Saint Francis University

About: Saint Francis University is a education organization based out in Loretto, Pennsylvania, United States. It is known for research contribution in the topics: Population & Osteoblast. The organization has 1694 authors who have published 2038 publications receiving 87149 citations.

Treatment of Incarcerated and Strangulated Ventral and Incisional Hernias

Abstract: Ventral and incisional hernias are commonly encountered in general surgical practice today. These range in complexity and acuity with the incarcerated or strangulated hernia presenting a challenge in management. The true rate of the hernia “accident” with bowel obstruction or ischemia is difficult to ascertain, yet this must be discussed with the patient presenting with a reducible or chronically incarcerated ventral/incisional hernia. The decision making encompasses the timing of repair for the reducible or largely asymptomatic chronically incarcerated ventral hernia, preoperative risk modification, potential for mesh contamination, and the risk of hernia recurrence. The impact of these surgical decisions is amplified in the emergent setting with an acutely ill patient. There are many options for repair at the surgeon’s disposal. Thoughtful consideration of the advantages and disadvantages of each and the patient’s desires and expectations are central to the success of repair.

What you need to know about EBP.

Abstract: E vidence-based practice (EBP) is a process by which nurses make clinical decisions using the best available research evidence, their clinical expertise, and patient preferences.1 Information technology is an essential tool for obtaining relevant literature at each step of this process and it’s also instrumental in the implementation of practice changes through the electronic health record. Nursing documentation can also link to EBP rationale for nursing interventions to support patient and family education and nursing decision making.1 EBP is an important tool for hospitals that seek Magnet designation because it can help improve quality and safety. It also

Poor prognosis of Hodgkin variant of Richter transformation in chronic lymphocytic leukaemia treated with cladribine - Response to Jamroziak et al

Abstract: We appreciate the thoughtful comments of Jamroziak and colleagues regarding our study of Hodgkin lymphoma as Richter transformation (Hodgkin-RT) in patients with chronic lymphocytic leukaemia (CLL) (Bockorny et al, 2012). Mirroring our pooled analysis that showed a decreased survival in Hodgkin-RT patients previously treated with fludarabine (0.7 ± 0.2 years), their retrospective analysis demonstrated similarly unsatisfactory outcomes in Hodgkin-RT patients treated with cladribine-based regimens for CLL. Of note, they showed a survival of only 0.34 years (95% confidence interval 0–1.08) in a small cohort of Hodgkin-RT patients whose CLL had previously been treated with cladribine (n = 6). A plausible explanation for this dismal outcome is the marked and prolonged T-lymphocyte depletion caused by the purine nucleoside analogues (PNAs), which amplifies the intrinsic immunosuppression of CLL and possibly leads to reactivation of a latent Epstein-Barr virus infection (Cheson et al, 1999; Dasanu, 2008). In addition, Jamroziak et al hypothesized that the first-line chemotherapy commonly used to treat Hodgkin transformation in CLL might be suboptimal against the PNA-exposed clones. In our cohort, the most commonly employed regimens for Hodgkin-RT therapy were ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine) and CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone), with no statistical difference in overall survival between the two groups. As of today, the best therapeutic approach for Hodgkin-RT remains to be clarified (Tsimberidou et al, 2006). Rituximab with or without chemotherapy remains an attractive option for Hodgkin-RT cases with CD20 Reed-Sternberg cells or marrow/ nodal histologies composed of a mix of Hodgkin lymphoma and CLL. In conclusion, the outcome of the Hodgkin variant of Richter syndrome in CLL, especially when previously exposed to PNAs, should not be viewed as favourable when compared to the classic RT (as diffuse large B-cell lymphoma). Selection of a more intense first-line chemotherapy regimen, with or without targeted antibody therapy may improve the general outcome. Studies aiming to clarify the molecular basis of Hodgkin-RT along with the discovery of innovative therapeutic approaches for this rare variant of RT are awaited.