Dose adjustment in patients with liver cirrhosis: impact on adverse drug reactions and hospitalizations

To assess drug-related problems in patients with liver cirrhosis by investigating the prevalence of inadequately dosed drugs and their association with adverse drug reactions (ADRs) and hospitalizations.

General practitioner involvement in follow-up of childhood cancer survivors: a systematic review

BACKGROUND An increasing number of childhood cancer survivors need long-term follow-up care. Different models address this problem, including that of follow-up by general practitioners (GP). We describe models that involve GPs in follow-up for childhood cancer survivors, their advantages and disadvantages, clinics that employ these models, and the elements essential to high-quality, GP-led follow-up care. PROCEDURE We searched four databases (PubMed [including Medline], Embase, Cochrane, and CINAHL) without language restrictions. RESULTS We found 26 publications, which explicitly mentioned GP-led follow-up. Two models were commonly described: GP-only, and shared care between GP and pediatric oncology or late effects clinic. The shared care model appears to have advantages over GP-only follow-up. We found four clinics using models of GP-led follow-up, described in five papers. We identified well-organized transition, treatment summary, survivorship care plan, education of GPs and guidelines as necessary components of successful follow-up. CONCLUSION Scarcity of literature necessitated a review rather than a meta-analysis. More research on the outcomes of GP-led care is necessary to confirm the model for follow-up of childhood cancer survivors in the long term. However, with the necessary elements in place, the model of GP-led follow-up, and shared care in particular, holds promise.

Nessus und wilder Andres : Kentauren im Berner Oberland? Etymologische Versuche zu den fünf Namen des Berges Niesen im Bericht des Humanisten Benedikt Aretius von 1561

Zusammenfassung: Der Zürcher Universalgelehrte Konrad Gessner (1516-1565) war die zentrale Figur einer Welle der Bergbegeisterung, die knapp zweihundert Jahre vor Albrecht von Hallers Epoche machendem Lehrgedicht 'Die Alpen' theologische, philologische und naturwissenschaftliche Lebensentwürfe verband und sich an den Wundern der Gebirgsland-schaft berauschte. In diesen Umkreis gehört der Bericht des Berner Humanisten Benedikt Aretius über die Besteigung der beiden Voralpengipfel Stockhorn und Niesen im Jahr 1557. Die nachfolgenden Überlegungen zu den darin genannten Namen für den Berg Niesen (Nessus, Niesen, Jesen, Stalden, Zum wilden Andres) zeigen, dass Aretius Ausführungen hauptsächlich als Hommage an den Zeitgeist und an den Freund Konrad Gessner zu lesen sind – auch und vor allem die darin enthaltenen etymologischen Versuche und Anspielungen.

Two new flavonol glycosides and a metabolite profile of Bryophyllum pinnatum, a phytotherapeutic used in obstetrics and gynaecology

Bryophyllum pinnatum is a succulent perennial plant native to Madagascar which is used in anthroposophical medicine to treat psychiatric disorders and as a tocolytic agent to prevent premature labour. We performed a metabolite profiling study in order to obtain a comprehensive picture of the constituents in B. pinnatum leaves and to identify chromatographic markers for quality control and safety assessment of medicinal preparations. Preliminary HPLC-PDA-ESIMS analyses revealed that flavonoid glycosides were the main UV-absorbing constituents in the MeOH extract of B. pinnatum. Two phenolic glucosides, syringic acid β-D-glucopyranosyl ester (1) and 4'-O-β-D-glucopyranosyl-cis-p-coumaric acid (2), as well as nine flavonoids (3-11) including kaempferol, quercetin, myricetin, acacetin, and diosmetin glycosides were unambiguously identified by 1H and 2D NMR analysis after isolation from a MeOH extract. The flavonol glycosides quercetin 3-O-α-L-arabinopyranosyl-(1 → 2)-α-L-rhamnopyranoside 7-O-β-D-glucopyranoside (3) and myricetin 3-O-α-L-arabinopyranosyl-(1 → 2)-α-L-rhamnopyranoside (4) were new natural products. With the aid of HPLC-PDA-APCIMS and authentic references isolated from the related species B. daigremontianum, the presence of four bufadienolides, bersaldegenin-1-acetate (12), bryophyllin A (13), bersaldegenin-3-acetate (14), and bersaldegenin-1,3,5-orthoacetate (15) was detected in B. pinnatum.

Horbat Kur — 2011 Preliminary Report

Published in English and Hebrew

Argumentation et interaction dans les brochures du Conseil fédéral suisse sur les votations populaires

Lors des votations populaires en Suisse, le Conseil fédéral fait connaître la position gouvernementale à l’aide de brochures envoyées à tous les citoyens. Celles-ci mettent en jeu une corrélation étroite entre argumentation et interaction, tant sur le plan interdiscursif qu’interlocutif. L’objectif de cet article est de montrer, à partir de brochures représentatives, comment une telle corrélation varie fortement selon les stratégies adoptées par le Conseil fédéral. Ainsi, dans les brochures proposant un projet de référendum, on remarque une interaction limitée, en raison de leur argumentation rationnelle et de leur tendance à se fermer sur le point de vue du Conseil fédéral. Par contre, dans les brochures soutenant ou rejetant des initiatives populaires, on observe une montée au premier plan des procédures interactives. Celles-ci peuvent être convergentes ou divergentes, en liaison avec différentes stratégies argumentatives qui vont de la surenchère à la polémique. Au total, ces brochures gouvernementales nous confirment que l’analyse du discours politique gagne à être repensée à l’aide des modèles dits « dialogaux » (Plantin 2005) de l’argumentation.

Effect of B-type Natriuretic Peptides on Long-Term Outcomes After Transcatheter Aortic Valve Implantation.

B-type natriuretic peptide (BNP) levels are elevated in patients with aortic stenosis (AS) and decrease acutely after replacement of the stenotic valve. The long-term prognostic value of BNP after transcatheter aortic valve implantation (TAVI) and the relative prognostic utility of single versus serial peri-interventional measurements of BNP and N-terminal prohormone BNP (NT-pro-BNP) are unknown. This study sought to determine the impact of BNP levels on long-term outcomes after TAVI and to compare the utility of BNP versus NT-pro-BNP measured before and after intervention. We analyzed 340 patients with severe AS and baseline pre-TAVI assessment of BNP. In 219 patients, BNP and NT-pro-BNP were measured serially before and after intervention. Clinical outcomes over 2 years were recorded. Patients with high baseline BNP (higher tertile ≥591 pg/ml) had increased risk of all-cause mortality (adjusted hazard ratio 3.16, 95% confidence interval 1.84 to 5.42; p <0.001) and cardiovascular death at 2 years (adjusted hazard ratio 3.37, 95% confidence interval 1.78 to 6.39; p <0.001). Outcomes were most unfavorable in patients with persistently high BNP before and after intervention. Comparing the 2 biomarkers, NT-pro-BNP levels measured after TAVI showed the highest prognostic discrimination for 2-year mortality (area under the curve 0.75; p <0.01). Baseline-to-discharge reduction, but not baseline levels of BNP, was related to New York Heart Association functional improvement. In conclusion, high preintervention BNP independently predicts 2-year outcomes after TAVI, particularly when elevated levels persist after the intervention. BNP and NT-pro-BNP and their serial periprocedural changes provide complementary prognostic information for symptomatic improvement and survival.