativos na Terminalidade da Vida , Humanos , Irlanda , Pais , Qualidade de Vida , Irmãos , Assistência Terminal
9.
Gut ; 63(12): 1913-20, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25021423

RESUMO

OBJECTIVE: The commensal microbiota, host immunity and metabolism participate in a signalling network, with diet influencing each component of this triad. In addition to diet, many elements of a modern lifestyle influence the gut microbiota but the degree to which exercise affects this population is unclear. Therefore, we explored exercise and diet for their impact on the gut microbiota. DESIGN: Since extremes of exercise often accompany extremes of diet, we addressed the issue by studying professional athletes from an international rugby union squad. Two groups were included to control for physical size, age and gender. Compositional analysis of the microbiota was explored by 16S rRNA amplicon sequencing. Each participant completed a detailed food frequency questionnaire. RESULTS: As expected, athletes and controls differed significantly with respect to plasma creatine kinase (a marker of extreme exercise), and inflammatory and metabolic markers. More importantly, athletes had a higher diversity of gut micro-organisms, representing 22 distinct phyla, which in turn positively correlated with protein consumption and creatine kinase. CONCLUSIONS: The results provide evidence for a beneficial impact of exercise on gut microbiota diversity but also indicate that the relationship is complex and is related to accompanying dietary extremes.


Assuntos
Dieta/efeitos adversos , Proteínas na Dieta/metabolismo , Exercício Físico/fisiologia , Trato Gastrointestinal/microbiologia , Microbiota/fisiologia , Esportes/fisiologia , Adulto , Biomarcadores/metabolismo , Índice de Massa Corporal , Creatina Quinase/sangue , Análise de Alimentos , Humanos , Imunidade/fisiologia , Inflamação/metabolismo , Masculino , Fenômenos Fisiológicos da Nutrição Esportiva
13.
J Pediatr Hematol Oncol ; 35(7): 537-42, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24060836

RESUMO

INTRODUCTION: The use of complementary and alternative medicine (CAM) in the Irish pediatric cancer setting has not previously been established. METHODS: To investigate the prevalence and predictors of CAM use in this group of patients, an anonymous cross-sectional survey was offered to all carers of patients either on or off treatment for malignancy at a single pediatric cancer center over an 8-week period. RESULTS: Of a total of 220 questionnaires distributed, 98 (43%) were returned. Six were excluded because of inadequate data. A total of 58% of children were male and the mean age was 9 years. The most common cancer diagnosis was leukemia (45%). Fifty-two respondents (57%) said their child had used or was using CAM, and 55% of whom had started since their cancer diagnosis. The most common types of CAM used were vitamins and minerals (18%), reflexology (11%), dietary supplements (11%), faith healers (9%), and energy therapies (9%). The most common reason for CAM use was to improve physical well-being (31%). A total of 65% of CAM users had not told their doctor that they were doing so. Of the 52 CAM users, 30 (58%) were using oral CAM medication. A total of 86% of CAM users reported benefit from the treatment, and no respondent reported side effects.There was no significant relationship between sex, tumor type, age, income, previous treatment, and CAM use. Where parents had a higher level of education, children were more likely to use CAM (P=0.035.) There was a statistically significant relationship between respondents rating of conventional therapy and CAM use (P=0.007). Interestingly, parents who were satisfied with conventional therapy were more likely to use CAM. CONCLUSION: The high prevalence of CAM use demonstrated in this study and particularly the high use of CAM medication therapies underlines the importance of physicians asking routinely about CAM use in this population.


Assuntos
Terapias Complementares , Neoplasias/terapia , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Irlanda , Masculino , Neoplasias/epidemiologia , Prevalência , Fatores Socioeconômicos , Inquéritos e Questionários
15.
Pediatr Hematol Oncol ; 29(5): 446-9, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22632142

RESUMO

Central venous access devices (CVADs) play an essential role in the care of critically ill children. Significant challenges exist for teams in managing CVADs particularly in a community setting. The authors aimed to assess the experience of general practitioners (GPs) caring for children with CVADs. From 200 CVADs inserted in a pediatric hospital in 2009, 50 patients were randomly selected and 44 GPs were forwarded a questionnaire. Twenty (46%) GPs responded. The main reasons (n = 22) for using CVADs were medication administration (n = 11), nutrition (n = 6), and blood sampling (n = 5). Thirteen (65%) GPs had no education in CVAD management and 14 (70%) were unaware of existing guidelines. Those identified by GPs as having primary responsibility for care of CVADs in the community included hospital/pediatric teams (n = 9), parents (n = 3), GPs (n = 2), public health nurses (n = 1), and palliative care ("home care") teams (n = 1). The main challenges (n = 15) identified by GPs were lack of education (n = 4), line management difficulties (n = 3), infection risk (n = 3), infrequent exposure to CVADs (n = 3), and poor communication (n = 1). GPs felt that these challenges could be addressed through: education (n = 8), increased manpower and community support (n = 1), and improved communication (n = 1). This study highlights the inconsistency and challenges for GPs surrounding CVAD use in children. Further education and support is necessary to assist GPs in their use particularly when providing end-of-life care for children in the community.


Assuntos
Cateteres Venosos Centrais , Educação de Pacientes como Assunto , Inquéritos e Questionários , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Cuidados Paliativos/métodos
16.
BMJ Case Rep ; 20122012 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-22605696

RESUMO

The authors present a case of unilateral mydriasis in a teenager prescribed transdermal hyoscine hydrobromide (scopolamine) for chemotherapy induced nausea and vomiting. The authors discuss the ocular side-effects associated with this particular drug and delivery system and the potential use of transdermal hyoscine as an antiemetic agent in this group.


Assuntos
Antieméticos/efeitos adversos , Midríase/induzido quimicamente , Escopolamina/efeitos adversos , Administração Cutânea , Adolescente , Antieméticos/administração & dosagem , Antineoplásicos/efeitos adversos , Diagnóstico Diferencial , Feminino , Humanos , Midríase/diagnóstico por imagem , Náusea/tratamento farmacológico , Sarcoma de Ewing/tratamento farmacológico , Escopolamina/administração & dosagem , Tomografia Computadorizada por Raios X , Vômito/tratamento farmacológico
17.
Am J Hosp Palliat Care ; 29(8): 618-21, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22363032

RESUMO

BACKGROUND: Seizures are a common complication in patients with central nervous system (CNS) tumors. Optimal management is unclear with no defined guidelines and pharmacological management poses many controversies. Due to a hypothesized lack of consistency, we aimed to retrospectively review seizure management in patients with high-grade CNS tumors in our institution. METHODS: The medical records of patients with high-grade CNS tumors referred to the specialist palliative medicine service in our institution from January-June 2008 were retrospectively reviewed. Seizure incidence, antiepileptic drug (AED) choice, neurology input, medication interactions, and appropriate drug level monitoring were assessed. RESULTS: Twenty-seven patients were included for analysis. Fifteen (56%) were female. The mean age was 58.8 years (range 31-82 years). Three (11%) patients presented with seizures and 8 (30%) developed seizures subsequently. Eight (73% of those with seizures) were on monotherapy AED. Six different agents were used as first-line agents. Phenytoin was the most common AED used (n = 4). Three (27%) patients were on combination AEDs. Five (45.5%) patients had been seen by neurology and 6 (54.5%) had appropriate drug level monitoring performed. Six (55%) patients had potential AED-non-AED interactions. None of the patients had instructions documented in the clinical notes against driving. CONCLUSION: Seizure management in patients with CNS tumors is not consistent and remains very much a neglected area. Appropriate choice of AED is crucial. Physicians should be aware of potential drug interactions. Ownership and regular follow-up of this group is required to ensure optimum patient management.


Assuntos
Anticonvulsivantes/uso terapêutico , Neoplasias Encefálicas/complicações , Convulsões/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Condução de Veículo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fenitoína/uso terapêutico , Estudos Retrospectivos , Convulsões/epidemiologia , Convulsões/etiologia
19.
Reg Anesth Pain Med ; 27(3): 316-8, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12016608

RESUMO

BACKGROUND AND OBJECTIVES: Sternal fracture pain is severe and is difficult to alleviate due to the forces acting on the chest wall during respiration. We describe a continuous infusion regional analgesic technique for pain due to sternal fracture. CASE REPORT: A 47-year-old woman presented with a spontaneous sternal fracture, precluding effective coughing. Diclofenac and increasing doses of opioids did not give adequate pain relief and led to opioid toxicity. Two brief periods of analgesia were achieved with deep subcutaneous infiltration of bupivacaine. An epidural catheter was positioned periosteally, and an infusion of bupivacaine was commenced at 5 mL/h, achieving long-lasting analgesia. The bupivacaine concentration was reduced in a stepwise fashion from 0.5% to 0.25% and was changed to levobupivacaine after 3 days. Adding morphine (5 mg/60 mL levobupivicaine) permitted a reduction in infusion rate. The catheter was removed after 14 days because a local infection developed that resolved uneventfully with antibiotic therapy. CONCLUSIONS: Continuous infusion of local anesthetic and opioid to a sternal fracture site using a periosteally positioned catheter led to successful analgesia and hence improved respiratory function. Clinicians should consider placing a periosteal catheter when pain associated with sternal fracture cannot be adequately controlled with conventional methods.


Assuntos
Analgésicos Opioides/uso terapêutico , Anestésicos Locais/uso terapêutico , Bupivacaína/uso terapêutico , Fraturas Espontâneas/complicações , Morfina/uso terapêutico , Dor/tratamento farmacológico , Dor/etiologia , Periósteo , Esterno/lesões , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Bupivacaína/administração & dosagem , Bupivacaína/efeitos adversos , Cateterismo , Enfisema/complicações , Feminino , Humanos , Infusões Parenterais , Pessoa de Meia-Idade , Morfina/administração & dosagem , Morfina/efeitos adversos , Cuidados Paliativos
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